Trust is a foundational building block for relationships. It also takes time to build. Given these two inputs, our health care industry’s norm around 15-minute primary care appointments does not lead to trusting relationships or better health.
Individuals “hire” primary care providers for many reasons or jobs to be done. In research I performed at Atrium Health, one reason we uncovered was: “When I’m scared about my future, I want a trusted solution so I can address my health problems and be here for my family.” In this context, the person is looking for 1) trust, 2) a solution to their problem, and 3) longevity to be around for their family. Hiring a 15-minute encounter is not likely to yield these results.
Take a minute to think about the last time you created a genuine, trusting connection in 15 minutes. What about a time when you created such a relationship over a period of four 15-minute engagements across a year?
If you’re like me, you probably can’t think of one.
There is a reason we don’t go on 15-minute dates and then agree to spend our lives with someone. Trust is rarely built in bite-sized time slots. Instead it’s built over hours of time together. It’s built by listening and learning about the other person, and by genuinely caring about how to enhance their lives. We don’t build friendships, marriages, or partnerships in 15-minute segments. We don’t even hire lawyers for that short of a time period. Why do we think we can help people live better, healthier lives through 15-minute encounters?
The truth is most providers, individuals, and health care administrators probably don’t believe this is the ideal solution, either. However, the market forces inherent in a fee-for-service industry have led to 15-minute visits becoming a core part of most primary care models. If you are paid for the number of transactions you perform, you are incentivized to perform as many transactions as possible.
New competition is challenging the rules of the game
Many organizations striving to disrupt the traditional model of primary care are challenging the 15-minute visit norm. They are swapping out this sub-par “ingredient” to ensure the recipe for trust and health turns out well. Models such as One Medical, Parsley Health, Cityblock, Oak Street, ChenMed, and many others have made a 30-60+ minute appointment their new normal. The rapid growth of these models and their high patient engagement suggest longer visits are critical for building trust and improving health.
Individuals who seek out a primary care provider to meet the “trusted solution for longevity” job are more likely to achieve their desired progress if they hire a model that embraces longer encounters. In a predominantly fee-for-service industry, these models are not the norm. To make them the norm, market incentives must pay for health, not just health care. The market would then support business models that create both trust and health, and include longer visits as a key process. Until it does, those with the “trusted solution for longevity” job will be woefully underserved by the 15-minute primary care encounter.
But industry payment models change slowly. As the health care industry makes the transition, there is an opportunity to learn from the primary care challengers. Without upending the entire business model, primary care could make great strides by trading 15-minutes for 30 or more. As payment shifts to outcomes-based instead of transaction-based, lengthening the typical doctor’s appointment would strengthen the patient-provider relationship, improve health, and even enhance provider happiness.
