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.
