The financial incentives must be changed, or else the PCP shortage will kill any universal health care initiative.
Massachusetts is finding that out first hand:
Even more disturbing is the fact that primary care physicians who already earn far less than some of their peers are falling even further behind. Doctors can earn far more in the U.S. if they specialize in areas that lean heavily on costly interventions. That means that new doctors are deterting primary care, the specialty that’s arguably most critical to universal coverage plans.
Related posts:
- Universal coverage and primary care
- Universal coverage without primary care
- Will the lack of primary care doctors make universal coverage useless?
- Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club
- Universal coverage without primary care access is useless
- Can universal health coverage be sustained long-term?
- Universal coverage will fail without fixing primary care first
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If primary care medicine wants to save itself and to lead the way to halting one of the most pernicious trends in health care, it must disassociate itself from third-party payment as much as possible. Away from Medicare, Medicaid and HMOs, away from insurance companies and their arbitrary and self-serving requirements, away from the immoral tasking of doctors as gatekeepers and as professionals who can be compromised by withholding earned compensation or by being given downrated copayment status for failing to meet the business objectives of an insurance company.
When will the national organizations that claim to represent internists do the right thing and condemn outright any entity that ties compensation to business performance ahead of good practice? When will those same organizations go public and name the names of those companies and government agencies that no consciencious and ethical doctor should have anything to do with? Where is the sense of responsibility and leadership that these professional organizations need to show?
“When will the national organizations that claim to represent internists do the right thing and condemn outright any entity that ties compensation to business performance ahead of good practice?”
And the AMA wonders why membership continues to fall. Heaven forbid that they pursue the good of the physicians, that is, those who are the face of American medicine. Primary care is underpaid and overworked; it will remain so until a physician’sorganization can force change. Good luck.
The AMA does not represent the best interests of physicians, and has not for some time.
Really, let’s face it. 1) Fix the tort lottery. 2) Pay an Orthopaedic specialist (one of those surgeons Obama thinks makes 30K for an amputation – WTF) less than what they make now and if you get injured (broken bone, not litigation based injury) in the middle of the night, on a weekend, or during his/her vacation, you are just gonna have to suck it up and wait. Iwouldn’t go in during the middle of the night or deal with all those drunk idiots at 2:00 AM for less money. Orthopaedics is primary care and specialty care all rolled into one. If you disagree, then how come FP’s do a fellowship in Sports Medicine to learn to diagnose sports injuries that most second year Orthopaedic students can do in their sleep. Most older FP’s and internists had a good grasp of anatomy, could do a musculoskeletal exam and could treat basic injuries including fractures. Now, they are just as dependent on technology as your average radiologist and refer sprains for fear of litigation. And, BTW, make radiologists technicians (not doctors), or at least the ones that never treat a patient, and bill for work they do at home – they aren’t doctors anymore anymore than an ECHO tech is for the cardiologist. That would save a ton of money. Oh yeah, BTW, when you give universal coverage, get rid of all the “not-for-profit” hospital tax exemptions and collect over three times your current revenue in taxes from those self-serving hospitals given a tax break to provide indigent care (NOT). Solving this is easy, if you know where to look and have a set of large cojones. If you don’t, just sit down and watch from the sidelines like the rest of the spectators.
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