Richard Helppie's Common Bridge
The problems we have in the country are solvable, but not solvable the way we’re approaching them today, because of partisan politics. Richard Helppie, a successful entrepreneur and philanthropist seeks to find a place in the middle where common sense discussions can bridge the current great divide.
Richard Helppie's Common Bridge
Episode 319- Primary Care Under Pressure. With Dr. Harry Albers
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Primary care is where healthcare either works or quietly breaks, and Dr. Harry Albers helps us say the uncomfortable parts out loud. We talk about the emotional reality of managing chronic disease without instant wins, and the operational reality that burns physicians down: EMR documentation, inbox overload, prior authorizations, and the steady creep of uncompensated work after hours. When you stack that on top of low reimbursement and high overhead, it’s no mystery why so many primary care physicians feel trapped in a system that rewards speed over relationships.
We also dig into the RVU treadmill and what it does to quality, continuity, and professional confidence. If primary care can’t get paid for time spent on prevention, lifestyle change, and complex decision-making, the incentives push referrals and volume. That has downstream effects for patients who struggle to see their own doctor, get routed to urgent care, or wait months to see a specialist. Access becomes the product, not just the outcome.
From there, we explore concierge medicine and what “high-touch” care really means, including Dr. Albers’ move into MD Squared and why a small patient panel can restore the core promise of primary care: access, advocacy, and a clinician who actually knows you. We don’t ignore the hard question either, whether concierge and direct primary care models can scale during a national primary care shortage. We close with concrete advice for young doctors, health systems considering employment models, and patients who want to choose a PCP wisely, plus where AI in healthcare may reduce administrative burden soon.
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Welcome And What We Cover
SPEAKER_00Welcome to this episode of the Healthcare Bridge, where we explore the vital connections shaping our healthcare landscape. Hosted by Nathan Kaufman, Managing Director of Kaufman Strategic Advisors, the Healthcare Bridge is dedicated to improving healthcare delivery by strengthening the strategic and financial performance of healthcare providers. As part of the Common Bridge family, our focus is on fostering insightful, nonpartisan conversations that drive meaningful change in the healthcare industry. We invite you to join us as we build bridges toward a healthier future. The show is available on Substack, YouTube, and your favorite podcast platforms. Search for the Common Bridge and stay connected.
SPEAKER_01This is Nate Kaufman with the Healthcare Bridge. This podcast is based on a very unscripted but brutally honest perspective from insiders of the healthcare industry. And today I am lucky enough to get Dr. Harry Albers to be our guest. Dr. Albers is a preeminent internal medicine physician in San Diego, and he is my doctor. So what we're gonna say. Enough said. Enough said, exactly.
Dr. Albers’ Path To Primary Care
SPEAKER_01So Harry, why don't we start with your origin story? You know, people talk about primary care, and that's the answer, and all that. You are a primary care doctor. You know, tell us about how all this got going.
SPEAKER_02Yeah, so first of all, uh honored to be here, Nate. Thanks for asking me. I'm not quite as honored as I was when you named your puppy after me, but close. Well, I'm a pseudo uh San Diego native. Um, I went to San Diego State undergrad and UCSD medical school residency, chief residency, and finishing up my chief resident year at UCSD, I pondered specializing in pulmonology, critical care. And I just had reached a point where I wanted to take care of patients. And I said, I can't be uh in training any longer. I got to get out there and start doing something um productive. So um ended up on fac junior faculty at UCSD for a couple of years before moving over to Scripps Clinic ther almost 30 years ago, and was at Scripps until three years ago when I made a jump to private practice. And but all the theme throughout, the thread throughout is how I know I made the right decision. Um primary care is the most rewarding career I could have had.
SPEAKER_01So let's
Burnout, EMRs, And Unpaid Work
SPEAKER_01talk about that for a second. There's been research that came out recently uh uh about primary care physicians, and a lot of them are burning out and leaving practice. The other thing I notice as a business guy is it's a high overhead business with low reimbursement. It's very difficult to be sustainable. Any thoughts on why people are burning out or how to make it a more sustainable practice?
