The castle and the moat

By Janet Hurley, MD

One of the greatest challenges for family medicine practices today is the risk of alternative treatment options for our patients. The last decade saw the uptick of retail health centers and urgent care centers, designed to provide convenient, fast access to acute care services at times when patients want it. Smart practices have created same day access models and extended hours to reduce this risk to their practice. The next decade will see the emergence of telehealth services, such as virtual office visits, secure videoconferencing, secure email access, and online scheduling. How family physicians approach these challenges will determine their financial success heading into the future. Will they provide convenient access portals for their patients, or will they retain the “Castle and the Moat” thinking prevalent in many practices today?

In my leadership roles as chair of my organization’s customer service committee, and Operational Chief for Primary Care, I have had access to secret shopper reports, customer service survey results, and post visit survey results that give me exposure to the tangled web of access hurdles many patients experience as they try to obtain care. I have also had direct access to our consultants and executive leadership, and have had engaged discussions with experts in this field. When surveyed, most of our patients say they have very good opinions of their nurses, doctors, and staff, but some had much difficulty scheduling appointments and getting answers to questions over the phone. They dislike voicemail, and they don’t want to wait too long for their appointment. In essence, many practices have provided a quality “country club” experience to patients once they enter the facility, but there is a perceived selection process about who may enter. It would seem our “moat” needs more bridges.

One bridge is open-access scheduling. Sick patients want to be seen today. Worried patients want to be seen today. People in pain want to be seen today. They also want to have a quick answer about when they can be seen today. Voicemail messaging and scheduling barriers prompt patients to seek care elsewhere. Having online scheduling access provides a competitive edge against retail health clinics and urgent care clinics.

Another bridge is Internet-based online services. Taxi services are online. Hotel services are online. Banking services are online. We can pay taxes and buy shoes online. Telephone communication is getting more and more outdated. Secure email and secure texts are often more efficient ways to communicate with patients, especially if the message is something simple like “Your refill has been sent to the pharmacy.” Most patients do not want to play phone tag for that.

A third bridge is e-visits, also known as virtual office visits. Yes, there are many times when face-to-face visits would be more ideal, and there has been some criticism that telemedicine services sometimes create unnecessary antibiotic prescriptions. But there are many times when a virtual office visit would be more efficient and more appropriate. Some employers are starting to provide after-hours telemedicine services to their employees for free in a cost-conscious attempt to keep patients away from urgent care centers and emergency rooms. How long will it be before these alternatives also keep them away from us, simply because patients do not want to miss work or cannot access care by us as soon as they desire? Family medicine practices should embrace telemedicine modalities now in order to stay competitive in the future.

I read an interesting term recently: “disintermediation,” defined as “the opportunity to deliver a product or service to a consumer with higher perceived value than an incumbent’s by changing the fundamental way it is delivered.” Uber has done this with transportation services. Netflix has done this with television and movie services. Airbnb has done this with lodging services. Amazon and eBay have done this with merchandising services. Like these other industries, our family medicine practices will see this in the near future from TelaDoc, AmeriDoc, or many other telemedicine companies that are trying to service a niche for patients who want care when they want it, wherever they are, and at a cost they can afford. A progressive family medicine practice will provide an “electronic bridge” to their patients now before it is too late.

The castle provides excellent care to patients, but the moat is wide and the bridge is narrow. We have to start construction now to provide convenient portals of access for our patients before other industries snatch the opportunities out of our hands.

Janet Hurley, MD, is TAFP Treasurer and the operational chief for primary care for Trinity Mother Frances Health System, South Region. Read her blog at

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