Occasionally, I’ll publish some of the reader mail I receive. Here’s one from a former PCP in California. Fed up with the downward spiral of primary care, he chose to leave primary care altogether. I assure you he’s not alone:
“I am an Internist for over 20 years, and I recently closed my primary care practice as I cannot make a living at it. I made $23K in the last 11 months. And, my departure from practice is only the beginning of a tsunami of closures of primary care practices due to: defections by doctors to the likes of Kaiser (as is already happening here in northern California); or to ’boutique’ practices serving just a few wealthier patients across hi-rent areas like California, New York/East Coast, Florida etc.; and early retirements of an aging Internist work-force. For a population of >250,000, Santa Rosa, CA now has 15 practicing Internists (outside of Kaiser) of which only 3 are under 55 years old. More choose early retirement each day and will not be replaced in the current regulatory and economic climate. Medical students are not going into primary care specialties as they are not idiots. Given the unhappiness of current primary care docs, the huge debt accrued by medical students and the paltry return on investment in Internal Medicine/Family Practice and Pediatrics, the collapse is inevitable and will be truly frightening in its scope and degree.
Our medical & political leadership are still not getting it either. They say they want to address primary care’s survival; but I’ve seen no real action in all the years I’ve been practicing. They couch the crisis in primary care with terms like ‘may’ or ‘will be’ as if the crisis were not already upon us and worsening by the day. They offer ‘pie in the sky’ solutions like the ‘medical home’ while oblivious of the up-front costs of these programs and the EMR’s that would be necessary to implement them.
And to the policy wonks that say; ‘oh, universal single payor will fix everything’, let me remind you all that it was the government run, entitlement driven system for all Americans over the age of 65 that has put me out of the business of seeing my patients.
I am apparently supposed to shuffle elderly and/or complex/complicated patients in & out of my office every 10 to 15 minutes, or I cannot make a living. Alternatively, I can bring them back every week to address one more of their multitude of problems. Frankly, this is not a solution that I, or these debilitated patients can live with.
Primary care is unraveling around us. Indeed, all of the articles about the inordinate strain & crowding of emergency departments across the U.S., overlook the obvious – the impending failure of primary care is going to completely overwhelm emergency rooms. There is no way to prepare for this other than to save primary care.
The whole house of cards has begun to collapse, and all the articles and discussions fail to put it in terms with sufficient emphasis. All of the ‘universal’ systems that actually work are built on very strong and well-funded foundations of primary care. Everything else in health care is built upon that foundation, and that is precisely what is failing across the country. Why are emergency rooms overcrowded? Why are the wait times increasing even for the seriously ill? Because primary care is failing!
Just remember, I told you so.”
Related posts:
- ER visits and health care costs rise in Massachusetts due to lack of primary care access
- Primary care sacrifice
- Op-ed: Shortage of primary care threatens health care system
- Reader take: Ganging up on primary care
- The Boston Globe continues to spotlight the primary care crisis
- Primary care, the reality
- MinuteClinics: Reflects "the sorry state of primary care in America"
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Folks,
This is the beginning of the end. Just like the housing/subprime mortgage bubble that everyone could see coming but heads were kept in the sand.
I did primary care, saw this coming and reinvested in myself as a specialist. Now I think there is about 5 years before all of medical care collapses. Primary care and ER care is already feeling the crumble.
Organizations like Kaiser will survive a bit longer because they skim the cream off of healthy people. Doctors I know who work at Kaiser are stifled and handcuffed by the organization but they tolerate it because of the security of promised benefits and retirement. This won’t last. Any type of socialist health plan will likely put Kaiser and specialists at great risk because they won’t be able to just skim the cream.
At work I run across a lot of pre-med students. I feel so sorry for them. Although I try to tell them, they just don’t have a clue as to how destitute they are going to be.
I am sorry I left attorneys off my list. However, this is the one area of the current healthcare situation that has affected specialty care more than primary care. My current malpactrice is 15,000 per year, a lot of money to be sure, but nowhere near the amounts other specialties pay, ie ob-gyn.