SPEAKER_02Yeah, I definitely have a couple of thoughts. One is uh I won't say uh an existential issue, but the nature of primary care is you're not getting instant gratification. So it takes a unique personality to do primary care. You you're not fixing a broken bone and sending the patient on their way. You're not putting a stent in an artery and sending them on their way. You're managing chronic disease. So it really takes a unique personality to start with in terms of knowing that you're you're not gonna have those big wins. You're you're gonna have great relationships with the people you you're responsible for, but that wears on people, I think, over time dealing with chronic disease. That I don't know is something we can remedy. That's the person themselves. I think my observation is the advent of EMR has has exponentially worsened the burnout in primary care. And it's so physician-centric. A PCP's happy place is is one-on-one in the room with the person they're taking care of. But outside of that happy place, there's so much added on in terms of documenting the visit, ordering medications, ordering tests, fighting with insurance companies for studies that get denied. And that's all essentially, you can I think of it as uncompensated work. We're doing it uh off the clock. And I think that just that's what the enthusiastic young physician hits a wall five or ten years out.
SPEAKER_01Right. I I guess now I think it's something like 70% of primary care doctors are employed by health systems. As I said, because Medicare's conversion factor is so poor and you have a high Medicare population and your overhead's high, it's hard to be financially sustainable in independent practice.
The RVU Treadmill And Volume Pressure
SPEAKER_01And when you go into these health systems, they put you on the RVU treadmill. What's that like?
SPEAKER_02Well, I'm speaking from distant memory, because thank goodness I haven't uh had to deal with that for a long time. But I do, you know, many of my colleagues do, and the other Dr. Albers um sleeping in the same under the same roof as I have been. She's been doing it for 30 years. So it's rough. It's a system set up, especially for primary care, since primary care doesn't get to do much high RVU work. We don't do many procedures. So how do you increase your compensation? You increase it by volume, you increase it by seeing more visits, which diminishes the relationship with the people you're taking care of. It diminishes your confidence. Now I'm getting personal. For me, it diminished my confidence in what I was doing and the care I was providing because I felt like I was going home at the end of a day and not having had time to pee. Never mind, think about problems that I'm talking through with people. So it's rough. You have to make a decision whether you want to churn and burn and increase your compensation versus having relationships.
SPEAKER_01And if you have your relationships, your compensation goes down.
SPEAKER_02Exactly. Your compensation goes down. Maybe your workload decreases a little in terms of what you're the charts you're doing at night. But yeah, you have to strike that balance or you're burnout.
SPEAKER_01Yeah, I mean, it I it seems to have taken it from a profession to kind of employment to be you're like you're just working for the man type of thing. And so that that makes it kind of difficult. Um, you worked at at Scripps, and when you were there, I I know some doctors were capitated. Did you ever get involved in the those value-based programs?
SPEAKER_02Yeah, definitely. I was always of the mindset that relationships were what drove me. That was the only reason I continued to do what I what I've done for 30 years. So I didn't pay that much attention to numbers. Um But I I I do think to your to your point, Nate, about how you approach an RVU-based system. Uh my observation is a lot of the younger doctors that are coming out have a different mentality about this. And and and uh this is what um made me think the comment you just made. A lot I think there's a lot more of um I'm prioritizing quality of life over compensation. I want this to be a job. Not that they don't care about the people they're taking care of, but they want it to be uh a job where they don't have to take it home every day.
SPEAKER_01Yeah, so so like if I went to visit you and my lifestyle isn't, let's assume it at the time wasn't very good. I was smoking too much, and I was pre-diabetic. By the way, I guess everybody's precancerous and pre-diabetic, from what I understand. But that's another story. But I was pre-diabetic, and you know, you needed to really work with me on stop eating those, you know, uh Cheetos and drinking all of that nasty sugar beverage stuff. How many RVUs do you get for something like that?
SPEAKER_02Oh shoot. I I I I don't have a number. I mean, it's it's not much, right? Which is why the motivation is for PCPs to just refer everything out. You send them to the nutritionist or the endocrinologist, or uh because no, you're not compensated for it for that time.
