A family medicine director is scared for the future:
Medicine is again overspecializing, fueled by a market-driven health-care system that promotes the expansion of procedural medicine and specialty practices that create large profit margins. Primary-care physicians are increasingly employed by health-care corporations that judge and pay them mainly on the basis of productivity. Our reimbursement system is not designed to reward spending time with patients to counsel, educate and to develop the necessary therapeutic relationship by knowing the patient as a person. Medicine is becoming increasingly depersonalized as a system largely dominated by corporate interests and a business ethic. Primary care is today fragmented with overspecialization on one side and immediate care centers and “minute clinics” providing episodic care on the other.
I have to admit, it looks bleak.
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{ 2 comments }
Do not blame the market for over-specialization. Blame the perverse incentives created by payors, starting with Medicare RVUs.
Going to single-payor is not the answer. Pay-for-performance that would favor primary care is.
Family Practice today is headed to the same fate as tomato farming. The reimbursement in FP is becoming so low that few americans are going to pick the tomatoes/go into family practice. Then Dr. Feldman is going to have to decide whether to close his tomato farm (AKA his family practice residency program) or just import a bunch of foreign physicians to pick the tomatoes.
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