Galveston's uninsured, physician satisfaction, and concierge medicine

This is an old article, but it's one that's fairly important to me for obvious reasons - I live in Texas, and more specifically in Galveston.

http://www.texasobserver.org/a-galveston-med-student-describes-life-and-death-in-the-safety-net/

If you recall, the island was hit by Hurricane Ike in 2008, and this devastated large parts of Galveston Island. UTMB, the major healthcare provider and employer in the region, was nearly bankrupted in the aftermath, and the solution at the time was to begin cutting services to patients lacking health insurance, or patients covered by programs like Medicaid which are notorious for poorly reimbursing doctors and hospitals.

From another article in the Texas Observer, UTMB went from turning away 35% of uninsured people seeking care to 91% as of 2011.

As a result, the estimated 21.5% of Galveston County's residents who are uninsured suddenly have a lot fewer options. One choice is the student-and-volunteer-run free clinic of St. Vincent's House, which sees patients on Tuesdays, Thursdays and Saturdays. The physicians who oversee patient care are strictly volunteers. Poorer patients may rely on donations of medication from the stores of dead former patients, and access to some basic drugs like antibiotics for simple infections is difficult (a 7-day course with some of those may cost well over $100, which is outside the financial reach of many of those coming to a student clinic).

Luckily, a major resource that the clinic can afford its patients is time. Because medical student education is a goal (and the physicians are not getting paid for their time), the initial patient interviews are conducted by medical students who can listen for longer than the 5-to-10 minute window of a typical doctor visit in the US. This is fairly rewarding, both for the students involved and (usually) the patient. There is little financial pressure cutting the visit short. More important, it is how many medical students envision patient care: you spent a lot of time listening to the patient's health complaints, and then try to come up with a plan to treat them. The relaxed pace of the interview means that you have time to learn about the patient outside of their hypertension or diabetes.

I bring this up because I read an article in the Guardian by one physician who is deeply dissatisfied with the medical care he is giving:

The same "reward and punishment" that is the hallmark of the American free market system has rewarded physicians for seeing more patients (no different than hourly billing rewards for lawyers) and doing more to patients (such as surgical procedures and other interventions). Consequently, physicians have been pressured to see more and more patients in the same amount of time. It should be no surprise that such encounters have become more like business transactions rather than what they should be: rich and intensely human interactions potentially resulting in tremendous fulfillment for both parties.

 He is getting at what I believe is a fundamental part of medicine: the idea that it is not merely a job like many others, but a chance to connect with people on a very deep level. Some of this may be conceit: it is pretty ambitious to view your profession as a "calling", a term I've commonly seen in reference to medicine. But many physicians do enjoy talking to and connecting with their patients. The main reward for primary care isn't financial but being able to build a long-term relationship with patients and their families, if you're lucky.

I find it darkly amusing that this style of medicine has been pushed out of many hospitals and doctors' practices, but is still thriving at a clinic run by medical students for Galveston's poorest. Even with excellent insurance you may not be able to develop this kind of long-term relationship with a physician.

Maybe patient satisfaction scores were highest back in the days when doctors had no medical option but to listen. Surely there must be some way to reconcile the tremendous advances in medicine and technology with an approach that does not dehumanize patient and physician alike. Is it concierge medicine? Will healthcare reform help or hinder this process?

Physicians are too bright to allow office visits to become merely a commercial transaction. I hope.

Concierge medicine is one solution to this problem, but the problem remains how to make this kind of care cost-effective for more Americans. I don't think too many of the patients at St. Vincent's could afford a physician retainer, no matter how excellent their care would be. How can we bring that kind of quality long-term relationship care to more/poorer patients? Is it economically possible?