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How your Primary Care Manager Team works

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The PCM sees 20+ patients in clinic EACH DAY; the Nurse has 30+ requests/consults EACH DAY. The technician is part secretary and good ones help their PCM's stay informed and prioritized. Sadly, this rarely happens.

The PCM is horrendously overworked and "good" care for their empanellment size requires 70+ hour work week in clinic (seeing patients and doing admin work) and then go home and read or research cases there too. Most are just overworked and punch out after around 50 hrs/wk. Many patients get a level of care that fills the box. Just about every time you see your PCM, they are thinking about the clock and the few minutes they can spend with you, and try to do whatever is the minimum necessary for you to walk out of the door. This doesn't mean they don't care, but that they don't have the time to perform real, full-length discussions except for the extreme cases (diabetes, MEB's, etc.). Additionally, they have plenty of appointments with patients that only want to fill the box on their checklist so they can leave (PHA, Post-Deployment Re-Assessment, Occ. Health Exam, etc.) or the patient already knows what they want and the PCM is just facilitating that (Sudafed for my cold, STD test, referral to specialist). Essentially, all these patients want is to get the box checked.

Also, PCM's often focus on being good Dr.'s (or PA's/NP's, etc.) and let the administrative tasks fall on the tech, who does it wrong because it's above their level/training.

The Nurse is overworked, but as most of them are civilians, they can't work more than 40 hrs a week, and the burden transitions to the other team members. The AD nurses burn out quickly and are upset because they are stuck to their telephone, rarely actually seeing patients (kinda not why they went to school for several years). They talk to whiny, needy patients that soak up appointments, then have to work out what to do with AD personnel with a real mission need but there is no appointment availability.

Good technicians become NCOIC's and are taken away from general care to write EPR's and babysit screw-up Airmen instead of doing their job (that's leadership!). Bad technicians who stick around sometimes become NCO's through time-in-service overcoming the WAPS cut-offs and stay in patient care and continue to give bad service, but now they have rank, so it seems authoritative and official!

This post is not to bash the PCM teams, but to let the patients know the stress and how these teams are required to operate. Many PCM teams give fantastic support, but many variables lead to less than stellar support for some patients—and this is why.

My next post is how you can get better administrative support for your clearances, and hopefully make the process easier for the patient, the PCM team, and the MPF.

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You forgot to add that most PCMs were bottom third of the their medical school class-that's why they are in family medicine.

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