Cons of exclusive house call practices outweigh pros

Add high-tech to an old fashioned house call. It seemed the perfect innovation for a young physician entrepreneur, garnering so much media attention that Jay Parkinson, M.D.'s 'Uber'-esque practice filled nearly instantly, as he shared in a recent post on the KevinMD blog.

Though Parkinson referred to the $1,500 and seven months he dedicated to his unique practice well spent, he cited numerous reasons that being a traveling doctor wasn't sustainable--and why similar healthcare startups may struggle.

A key problem with Parkinson's house call practice was inefficiency. Despite the ease of scheduling appointments and collecting pertinent health information online, caregiving logistics (e.g., travel to appointments and obtaining supplies) limited the solo doctor to seeing no more than eight patients per day.

At a direct patient fee of $100 per appointment, Parkinson's income was likewise capped at $800 per day. Even with the house call practices' expenses limited to taxi fare and relatively low-cost Web services, office-based physicians who pay rent and administrative overhead can earn twice as much, Parkinson noted.

With primary care physicians in short supply, the U.S. healthcare system needs efficiency to survive, as do the doctors themselves. "Every second the doctor is not seeing patients is wasted time. Doctors already spend roughly 40 percent of their day documenting and doing other administrative tasks," he wrote. "To waste the other 50 to 60 percent of your day traveling between patients is a 50 to 60 percent reduction in efficiency."

Furthermore, even for a new doctor used to averaging 70 to 80 work hours per week, traveling through the New York cold--via cab, bike and on foot all day--proved to be a difficult grind. With physician burnout already consuming more than half of the work force, doctors must acknowledge their limitations and care for their own well-being.

Therefore, because of the lack of scalability and propensity to wear physicians down, physically and psychologically, house call models are irresponsible for the healthcare system, Parkinson argued.

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