Concierge Medicine At Scripps
SPEAKER_01So then you you went from being a uh let's call it a rank and file internal medicine physician to forming the private internal medicine group within Scripps Clinic. Can you tell us about that?
SPEAKER_02Sure, yeah. So uh I had been with the clinic for 11 years, and I actually I I didn't um pioneer the um the concierge group. I I was one of the early members. Um, but the the motivation with Scripps creating this little concierge division, which they actually modeled after the Virginia Mason concierge group, which was modeled interestingly after MD Squared, which started in Seattle. Uh my motivation was what I said. I just I couldn't do the 25 to 30 visits a day. I know, I think, you know, now that that I wouldn't have been doing that anyway, even if I was doing general internal medicine. So it's gotten a bit more humane. But I couldn't do it anymore and feel like I was really taking care of the people that I'm that I'm responsible for. So it was a make or break, my my first make or break moment, and I knew that um with decreasing my patient panel from 2,800 people to 300-ish patients, I was gonna be able to enjoy those relationships again and feel like I wasn't just pushing care onto all the specialists. I was actually within my the limits of my ego, I was able to really practice medicine again.
SPEAKER_01So if every doctor did that, let's make believe, okay, we already have a 29,000 shortage of primary care physicians.
Shortages And Training More PCPs
SPEAKER_01And if physicians basically limited their practice either through direct primary care or through concierge or some other method, I mean that shortage would get would increase, wouldn't it? So I I guess from one's perspective, it's a great solution for you and a great solution for me, but not necessarily a great solution for society, would you say?
SPEAKER_02Absolutely. My perfect medical world would be that all patients get to have some level of um, you know, within their means, some level of concierge care so that you have some in in terms of access, in terms of somebody who's looking out for you, somebody who's your advocate. But uh absolutely, I mean, it's it's not sustainable for the caring for the population.
SPEAKER_01Any thoughts from your perspective? I mean, you're not necessarily in my position of having to be a strategist, but how how do we care for the rest of the people out there?
SPEAKER_02I think probably my most obvious response today is we need to train more physicians in general. Medical schools need to train more physicians. We need to encourage people to go into medicine that, you know, it it's not, uh you're not going to be turned away at every medical school you apply to. I think within medical schools, we need to encourage more PCPs to be produced, whether that's through government subsidy to get people to commit to being um primary care providers, or whether it's through some kind of a mandatory payback, like military people do. And then I also think significant thought needs to be put into cross-training people who are interested in going into primary care. Give us more ability to do things like procedures, for example, where it's going to benefit our patients, it's going to benefit us at our bottom line, our paycheck. It's going to benefit the access issues with specialists. If we can do, I mean, too many PCPs just really don't do anything procedurally.
Specialist Access And Referral Reality
SPEAKER_01You mentioned specialists, and a lot in order to have a successful primary care RVU-based practice today, you need to kind of be a traffic cop and start if a patient's going to require a procedure or take a lot of time and so on, then you would you refer them to specialists. Um specialists are in short supply and exceptionally high demand. Are you finding over your 30 years that it's harder and harder to get a new patient in to see a specialist?
SPEAKER_02Without a doubt. Um, not to be cynical, but uh obviously surgeries and and high RVU um interventions are what a lot of a lot of the that community is interested in and and where their focus is. So PCPs are left with essentially everything else. I mean, that's where my thinking about cross-training us, it's it'd be gratifying for the for the PCP to be able to do more for their patient rather than just being a traffic cop.
SPEAKER_01Yeah, I mean, I'm having a personal experience right now where I have a couple, let's say I'm in a little bit of pain, right? And I go to you, and you know, we've tried to work through it, but it probably time to see a specialist, and you refer me, and one of the things I rely on you for is there are better specialists and less better specialists. Yeah. Healthcare is not a commodity, and you want to go to the better specialists and the better hospitals. And when you refer to me one of these places, I immediately get a call and they say, You've gotten a referral from Dr. Albers. How's your July look? Or how's your August look? Yeah.
