March 4, 2026 Forum

Jeremy

I guess that’s part of what I’m hearing from Bill Gallanters. I could guess Jack, that probably 30% of practicing family physicians are engaged in triage.  Depending on the health plan that they work with, if they’re a commercial PPO, they’re like therapists plus neurology, chest surgeon, pulmonologist and cardiologist. And I was afraid of that being the case, because of the payer mix

I was concerned about these matters when starting this residency. And so the fact that we actually would be serving the public interest with the Contra Costa Health Plan patients, I felt solidified my belief that our residents would not be getting trained to do that. And that helped encourage me to take this job. So part of why I emphasize the behavioral health part is that I think from an affordability basis, that most health systems right now, because the reimbursement of primary care is so terrible. Another big challenge we have in this area, is they can’t afford technically to have any other professionals in the practice with us.

My personal experience is that I think there were more professionals helping us in our practices 30 years ago than there are now. So we’ve actually gone backwards in personnel expertise. We used to have RNs in our practice. Many people had dieticians and diabetic educators in their clinics. Physical therapists sometimes would come and do an initial assessment. I’m seeing where the teamwork has actually been stripped away from primary care. And I think at the same time, we need to be considering AI to be a member of the team. I think, as Bill Gillanders said, “How do we partner with this team member?” Because we are in desperate need of some team help.

Otherwise, our ranks are destined to further thin. The pathway to primary care is much worse now than it was 30 years ago. With regard to medical student interest, it is not going in the right direction. And that is going to pose serious challenges concerning dilution of the level of our graduates as well. So I just think that we need to figure out how to engage AI and not see it as the enemy that’s going to replace us, I think this is important.

So there are some positives we can get, but behavioral health is a little mystifying for me. Right now, telebehavioral health is where a lot of behavioral health is happening, right? Better help and these kinds of things. These are huge companies now that have been much more successful than the medical online community has been. AmazonCare is still in its infancy, but they just introduced their health AI assistant. So now for $9.99 a month, you can access and ask any question of your health AI assistant from AmazonCare, and they will then engage you. So I do think the implementation, as Bill Gillanders said, is getting ahead of us now.

It’s going to be challenging.

Bill G

The 30% of the family docs who exist in a rural setting still have the family medicine model, but 70% do not, and they don’t wish to engage in it.

Bill B

During our previous forum, we were talking about the challenge for ministers. You have men and women with mental health issues who are stigmatized. They don’t want to go to a therapist, and so they look to their physician for the therapy. I think that’s also a case with physicians. I think part of the pressure concerns people coming to see you with mental health issues. However, they’re unwilling to acknowledge that it’s a mental health issue, which would mean going to see a therapist. So they’re hoping their physician will help them. However, as Bill Gillanders was saying, their physician is even less likely to be therapizing than they were 20 years ago. I think there’s a real pressure that way. So it’ll be interesting with Amazon’s $9 a month, to have AI providing quasi-therapy to people, because they’re unwilling to admit that they need real help with someone who’s in the mental health business.