Primary Care Needs to Evolve to Survive – and Millennials Are in the Driver’s Seat

Millennials utilize technology to get a variety of things done in the most convenient, quickest way – so why should healthcare be any different?

The other day, I was asking one of my 20-something colleagues to describe how she uses new technologies to buy things in her life. She looked at me kind of puzzled, and said that she doesn’t really use much technology… until I asked her to list things she does on her phone.  As the list went on and on, she realized to both of our amusement that she does almost everything – from getting her dog walked to purchasing a tampon subscription to meeting new friends – all from her phone.

Her experience of having mobile and online technology blended seamlessly into her life has become so commonplace, that for many younger people, it’s hardly noticeable. Either we find what we need nearby (thank you Google), or we can get it online. With so many businesses around, each one has to make it incredibly convenient to get whatever it is they are selling, and if they don’t, they will most likely lose business – and no one wants that.

This way of living has become second nature to many Americans under the age of 30 – and their expectations of health care are no different. According to a recent survey, Millennials are twice as likely as Baby Boomers to use walk-in clinics and telemedicine, mostly due to their combination of faster service and more affordable pricing. For a generation used to comparing prices online for everything, taking those shopping habits to health care seems like a natural extension of many other aspects of their lives.  

Rise of walk-in clinics

Many older physicians that I speak with bemoan the lack of connection and longitudinal care that the rise of retail clinics and telemedicine represent. They argue, often with significant evidence, that the advantage of having a PCP goes far beyond diagnosis and treatment of individual urgent care concerns, and is based upon a provider having a comprehensive knowledge of a person’s life, health history, and social determinants of health. For example, if a person comes in with an asthma issue, it’s important to know that the patient has mold in their home, but doesn’t have the means to move residences. Many important details like this don’t surface within quick urgent care visits, but are still very important to treating the underlying issue, not just the symptoms.

And yet, Millennials are moving away from establishing these PCP relationships. Whereas 85% of Baby Boomers say that they have a PCP, this number drops to 78% for GenXers and 67% for Millennials. It’s unclear exactly why Millennials aren’t choosing to create the same physician-patient relationship as previous generations, but research gives us some clues. They found that when scheduling an appointment with a doctor, almost half of the surveyed Millennials felt frustrated and/or confused by the interaction, while only a third feel relieved.

Establishing Relationships Beyond the Exam Room

In a world where it takes over 2 hours out of a person’s day to travel in-person to see a physician, who is likely also suffering from inflexible schedules that can be thrown off for a whole day’s worth of patients if the first patient takes longer than scheduled, some researchers have gone on record to say that the annual physical should be eliminated for healthy people. But what if having a relationship with a PCP weren’t so frustrating and time consuming? What if we applied the same technology we use in other areas of our life to health care?

From Facebook to Instagram, Millennials have shown again and again that they see the online and physical worlds to be two points on a continuum, not separate entities. They don’t feel the need to see someone in person to feel a strong sense of connection; that connection can be built online. For years the health care community has been telling them that they were wrong, and that if only they did health care the way that we want, they would see that we were right. But times are changing.

Telehealth to the Rescue

Primary Care can keep the personal connection and create the same convenience - through virtual care.

As a telemedicine urgent care physician myself, I have trained in webside manner and have found that I am able to establish a relationship with a patient just as easily over video as I do in-person. The two emotions that I see more often from my patients and their families online than in-person are relief and gratitude. Relief that they were able to find a kind and knowledgeable person without entering the labyrinth of most in-person clinics, and gratitude that I was so quickly there for them in their time of need. Coming through for people when they are worried and sick is a fantastic way to build a relationship, whether in-person or online… and those bonds are real, not virtual.

When innovative companies offer easy ways for patients to connect with their care providers virtually, they find that their patients and members often choose to have much shorter interactions, such as a few emails or texts messages, but have these interactions far more often than they would if they needed to come in-person. For example, Kaiser says that their visit numbers have ballooned to over 100 million visits per year, but that 52% of their visits are now virtual. These quick but frequent visits could be actually better for our patient’s health than the traditional 20 minute visit once per year. Increasing patient engagement has been correlated with a variety of health benefits, including reductions in hospital visits and decreased mortality and morbidity.

My take

Now that creating and maintaining relationships online has become the norm for millions of people, and the technology to support that relationship building is ubiquitous, health care must follow suit. We have the ability to create rich and affordable preventive medicine, wellness, care coordination, and chronic care management programs that are primarily online and not bound by geography. Millennials are going to drive this transformation and it will change the foundation of how health care is delivered for generations after.

Next up: What would it look like to have Virtual Primary Care?

Sylvia Romm, MD, MPH, is a pediatrician and VP of Medical Affairs at American Well. She lives with her family in New York City.