Graham tries to take it on (good luck). Ignoring the health care policy points that we disagree on, he touches on the major reasons why primary care is dying: the reimbursement system, lifestyle, and paperwork.
The reimbursement system is the key element that is killing off the profession. The more that the public and politicians can understand this, the better off we would be. Graham writes:
I also think the RVU system needs to reward primary care work more and reward some procedures less. This would encourage more people to go into primary care and keep more people in primary care as well.
Bringing about this change will be difficult for two reasons. Politicians are oblivious to the unique issues facing specialists and PCPs, and lump all physicians into one category. Secondly, those who truly have the power, namely the RUC, are disproportionally filled with subspecialists not willing to give primary care a break.
I don’t think that retainer medicine by itself will solve the primary care mess. However, I think it is a powerful tool to force the necessary change needed to keep primary care from collapsing.
Related posts:
- "We have to make primary care a more attractive profession"
- Is history squeezing out primary care?
- Should primary care distance themselves from specialists?
- Can primary care doctors actually increase health care costs?
- Primary care: "Second class citizens"
- Is money enough to save primary care?
- Are cardiologists going to take their reimbursement frustrations out on primary care residents?
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As with many industries in our nation, lobby power wins. The urology lobby is different from the cardiology and radiology lobbies which are yet different from the IM lobby. Who ever has the most money wins, I guess.
As an undergraduate considering the field of medicine, I’m finding that the more I read about the state and nature of our health care system the more I grow discouraged to make such an attempt. I initially had thoughts of becoming a family physician, thinking that it was by far the most noblest of all specialties and truest to the creed “to help people”, but after some research I have grown disillusioned with the system under which primary care physicians work.
Funny how MD hopefuls, like myself, initially think of medicine purely in terms of helping people (barriers to access, excessive paperwork, and disproportional reimbursement models non-existent). Knowing that I could potentially enter the field under a dysfunctional system gives me the strong desire to turn my head settle with something less gratifying.
Anyone working or on the road to working in primary have any thoughts to help me make a decision? They would be much appreciated…
everyone keeps telling me the urology lobby is the best. well everyone outside the state of alaska which apparently has a well oiled machine.
Anon 6:14,
I’m going to respond to this from a patient’s perspective. That may not be welcome, but here goes.
I consider my primary care physician to be the only medical professional I’ve encountered in the past decade who continues living up to the bygone stereotype of doctors being genuinely interested in and eager to help those they treat. He seems to respect that my time has some worth; he doesn’t patronize me by assuming I couldn’t possibly understand medical jargon; he appears to treat his staff with respect; he doesn’t begin consults with assumptions and force any dialogue to fit those preconceived ideas; he makes a noble effort to help me navigate through the fog of bureaucracy that interferes with getting any sort of test or procedure or billing concern handled properly at his very large clinic. I have a great deal of respect for him, and above all else, I trust him.
I’ve also had some interactions with surgeons at his clinic and, most unfortunately, with their legal department — both of which struck me as the most incredibly self-absorbed, ill-mannered, condescending, misanthropic, dishonorable entities I’ve ever encountered in 50 years on this earth. The surgeons simply couldn’t be bothered to communicate. The risk managers had no qualms about lying, about refusing to even acknowledge evidence that refuted their false claims, about treating me like a valueless piece of crap (oh, but as an “honor member” of the clinic’s “Circle of Friends” I continued to get calls from their fundraising dogs for charitable donations all the while…my money remained very welcome there, even if my opinions about a questionable practice or two were cause for capital punishment).
America desperately needs strong, independent, professionally tempered family physicians who can stay above the fray and deliver effective care to our mothers and fathers, our sons and daughters, our friends and ourselves. That need is never going to go away, and I have immense respect for anyone willing to rise to the challenge.
If that describes you, then the very best of luck to you. I wish you personal, professional, and financial success.
Anon 6:14:
It’s too early for you to decide on a specialty. If, after completing most of your 3rd year rotations you decide that you still want to be a pcp, I would encourage you to do IM instead of FP. With IM you have a wide range of options if you change your mind about being a primary care doc: you could become a hospitalist or choose from a wide variety of medical specialty fellowships. FP only has a few specialties open to them, although they do have the exciting subspecialty of Sleep medicine, which was recently added.
Thanks to the above posters.
- Poster #2.
Thanks Anonymous 6:14, I needed that.
Sometimes you wonder if anyone notices all that you do. I am proud to be a Family Doctor, but the job can feel thankless at times.
You don’t know thankless until you’ve taken care of a trauma patient. The only people worse are their family members.
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