The Decline of House Calls: Profits, Technology, and Specialization

House calls, once a common feature of healthcare delivery, have significantly declined over the past century, with a notable shift occurring in the mid-20th century. This article explores the reasons behind this decline, focusing on advancements in medical technology, increased specialization, and changes in insurance models and urbanization.

Advancements in Medical Technology

The mid-20th century marked a turning point in the availability and sophistication of medical facilities and diagnostic technologies. As hospitals and clinics expanded, they were equipped with advanced tools that made it more efficient and practical for patients to receive care in a clinical setting. These technological advancements led to a shift in medical practice, where specialist doctors preferred to treat patients in dedicated medical facilities rather than in the comfort of their homes.

Increased Specialization

As medical knowledge and practices became more specialized, the role of the general practitioner began to evolve. In homes, a doctor had to be a jack-of-all-trades, capable of providing a wide range of treatments and medical advice. This multifaceted approach to care became less practical as medicine advanced, and it became increasingly common for doctors to specialize in specific aspects of medical care. For instance, a doctor who treated trauma patients might have had little experience with the specialized patients they would see in home visits, such as patients with chronic illnesses or disabilities.

Insurance and Payment Models

The rise of healthcare insurance and changes in payment models further contributed to the decline of house calls. Before the advent of health insurance, doctors might have found it economical to make house calls, as the cost was often paid directly by the patient. However, as insurance became widespread and healthcare facilities began to dominate the market, it became more difficult for doctors to be reimbursed for home visits. Insurance companies typically offered lower reimbursement rates for house calls, making them an unattractive option for doctors seeking to maximize their income.

Urbanization

As people moved to urban areas and public transportation systems improved, patients were better able to travel to see their doctors. In cities, medical facilities were more accessible and numerous, making it convenient for patients to visit their doctors in person. This shift led to a decline in home visits, as the increased mobility of patients reduced the need for doctors to make house calls.

Personal Experiences and Insights

One anecdote from a doctor's perspective vividly illustrates the decline of house calls. Dr. John, a practicing pediatrician, remembers making house calls to his patients in the 1960s. He recalls that in 1967, he was still making home visits for sick children. However, by 1971, he was told that house calls had become a thing of the past. Dr. John noted that house calls were inefficient, as it was difficult to see as many patients in a day during home visits compared to office visits. A typical office visit might last 10-15 minutes, allowing a doctor to see 4 patients per hour, whereas home visits often meant seeing only 2 patients per hour due to the time spent on transportation.

Conclusion

The decline of house calls can be attributed to a combination of factors, including advancements in medical technology, increased specialization, changes in insurance models, and urbanization. While house calls continue to be made in certain contexts, such as palliative care and home health services, they have become much less common than they were in the early 20th century. Doctors today must balance the need for efficiency and profitability with the desire to provide comprehensive, home-based care.