How Corporate Healthcare Killed Continuity
I remember talking to one of my midwifery teachers back in grad school about her first job. It was in a small private practice. She said it was great because she was able to see the same patient over a long period of time. She saw them for all their prenatal visits, was often at their birth, and then also saw them postpartum.
The continuity helped her learn. She could observe how the stitches she gave someone were healing, and how the medication she prescribed was working. It allowed her to refine her care plans and also learn from her mistakes.
That private practice closed. A big healthcare company moved into town and the small practice couldn’t compete. Giant healthcare corporations make deals with insurance companies that smaller practices can’t get. So they close. It’s the same thing that happens with any big chain out-competing the mom-and-pop shops.
The same fate has befallen dozens of birth centers. When I graduated from UCSF in 2018, there was only one birth center in the city of San Francisco. You would think that San Francisco, mecca of hippie culture, would be a a hub for midwifery care. When I talked to people who tried to start birth centers, they said the lack of birth centers isn’t due to a lack of a demand. It’s because of money. The finances of a birth center simply don’t work in the context of a corporate medical system. And that’s what dominates the US medical system: corporate healthcare.
The big hospital systems don’t tend to offer continuity of care. Instead of being able to book appointments with the same doctor every time, patients are shuffled around among everyone on the team. There are a number of terms for this, all of which I believe are marketing-speak meant to divert attention from the fact that nobody wants this.
Sometimes it’s called “team-based care.” Or it’s explained as a way for patients to meet all the doctors in the practice before they give birth. That way, they’ve met the person who ends up delivering their baby. But that doesn’t make sense. The value of seeing the same person throughout your pregnancy is so much greater than having met someone once who delivers your baby, and meeting 5 other people briefly who you never see again.
Continuity is better for doctors and midwives too. It eases the work load. Every time you see a patient you’ve never seen before, you have to read their entire chart to get up to speed. If it’s someone you already know, there’s much less catch-up time required. It’s a more efficient use of brain power.
For both patients and providers, there are so many benefits of continuity of care and almost no benefits of doing it the other way. And this isn’t just an issue with pregnancy and birth. I’ve experienced a shocking lack of support for continuity of care in other specialties as well. So why is continuity of care going the way of the dodo bird? My spidey sense tells me to follow the money.
I don’t fully understand how, but continuity of care must hurt profits. Scheduling is part of it. It’s easier to pack a schedule if you don’t have to worry about continuity. I believe indifference is probably at play. The people making these decisions don’t work with patients, don’t understand the value of continuity or don’t care because they’re only thinking about business interests.
There is also the question of power. Strong patient-provider relationships give more power to the provider. I doubt it’s an explicit intention of corporate healthcare decision-makers to weaken our relationships with patients, but it does serve their interests to do so. It’s in step with the ethos of industrialization: make the doctors cogs in the machine. Make sure they can’t start their own practice and take their patients with them. Make sure they’re not too empowered within the system to make changes that hurt the bottom line.
So what do we do about this? First we need to name and acknowledge that continuity of care, and the relationships that go with it, are not just fluffy add-ons to “real” healthcare. They are absolutely essential to it. We have reached a point of diminishing returns with healthcare these days. It has to be about more than saving time, billing insurance and avoiding a lawsuit. Just like there are essential nutrients we need from our food, there are some essential ingredients to good healthcare that we’re currently missing. Ingredients like time, presence, relationship and community.
We’ve allowed the human elements of medicine—trust, relationship, the ability to witness and learn from our own work—to be sacrificed in favor of efficiency and profit margins. The path forward requires us to reject the premise that healthcare can operate like any other industry. We need to support independent practices and birth centers through policy changes that level the playing field with corporate systems. We need insurance structures that value outcomes and relationships, not just volume. And we need to empower patients to demand continuity of care as a non-negotiable standard, not a luxury.
This isn’t about nostalgia for some idealized past. It’s about recognizing that some things in medicine—like knowing your patient’s story and being able to follow your own clinical decisions through to their outcomes—cannot be optimized away without losing something irreplaceable. The question isn’t whether we can afford to prioritize continuity of care. It’s whether we can afford not to.
About Me
I’m Jane Riccobono, WHNP, CNM. I’m a Women’s Health Nurse Practitioner and Certified Nurse Midwife with over a decade of experience in women’s health. I work with women who feel a disconnect between the care they’re receiving and the care they need.
I went into healthcare thinking I could change things from inside the system. But after years of watching myself become what I didn’t want to be—rushed, burned out, unable to provide the care I knew women deserved—I had to choose.
I could keep trying to fit myself into a system that treats women’s natural cycles as inconveniences to be suppressed. Or I could step into what I know to be true: that women’s bodies are wise. That our cycles are sacred. That the pain we experience often carries messages we need to hear. That healthcare can be both scientifically sound AND spiritually profound.
This is healthcare for women who know we deserve better. Who are ready to trust our bodies again while having the medical support we need. If you’re interested in working with me, I invite you to book an introductory call. I look forward to meeting you.
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Jane this is a wonderful discussion of how "corporate" has harmed continuity. I've seen the same things at work in pain/rehab practice.
One of the insidious false assumptions in the corporate model goes something like, "all the important stuff can be quantified and recorded in the chart".
So they assume that a patient can be handed from provider to provider because they assume a patient can be quantified and that "all the important info is in the chart".
But some things that count can't be counted.
Any provider with a clue knows that there is therapeutic potency in the relationship that grows over time. And there are aspects that are nonverbal. Or verbal but nuanced in a way that defies "putting them in the box on the form"
For the patient, all of those touch points of shared conversation give a sense of being seen and known.
And that creates trust.
And trust influences physiology, choices, and behaviors. Especially when things get challenging.
And for the provider, there are things we know about our patients that don't go in the chart. And the importance of those things often reveal themselves on the second or 5th visit. When we have an insight about what they're experiencing, or the best way to word something so that it touches both their heart and their mind.
So...yeah...lets keep it personal. Built therapeutic relationships. Serve our patients as human beings, not just diagnoses.