Efficiency is defined as solving problems using the least number of steps, in the least amount of time. The way a practice solves problems highly depends on their reimburement model.
The Fee-for-service model
By far the most common model in the United States is the fee-for-service model. Unfortunately, this model is often incentivizes inefficiency. Since the only way to get reimbursed is with a face-to-face encounter, it incentivizes the doctor to draw you into their office. Yet, once in the office, the Fee-for-service model disincentivizes the doctor to diagnose and treat your problem. He gets his small office fee whether he solves it or not. He is not rewarded for spending extra time, nor does he want to take on the medical-legal risk of diagnosis and treatment.
This is quite unfortunate, since the majority of medical problems are common problems. They make up a short list that includes: headache, backache, fatigue, cough, nausea, diabetes, and high blood pressure. These problems may take more than a ten minute visit to properly address, but they are well within the scope and training of a primary care doctor.
Instead of handling these common problems, the fee-for-service primary care doctor offloads the work and the risk by referring you to a specialist. This delays diagnosis and treatment by exposing you to additional time-consuming visits and testing, and to the bias of the specialist. Specialty care is extremely important in medicine; however, specialists are professionally, legally, and financially incentivized to aggressively diagnose and treat you. For common problems, this can be inefficient and even potentially dangerous.
Concierge Medicine model
The Concierge Medicine model, based on an annual fee, rewards me for solving your problems - and solving them efficiently - not for the number of face-to-face office visits I rack up. I want to make the best use of your time.
We can skip the office visit if it's only purpose is to bill your insurance. For instance, you don't have to come in to review blood tests when this can be conducted over the phone. If you have a rash, send me a picture. To review your blood pressures, text me your latest cuff readings. I try to employ technology and telemedicine whenever and wherever possible.
I handle common problems myself rather than referring them to specialists. In fact, we have more time to thoroughly examine these issues together than specialists do. As a result, diagnosis and treatment are precise and timely, and we can avoid unnecessary visits to specialists, and unnecessary tests and treatments.
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