SPEAKER_02Unfortunately. Yeah, I I think that one of the ways I've evolved uh over the years is is relying more uh in many instances, relying more on uh personal uh uh outreach and relationships. And um uh and it really takes that. Now, unfortunately, your your most PCPs, again, don't have the time to do that for the people they're taking care of. But you know, the personal outreach to specialists you trust, either a text or an email, makes a big difference. And then using specialists in the community, too. I think there's value in establishing uh good relationships with people in the community who are more interested in getting people into their practices.
What MD Squared Is And Why
SPEAKER_01Hmm. So let's talk about MD Squared. You um were with scripts and you were a concierge physician there, and then I got a letter uh saying you were moving to MD Squared, and that was kind of interesting. Um what is MD Squared and why did you do this?
SPEAKER_02Yeah, thank you. Thanks for asking. I think um so uh as I said, it 11 years in, I decided I had hit a wall and needed to do something different to reestablish my love for patient care. And then another 14 years after that, I was at a another the second breaking point in my life where I decided I was either not doing this anymore, uh uh uh even though I love it, or uh I needed to give myself a chance to really practice pure medicine, practice medicine um in the ideal, where you just do that. You just have your happy place um uh with the people you're taking care of, and you don't have to deal with the you know, the overhead, the HR, the back office, et cetera, et cetera, et cetera. And that's what MD Squirt is. Um backstory uh is Howard Maron, uh internist in Seattle, opened the first MD Squared office in 1996. He was a team doc for the Seattle Supersonics uh before they moved to Oklahoma City NBA team. Uh, and he wanted to create a practice where he got to provide this the the same high-touch care for his cohort of patients as he was doing for these young athletes who couldn't care less. Um and 30 years later, um MD Squared is almost 40 offices around the country. Every office is is just two physicians, two PCPs, um, and a hundred families total, 50 families per MD. Uh so it ends up being 200, 210-ish patients total um uh that uh myself and my partner Ramona Master are taking care of uh compared to the 350 to 400 I had uh with the concierge group at Scripps, compared to the 2500 or 3,000 or more that a general internist has. So MD Squared really is the top of the pyramid, uh, in my opinion, in the concierge world.
SPEAKER_01And some of the things that I've noticed in the practice, I never, I mean, I have to pay a monthly kind of membership, but uh I've never seen a bill. Uh I there's no you don't participate in Medicare. Correct. Um and I just go in, ring the doorbell, there's no waiting room. Um it is it's an awful nice place to get your care.
SPEAKER_02Yeah. Well, thanks for saying that. And I I I think it it's it it's again, it's relationships. It just it lets the relationship between us thrive, it lets the relationship with my partner thrive. And then there's these relationships with the other MD Square docs around the country. It's an incredible group of uh of physicians um that uh uh I never would have thought the collegiality for me would improve by moving out of a large multi-specialty group. Now I'm honored that I'm still affiliated with the Scripps Medical Group, and I have all my great specialists that that the relationships even there have only gotten better. But but it really is it's a unique situation where you have 24-7 access in any way, shape, or form to the person you're trusting with your health. But we also have this national reach when, you know, uh when unfortunately we we make diagnoses that we don't want to make.
SPEAKER_01Wow. That's uh yeah. And and is there, I I mean, again, I I kind of like that primary internal medicine. I mean, I think we need to move more towards that kind of model, um, at least as a patient. I mean, I knew I know that many people, most people that have traditional RVU-based doctors, when they get sick, they can't see their doctor and they're told go to urgent care. Um I mean, that's what prime or you get to see a PA or a nurse practitioner, nothing against them. Uh and and I guess that's one of the questions I have.
Using NPs And PAs To Scale
SPEAKER_01Have you ever thought about a model, not necessarily MD Squared, where you can actually train a nurse practitioner to be your partner and expand your practice so so that maybe it's, I don't know, more away from this RVU treadmill type of model?
