Finding physician market fit in primary care

Finding product market fit (PMF) is the holy grail for startups. This concept escapes a clear cut definition, but can be felt when it is or isn’t happening. Michael Seibel from YC describes the feeling as “when you are overwhelmed with usage—usually to the point where you can’t even make major changes to your product because you are swamped just keeping it up and running.” Doesn’t this sound like primary care? While the usual product market fit guarantees mutual benefit to producers and consumers, our healthcare system shortchanges primary care physicians and their patients despite an ideal fit.

I challenge primary care physicians to rethink their own worth and value in healthcare. A useful framework for doing this is through the lens of PMF, which in our context I call physician market fit (PMF*). Just as the right “market pulls product out of a startup,” the demand for any (not even high quality) primary care is far outpacing our supply. Primary care physicians reach de-facto PMF* upon completion of their training, but few have the know-how to leverage this advantage in a system that preys on their dedication to patient care and ignorance of the market forces.

Historically, primary care physicians have done a suboptimal job of advocating for themselves (e.g. holding minority fraction of the RUC committee seats that determines physician pay), succumbed to health insurance dictating patient care, and settled for unacceptable administrative burden - the perfect storm for perpetuating moral injury and professional burnout that echoes across physician lounges. Further, our healthcare systems led primarily by non-physicians with short horizons fail to recognize our foundational role in providing equitable health care.

Physicians see approximately 1% of their patient panel daily, which equates to about two dozen patients in fifteen minute increments in a current fee-for-service system. I would argue that very few patients receive good quality primary care their doctors are actually capable of providing because of externally placed constraints. It’s no surprise patients might view primary care physicians as “communications majors” of medical school who just refer to specialists (while bringing in $2.1M for their hospital systems) without seeing the full context. 

The advantage of reflecting on all of this during my residency training is that I get to straddle the past, present and future of primary care. Therefore, my call to action to primary care physicians is to think deeply about our PMF* because this insight holds their ability to shape the evolving primary care landscape. I realize that doing something off the beaten path is a privilege for those with high risk tolerance and without the shackles of crippling student loan debt, mortgage, family, and years of delayed gratification to experience “life” after spending the better years of our young adulthood in training. 

Working with seasoned clinicians who experienced various healthcare reforms (Figure 2) has taught me that many are skeptical of healthcare delivery and policy changes that promise “improvements” simply because the healthcare machine has too many stakeholders with competing interests and it’s clear who’s winning (admin and private equity). Incumbent health systems and payors “innovate” one committee at a time at the speed of fax machines and pagers that still dominate communications in medicine in the year 2022. Similarly, my involvement in organized medicine has taught me that state and national organizations serve an important role of playing defense to reduce the likelihood of “bad things” happening to our profession and the patients we care for. However, looking at the rear view mirror will not bring us into the future. It’s time to focus on both fronts, and emerging primary care physicians are particularly well positioned to play offense through their role in influencing #healthtech that has flooded the market in recent years. The future belongs to a new kind of physician who is tech-forward, business savvy and restless with the status quo of primary care. And perhaps a bit unreasonable as George Bernard Shaw notes “the reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.”

Physicians’ oath to do no harm and dedication to provide good patient care should be the motivation for trying to effectuate a better paradigm for primary care. The value primary care physicians (especially family medicine) bring to their future innovator partners is unparalleled:

Our generalist breadth of clinical training captures the largest TAM (total addressable market) compared to other specialties. We are the “Swiss army knife” of medicine. 

• Our care extends across different settings: outpatient, urgent care, emergency department, inpatient, operating room, intensive care unit, nursing homes, home visits, and virtual care. 

• We see patients of all ages: newborns, children, adolescents, adults, and elderly.

• We diagnose and treat acute and chronic conditions with expertise in preventive care. 

• We suture, splint, intubate, ultrasound, read imaging, assist with surgeries, and deliver babies. 

• We steward healthcare resources by triaging our patients’ ailments after hours by directing them to seek emergency care or reassuring them to recover at home. 

• We help patients transition to work safely after an illness and take care of their disability paperwork.

• We advocate for patients when an insurance company employee who has never met them denies coverage for medication that they would benefit from.

• We are a constant for our patients during transitions in their care such as admissions that require medication reconciliations and discharges that involve coordination of DME (durable medical equipment).

• We are the person on the patient’s health team who interfaces with all of their specialists, surgeons, pharmacists, counselors, social workers, nutritionists, and health coaches. 

• We are the ultimate “follow-up with PCP” referral from our colleagues when patients bring up concerns that don't apply to the organ system outside of their scope of practice.

• We view health systems as a whole because we view patients as whole beings and are able to see dysfunctions across all of the above from our unique vantage point.

Christensen predicts that primary care physicians are positioned to disrupt specialists when advances in information technology decrease knowledge asymmetry. Like the FedEx arrow, the value primary care physicians bring to patients and health systems is too obvious to unsee once you notice it. OK, so what’s next?

Stay curious about things that don’t make sense to you. Deepen your understanding of the primary care landscape. Connect with people who are asking the same questions as you. Research emerging digital health technologies and startups in primary care. Discern whether they are a “solution in search of a problem” or if they are actually solving a meaningful problem for patients or physicians. Explore emerging communities like MDisrupt or AngelMD which connects physicians with entrepreneurs seeking their counsel. Be unreasonable.