I get paid when you get sick.

The sicker you get, the more often you see me, the more money I receive from insurance companies that pay for each visit.

It’s kind of perverse, don’t you think? After all, I went to medical school for four years to learn about the human body and spent three more years in residency training mastering the knowledge of what goes wrong, and how to fix it.

But in the end, with the current reimbursement model, I get paid when more people get sick. If everyone feels well, I’m at risk of going out of business.

Is that really what medicine is all about?

Now, granted, I also see people when they are healthy, and we spend some time talking about prevention, but most of what I do all day is treat sick people. I prescribe antibiotics for infections, blood pressure pills for hypertension, sugar pills for diabetes, etc.

Each and every time I see a patient, I get paid. It’s quite a comfortable system, honestly. Cold and flu season is when I am the busiest in my office, and I make the most money.

However, deep down, there is just something so fundamentally wrong with that. I don’t feel good about it, I don’t feel fulfilled by it, and this very fact has me questioning why I ever went into medicine in the first place.

I recently came across a journal entry that I had written in college about why I was going to medical school. “I really want to help people feel better,” I wrote, “and help them to live longer, healthier lives by preventing them from getting sick in the first place.”

Ah, the wisdom of youth.

What if patients could have telephone visits and talk about the very same things we do in the office, but not have to fight traffic, find parking, sit in a waiting room, and take hours out of their day to spend 10 minutes with their doctor?

But is that what I do? Sometimes. But mainly I see patients who have complaints. It’s like I run customer service for the human body. Now, don’t get me wrong, there is something truly wonderful about helping someone when they are in need, and there is a basic level of satisfaction that comes from being there when it matters most.

So, when is that? When someone is seriously sick, or when they are well, and want to learn how to stay that way?

At first, when I learned about the new payment model being proposed by the Hawaii Medical Service Association, I was convinced it was another way that I was going to lose money working harder than ever. There are not enough hours in the day to catch up with all of the paperwork, charting, and phone calls, not to mention the office visits.

To their credit, HMSA is doing a pilot study for their new payment model for primary care doctors first, before just implementing the program with no mechanism to make any adjustments along the way. Dr. Mark Mugiishi, a general surgeon and senior vice president of HMSA explained the process to me in as much detail as is currently available.

Doctors are going to be paid to take care of a panel of patients no matter how often they are seen. Preventative visits, like physicals and general exams, are included. Sick visits, those are part of it too. There will be no increase in cost for the patients. However, the old model of patients coming in to the office so that every visit is paid individually, that system is soon going to be gone.

These are uncharted waters in Hawaii. It scares me, and I’m sure it scares most of the primary care doctors out there.

Risky as it may be for doctors, this new program might just transform how we practice medicine. What if patients could have telephone visits and talk about the very same things we do in the office, but not have to fight traffic, find parking, sit in a waiting room, and take hours out of their day to spend 10 minutes with their doctor?

What if I could take an afternoon off and then schedule phone visits in the evening when people are home from work? What about using a smartphone to do video visits with elderly patients whose families don’t have to time to bring them to my office for a simple problem that we can handle at home?

We can do all of these things now, but there isn’t any reason to look outside of the box if the only way I get reimbursed is if I keep shuffling patients in and out of my office all the time.

What if I got paid to just be their doctor, and use whatever tools I want to help them be well?

This is a whole new paradigm in the medical world, and it’s already here. Dr. Michael Nagoshi is one of the pilot physicians, and he admits, it’s going to be a big adjustment for a lot of doctors. But he’s seen a great return on investment with the amount of time he’s spent on preventive care, and feels the incentives are finally aligned with the reason we all went into medicine.

Next year, throughout 2017, the payment system is set to change, and as I see it now, things are only going to get better.