SPEAKER_02Yeah, I think that I think that is something that uh would really work for a lot of uh PCPs and a lot of patients. Um uh uh as I would envision it, it would be a larger practice because uh with MD Squared there's no need for that. Um you know, we are available and and and uh and and have no interest in growing the number of people we take care of. But absolutely for these concierge light, for example, um practices, which can be anywhere from you know 300 to 500 to even a thousand patients that a physician is responsible for, uh depending on what the membership fee may be annually. Um yeah, I think that would that would absolutely um APCs, whether they be uh uh nurse practitioners or physician assistants, uh again, if You find the right one, they can be amazing.
SPEAKER_01Yeah. I guess that's that's probably true. So let's talk about some advice.
Career Advice For New PCPs
SPEAKER_01Okay. Let's start with our producer's son who is coming out of residency next year. He's gonna be a full-blown primary care doctor. Um what would be your advice to him and other established doctors that are like teetering on burnout or trying to figure out what to do? Uh what thoughts do you have there?
SPEAKER_02Well, I think for for the young physicians right out of training, it's it's uh it's setting realistic expectations uh for that um mythical um work-life balance. It's it's really uh sorry.
SPEAKER_01Brian will take care of that.
SPEAKER_02It's really uh uh from the get-go, from day one, no uh uh sitting down and trying to decide what is going to make me happy in never mind five years, but 15, 20, 30 years. Uh and that includes what uh are uh do you have some background in business? Would you be someone who could who'd who could have a private practice, or do you need to be an employee of a of a hospital, as we talked about earlier? But I think uh the young physicians I'm seeing, they're already that's already uh at the front of their thinking. Um for the physician who's later on in their career, um, how do they sustain? I I I think it's uh diversifying, it's not getting stuck in a rut. Most primary care physicians have a bit of OCD, um uh, which is why we are doing charts at for three hours at the end of our day um when you've already had a busy day. Uh you don't want to leave any stone unturned. So um it's easy to get into that I do the same thing every day rut, and and then you just lose interest in then you're just going through the motions. So I think it's trying to uh diversify yourself within the profession, um and and uh uh cross-train, as I was saying earlier, learn to do new things, learn to offer new things to the people you're taking care of uh within your own um, you know, don't let your ego get the best of you, but but uh continue to try to improve the product you're offering to the people you take care of.
SPEAKER_01So, okay, that's so that's the new individual primary care doctors.
Fixing Employment Models With AI
SPEAKER_01Now here's the here's the data. The data shows that if if physicians work in a um physician-owned practice, 54% of them are satisfied. Uh that's about the best you're gonna get. Uh, but if they work in a hospital practice, only 19% of them are satisfied. So you have experienced all this stuff. What advice do you have for um health systems or excuse the expression, optum, or others on how how you can make their work life better without going bankrupt? Because as we know, uh a lot of primary primary care practices were bought by CVS and Walgreens and others, and that one was a disaster. How do you employ primary care physicians and make them feel like, I don't know, owners and not just simply, you know, peace workers?
SPEAKER_02Yeah. Uh I I I think the you know, in some respects, the the Kaiser model has it right, where you have a financial incentive to be uh a shareholder. Um uh I also think, and I I hope I'm not delusional, but I I also think that uh artificial intelligence is going to make a difference um for PCPs and in in in short order, I think in the just the next few years. Um if if insurance companies are using AI to deny um um requests for MRIs and CTs, then uh you know we're already using AI to do our documentation. Um I foresee that taking over a lot of the billing responsibility, a lot of the um requests for studies, prior authorizations, prescriptions, et cetera. Um so you know, that's uh I think that's coming, um, whether we want it or not, and it will make PCP's lives better. Um But from the from the large multi-specialty or hospital perspective, I think it's a respect issue. I I really think without sounding too um ominous, I think uh a lot of primary care providers feel that they're not respected. Specialists are respected, uh PCPs are not. Um I don't know how you remedy that, Nate.
SPEAKER_01Well, I think communication is pretty important in that in that whole process. Well, let's just talk one final point. I mean, uh because you know, you have to go see patients. They're calling you. Um, I can tell. And if that was me, I'd be saying, why isn't Harry answering? But um But the question, so you've been a primary care doctor for 30 some odd years. You were the primary care doctor for the San Diego Padres. Uh, you know, you have you've seen tons of patients, you do science experiments on people like me and and all that stuff. What advice do you have for patients?
