A unique, and one of the best, takes of the primary care crisis I’ve read:
What is happening to PCPs is what happens to many experts whose jobs are fundamentally based on knowledge and/or technology. That is, as knowledge and technology advance, some (and perhaps a lot) of what the experts do can be sufficiently simplified and “democratized” that less well-trained individuals become enabled (or believe they are enabled, which amounts to the same thing) to do it themselves.This is what the market is telling PCPs has happened to them.
It is proposed that primary care start to take on specialists’ domains, just as mid-levels have encroached on primary care.
That’s great advice.
Some of this is already happening. Cosmetic laser therapy. Botox injections. Trigger point injections. Non-invasive nerve conduction studies. All available in a growing number of primary care practices.
Make yourself indispensable and maximize your value. Soon, it will be the only way a generalist physician will survive.
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- Surviving primary care
- Why nurse practitioners and physician assistants will not solve the primary care shortage
- The primary care problem
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Rather than the mid-levels displacing doctors and taking over primary care while the doctors ‘move up’ to do botox and cosmetic laser, many mid-levels are leapfrogging all the way to doing the botox and laser themselves =(
For years cardiologists insisted that only they could supervise stress tests; now they let their own mid-levels do it.
We PCPs should attack the cardiology trifecta (stress/echo/holter) with gusto.
“It is proposed that primary care start to take on specialists’ domains, just as mid-levels have encroached on primary care.”
This makes no sense. Why would anyone rather have a PCP doing their cardiology over a cardiologist? The examples you have listed are cash-only things requiring little skill that represent a tiny portion of people’s practices. This will have no realistic impact on the developing problems with primary care and sounds like a grab for attention more than anything else.
When I went to medical school in the “old days” of the 1980’s, the domain of the generalist was much larger than now. The problem isn’t the glorification of mid-levels, but the trivialization of generalist physicians.
Moving into the specialists domain? It is all the domain of medicine and much of what specialists do now was within the domain of generalists then. As a liscensed physician you can do anything that you are competent to do, but making sure that stay within that compentency is an absolute ethical requirement–notice I said “competent to do” not “certified as competent.”
Want to do stress tests as an FP? Fine, as long as you know what you are doing.
The real survival of general medicine is going to be as a result of those who have the balls to practice in the free market outside of the strangling price-fixing system.
“The real survival of general medicine is going to be as a result of those who have the balls to practice in the free market outside of the strangling price-fixing system.”
The population with the resources to to afford ‘free market primary care’ is shrinking daily. That population can only support a relatively tiny fraction of the entire general practitioner pool. Despite the threats flying over Medicare and the anecdotes about Medicare patients not being able to find primary care – the fact is that the numbers do not add up such that primary care physicians will be able to alter their practices to harm the ‘cabal of payers’ in numbers substantial enough to make a difference.
There might be a place for some boutique practices, but in large the future of general practice is not “outside of the strangling price-fixing system.”
We’re going to have to work within the system to get the payers and patients to better respect the benefits of primary care as the centerpiece of any health system.
“We’re going to have to work within the system to get the payers and patients to better respect the benefits of primary care as the centerpiece of any health system.”
Why do they need to respect you if you do the work for peanuts or, in the case of doing all of their administrative work for them, nothing?
Why would they need to respect the benefits when they aren’t the one who is sick and therefore getting the benefits?
Why would they see you as the “centerpiece” when your role is being limited to signing “consultation agreements” with NP’s so they can practice medicine under your “supervision” which consists of one phone call a week?
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