My take: Primary care, treating lawyers, bitter at doctors

1) Joseph Martin wrote in yesterday’s Boston Globe about the impending primary care shortage:

But most important, new models of healthcare delivery must be developed – with a new focus on team work, where, for example, doctors, nurses, pharmacists, and social workers form efficient groupings to consider patient-centered care. Teamwork and new ways of delegating treatment will take the load off of the hard-pressed primary care physician.

Dr. Martin joins myself and a variety of other editorials publicizing the primary care shortage. I applaud him, and news outlets like the WSJ for bringing this issue to the public’s attention.

I’m not sure if Dr. Martin’s suggestion of the medical home “new models of healthcare delivery” is the answer. The dollar is the bottom line. If the disparity between primary care and specialist salaries doesn’t narrow, the shortage will continue. No way around that.

The fact the specialists are lashing out at the proposed increased reimbursement means that primary care will continue to have an uphill battle.

Here is the reality facing medical students:

As a medical student, I can honestly say that the only thing that trumps my classmates’ personal interests in a given field is the level of reimbursement . . . But the only thing that enables that kind of choice is the ability to fund it, and it’s damn near impossible to do it.

2) A reader writes: “If non-emergency doctors refused to treat trial attorneys, they would be making a huge statement and a big impact on the all the suits that are brought in this country against doctors. If the situation was reversed, would an attorney ever take a client who happened to be an attorney whose legal specialty is suing other attorneys? I don’t think so.”

And that’s what sets physicians apart from lawyers.

This issue came up before the AMA, and was subsequently denounced. The fact that it is an issue at all illustrates how poor relations are between the two professions.

3) A reader writes: “I was on your web site. As a patient with unsolved rare medical problems and also as one with wrongful diagnoses and surgery, I have no sympathy for most doctors. In the words of a very fine doctor that I now have, ‘most doctors are not worth a —-, because their main concern is money and not their patients’ health.’

When doctors live in millionaire neighborhoods, you had better believe there is a definite conflict of interest on the patients’ part. I have seen more than my share of bitchy doctors who spend less than 5 minutes of quality time learning about their patient. The older I get, the less I am valued as a human being and patient.”

Thanks for writing and I appreciate your readership on my blog.

Like any profession, there will always be bad doctors. I’m sorry that you had to deal with misdiagnoses. The majority of physicians try to do the right thing and have the patient’s best interests at heart.

However, the reality is that medicine is practiced and treated like a business in our society. You can’t practice good medicine if you’re bankrupt. And that is exactly what would happen if doctors ignored the business aspect of medicine.

The image of the wealthy physician is a myth. New physicians graduate with a mortgage-sized $140,000 of medical school debt, and I don’t personally know of any who live in houses worth over a million dollars.

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  • The Independent Urologist

    Re: the treating lawyer take:
    Legal malpractice is alive and well and can be very lucrative. Many lawyers specialize in it and seem to have no problem suing “their own”; I suppose no more so than a doctors testifying against other doctors.

  • Anonymous

    “I don’t personally know of any who live in houses worth over a million dollars.”

    That does not mean that they did not pay $2 million for those houses!

  • Anonymous

    I start med school in 2 months. Cost of attendance per year: $64k. So I’ll be $256k in debt when I start residency, and around $400k when I start practice. Those who aren’t lucky enough to get into a cheap state school (or have other means) are in the same boat, and really, that’s most of us. Primary care? I would if I could. Maybe after I pay it all off…

  • DDx:dx

    Kevin, You bemoan primary care and claim doctors are “poor” with education debt but publicize the high suicide rate. I don’t know about East Coast, but doctors(especialyy specialists) in the West do just fine. Three of the 5 highest assesed homes in my rural county are owned by specialist physicians. My home(Family doc) is above average. No, medicine is still a good living. It is the lack of morality that is depressing, not the financial aspect.
    But your answer to the letter unhappy with the quality of her care is: “Medicine is a Business”. So that’s our excuse now for our incompetence…
    If medicine is a business, the value of primary care would be evident in the market. But the government currently sets the value of doctors services. Like milk price supports…I think that is the kind of business you are talking about, one highly regulated and managed… like it is now.
    And all you are arguing for is a bigger piece of the government cut-up pie for primary care…not a system change.

  • Anonymous

    “And that’s what sets physicians apart from lawyers.”

    What, your lack of knowledge about whether other attorneys would represent someone who makes a living suing lawyers? Or your willingness to make wild guesses about professions you know little about?