What Patients Should Ask For
SPEAKER_02Uh I I think uh the best advice I can give is if you want, if you have the means, there's value in some level of concierge practice. Um, even if it's only a few hundred dollars a year, if that's within your means. As I say, the the two big issues I think are access and advocacy. And anything you can do to uh to get on uh on your uh PCP's radar uh uh in that way um it makes a difference. I think beyond that, you you know you want you want to ask the right questions when you're looking for a PCP, you want to you want to know, uh you know, are you uh available to me? When you're not in the office, how is my health managed if something comes up? Do you have a partner who covers you? Or is it gonna be one of 30 um uh physicians who don't know me from Adam? Um can I reach you or your partner after hours? How do you take care of me when I'm out of town? I mean, these are uh these are questions that people don't think to ask. Um and then lastly, what's your you know, what's your relationship with the the specialist that you work with? Um do I, you know, can I trust that you're going to advocate for me there as well?
Prevention Takes Time We Lack
SPEAKER_01So so but some people say that the answer is, well, primary care, I mean, the answer is we've got to make people healthier. So primary care physicians, I mean, we we have a sick care system, not a health care system, which by the way, thank you for having a sick care system at age 72. I mean, you know, I don't need a welfare system right now, necessarily, or a healthcare system. But I mean, how do we put this burden on the primary care physicians or health systems? Like we're supposed to change people's lifestyles, especially when we don't get paid for.
SPEAKER_02It's obvious. Yeah, yeah, you're so true. So right. I mean, it's a matter of there's only so many hours in the day. Um, and and for primary care providers, you're putting out fire, it's chronic disease management. You're putting out fires. You don't have the time to really spend on preventative medicine, on on proactive care, on on educating the people you're taking care of to uh how best uh how to optimize um where they're gonna be in in 30, 35, 40 years. Um that's the piece uh more than anything that needs to be fixed is the is the time um uh uh the allocation of time that that PCPs are currently burdened with.
Hybrid Concierge And Final Takeaways
SPEAKER_01Yeah, and I'll just we'll just sort of end with this point, which is that I hear all this this all the time that these primary care doctors that have a regular practice, they go, Oh, I provide my patient's concierge service, and I I can provide my you know, provide if they pay me a little bit more, they'll get more access, or something like that. My experience is you this is something, it's like being pre- you're either pregnant or you're not, right? You're either a concierge practice or you are not. I mean, that's kind of how I view it.
SPEAKER_02So I totally agree. I don't, I don't, I don't like the the quote unquote hybrid model. I mean, yeah, you're either you're either available and responsible and and engaged uh in people succeeding with their health, or you're uh um you're trying your best in a system that's not conducive to doing what you really would like to do.
SPEAKER_01Well, as a patient who started with RVUs, went to primary care within a system, and now have MD Squared, I mean, uh I'm pretty satisfied with the where I ended up. Um and I think that uh if people haven't ever experienced or learned about MD Squared, MD2, they probably should take a look at it as an option because it's been a great option for us. And uh I appreciate all you've done. As Harry mentioned, we honor Harry. We honored Harry by naming our Diamond Greyhound after him.
SPEAKER_02And that's what's really important when you visit is getting updates on Harry.
SPEAKER_01Exactly. That's the most oh, by the way, I have this pain. Anyhow, this is Nate Kaufman with the Healthcare Bridge, thanking Dr. Harry Albers for uh giving us his time. Um, it's been a great talk. Thanks a lot, Harry. Thanks, Nate.
SPEAKER_00Thank you for joining us on this episode of the Healthcare Bridge. We hope you gained valuable insights into how strategic and financial analysis can transform healthcare delivery. Remember, building stronger connections in our healthcare system is a collective effort, and we're honored to be part of that journey with you. Be sure to subscribe and stay tuned for more conversations that aim to bridge gaps and create a healthier future for all. You can find all your healthcare bridge episodes at the Common Bridge on Substack, YouTube, and your favorite podcast platform.