Housecalls Are Back and Booming. Are They a Threat to PCPs?

Neil Chesanow

Disclosures

July 20, 2016

In This Article

Critics of the Uber-Housecall Concept

If Dr Oppenheim has mixed feelings about housecalls, the feelings of other doctors are decidedly unmixed.

"I don't think you're going to find a self-respecting doctor willing to exercise the kind of judgment and treatment necessary to properly care for patients for what these companies are willing to spend," asserts internist Alan Kronhaus, MD, from Durham, North Carolina.

"I believe in the Uber service as it's constituted," Dr Kronhaus adds. "It's just not applicable to medicine."

New York pediatrician and preventive specialist Jay Parkinson, MD, seconds that. Dr Parkinson claims to have invented the idea for housecalls on demand in 2007, although his was a one-doctor startup. He launched a website from which patients could book appointments, and website-generated email informed him when he had a new patient.

The venture quickly gained media attention. Within a month, 7.5 million people had visited his site. His practice was almost immediately full, he told Medscape.

Then came the hard part: actually delivering care, which he did on foot, by bicycle, or by public transportation. But "the practice wore me down, both physically and financially, and therefore psychologically," Dr Parkinson says, even though, as a physician, he was used to working 70- to 80-hour weeks.

He charged $100 a visit, payable through PayPal, but "the travel time between patient apartments and my apartment or the pharmacy to pick up supplies and refrigeration-sensitive vaccines limited me to a maximum of eight patients, or $800, a day," he recalls.

In addition, "50% to 60% of my day was spent on supply logistics and traveling between apartments, not seeing patients."

"Short of teleportation, the doctor housecall will always be an irresponsibly massive reduction in primary care efficiency," Dr Parkinson now believes, especially with a shortage of primary doctors.

"Every second a doctor is not seeing patients is wasted time," he adds. "Doctors already spend roughly 40% of their day documenting and doing other administrative tasks. To waste the other 50% to 60% of your day traveling between patients is a 50% to 60% reduction in efficiency."

He does not think that the new crop of housecall startups will be able to maintain their low rates over the long haul, even with venture-capital backing.

"The venture-capital subsidy will run out shockingly fast," Dr Parkinson predicts. Once housecall visits are no longer subsidized, he is convinced, their cost will "be more like $499 or $599"—so primarily for affluent patients.

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