Another point: any statements that healthcare obeys market forces are incorrect and convey a lack of understanding of the issue. Healthcare is not like choosing what restaurant to go to. People utilize healthcare when they are sick, making it something they need, not something they choose to utilize. Preventive care is different, requiring a very motivated patient; like a tax rebate, people will spend their money elsewhere if given the chance, totally defeating efforts to pick up/treat illnesses early.
underpaid family practitioner in upstate New York
For many of the reasons listed by the other commenters I resigned from ownership of a family practice group and now work seeing urgent care patients 40 hours a week. I get paid a salary and get home on time. I do not have to spend several hours per week filling out forms for which I receive no reimbursement; I do not have to argue with faceless utilization nazis about prescriptions I have written or imaging studies I want to order. Do I miss the continuity of family medicine? You bet I do! But after 25 years in the trenches with no sign of relief, only “improvement” schemes proposed by private and government policy wonks, I felt it was time to take care of me for a change.
Wow! We should start a support group for former PCPs now doing fellowships. It’s tough to go back, but it is proving to be worth it!
I bailed on primary care in upstate NY after a few years of severe beatings. Now I am half way through fellowship and the job offers (outside upstate) flooded in. It was a joy to behold. More money, less work, more respect and a better place to live.
Let me start the refrain of the future: “Primary care who?” Never heard of it.
It’s nice to no longer have to worry about it.
“Why do we pay the primary care guy the least amount of money, but expect them to know everything, talk to the family, organize referrals, screen for a gagillion things, all in a 15 minute visit. “
Because it is “we” who pay, not the person who needs the service, and “we” use RVS to fight over the payment levels and decide how much it is worth. “We” naturally think “we” are worth more than “you”.
You have let someone who doesn’t need you decide how much you are worth. It is like letting vegetarians decide what hamburgers are worth.
b:
fellwship is going well. No regrets at all. Government, insurance company’s, and society all treat primary care like dirt. Well guys you get what you pay for. Garbage in….garbage out. I just feel bad for my friends who haven’t left it yet. Somehow I think I will end up being the PCP by default on a subset of my patient’s down the road as there will be not be enough PCP’s left to see them
Honestly, I know I’m not old yet, but I think the emphasis for the new generation should be self-care – diet, exercise, psychological health and then healthcare providers won’t be so overwhelmed. How many people old and young alike are going to the doctor for useless reasons? Why is our society addicted to fear? Fear of having cancer, heart attack, diabetes, etc?? Aging brings with it, unfortunately, a decrease in our body optimization. How can patients tell when it’s usually nothing or something to look out for? These days there is a ton of info on the internet, but elderly people often don’t know how to use the internet.
I know it’s extremely hard to prove, but I am a strong believer in a person’s psychological health and its link to physical health. Psychology should be equally considered with “chronic” ailments.
I’ve been a practicing chiropractor for 25 years and have greatly valued the relationships I’ve had with primary care physicians. During my time here I’ve seen a dramatic decrease in the number of primary care docs a situation that my patients are only recently beginning to notice. Why is this happening, many of them ask. Numerous reasons I tell them including financial strain imposed by insurance. They still don’t appear to understand until I put it in other terms. Look, in some instances your doctor may not be making anymore for an office visit than you pay your hair stylist. Now who has more education and a greater impact on your life, I say to them. Now they get the point and just maybe we need to make sure more of them get that point to assure that the time honored family physician is around for all of us to benefit from. My dad’s family physician was the beacon of light in the last few months of his life, being taken by prostate cancer. I’ll never forget the day he touched my dad on the shoulder and told him, you’re one of the lucky ones, your pain in under control. That single statement brought a smile to my dad’s face soemthing no other specialist was able to do.
Thanks Frank!
b
b:
You’re welcome. All I can say to ya’ll is try and fight the good fight. Someone has to do it and your patients’ need you. Being a DC I’ve been abused by insurance carriers for what seems like forever. I’ve battled them when the situation was right and have enjoyed giving a few of them a blackeye.
“……Health insurance for all will only make access worse – just look at Massachusetts……”
I’m no particular fan of schemes like Massachusetts, though I prefer the individual mandate approach of this plan. If it’s going to be done at all, at least try it by that approach.
Nevertheless, I’ll remain an agnostic.
Easy for me, as I’m nowhere near Massachusetts……
But is the access issue a sign of failure or success? Can’t tell from just that statement.
Does it mean that patients now have health insurance, want doctors, and supply has not caught up with demand? That would be a sign of success. Evidence would be an increase in people wanting to practice in The Bay State.
Or do these people have some sort of government-conceived insurance that no doctor wants? Like if Massachusetts uninsured suddenly got Medicaid, paying Medicaid rates, and doctors don’t take Medicaid ’cause a high-Medicaid practice would go bankrupt.
I suspect the latter is the case, but not being from there, I don’t know. Can someone provide the details?
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