Health Care Renewal agrees that our primary care leaders are out of touch with the real world

“In summary, primary care is under siege by progressively rising costs and lower reimbursement. Since this seems to be public knowledge, it shouldn’t be surprising that medical students are increasingly going into other fields. What is surprising, and troubling, is that leaders of major medical organizations either fail to recognize how hard it is to practice primary care, or recognize it, but fail to acknowledge any responsibility to do anything about the problem.

By avoiding any responsibility for the solution, such leaders become part of the problem.”

Bold words – and I completely agree. I recently emailed Dr. Weinberger trying to bring this to his attention. It’s time for our leaders to stop being afraid about talking about money, reimbursement, and compensation. Let’s face facts: with today’s medical students graduating with an equivalent of a mortgage of debt, they are going to where the money is. And it’s not in primary care.

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  • brahim

    I regularly interview physicians about the latest, greatest new treatments — Genentech’s Avastin, Tarceva, DePuy’s Charite, Eyetech/Pfizer’s Macugen, to name a few. Increasingly, my sources are making comments about the cost of treatment. They will say things like, “The cost of these new treatments are out of this world.” Some add that the benefits of the new treatments is not high enough to justify the cost, especially with drugs such as Avastin and Imclone/BMY’s Erbitux, which typically add 10s of thousands to the cost of treatment but extend life only a few months.

    But when I follow up with a question about whether the cost of the treatments will influence their prescribing, they universally say, “I never consider the cost of a treatment when I prescribe. I only consider the needs of the patient.”

    On the one hand I can understand this attitude. After all, the physician is expected to represent the patient’s health. In our free-market health care system, the patient is expected to be the limiting factor, saying yes to beneficial treatments and no to pointless treatment.

    However, our modern physicians use what they call evidence-based medicine. They present the evidence to the patient and the patient must choose. But how can the patient choose when the deck is stacked? I would suggest that the physician will only rarely explain the situation in a balanced way. Instead, if the patient’s insurance will pay for the treatment, the evidence he or she presents to the patient will favor the use of the treatment.

    It’s all about getting paid. The patient and the payers — ultimately all of us — are the losers. When patients and payers begin to accept the difficult choice of turning down the expensive treatments that only prolong the act of dying, then we will begin to see the health care system getting its priorities straight.

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