Comments on: Primary care, or trendy restaurant? http://www.kevinmd.com/blog/2008/07/primary-care-or-trendy-restaurant.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/07/primary-care-or-trendy-restaurant.html/comment-page-1#comment-86751 Anonymous Fri, 25 Jul 2008 01:05:00 +0000 http://clients.emmense.com/kevinmd/2008/07/primary-care-or-trendy-restaurant.html#comment-86751 50% of the fault lies at the feet of the current and past primary care physicians. I noticed a generation ago a sense of moral superiority in primary care docs that they were above the business of medicine. They really pressured impudent young whipper snappers like myself who were not bashful about expecting to practice caring competent medicine while being unembarassed about expecting patients to pay a full and fair fee regardless of what insurance companies and medicare thought they wanted to pay. For the most part they got their way, PCP's fell in line, and the third parties got control because simply sticking up for themselves was seen as greedy, crass, and uncaring. Meanwhile, specialties who refused to let others define their value, and demanded value for value thrived while primary care went down.<br/><br/>I recall a discussion I had with a guy 20 years ago in which I argued that they were doing patients a disservice because in the future the kind of care they were delivering would be unavailable if they did not defend it's value and their autonomy to set their value and prices. I imagine he is dead now--but I wish I could say "See, I was right".<br/><br/>The turning point was when physicians failed to respond to the limit on balance billing with massive non-participation. <br/><br/>In other words, PCP's of old had a martyr complex--but screwed the patients of the future because the martyr biz is always begging for applicants.<br/><br/>Another point about all this. Why do people need insurance for primary care anyway? A few thousand dollars worth of primary care every year for a family is not an unexpected expense that one must insure for, it is an expected expense that one must budget for. Pershaps the solution to the primary care shortage is to reverse the process that has created it--to reduce insurance. Once primary care is thrown back to free market between the doctor and patient, I think a lot more docs will like it, people will not be calling around looking for someone who "takes" their insurance, and the shortage will evaporate. Doctors will be seeing people who value their service, not using them as a gateway or form filler. Those in it, free to charge a fair fee to most, will be more willing to be flexible with the poor. 50% of the fault lies at the feet of the current and past primary care physicians. I noticed a generation ago a sense of moral superiority in primary care docs that they were above the business of medicine. They really pressured impudent young whipper snappers like myself who were not bashful about expecting to practice caring competent medicine while being unembarassed about expecting patients to pay a full and fair fee regardless of what insurance companies and medicare thought they wanted to pay. For the most part they got their way, PCP’s fell in line, and the third parties got control because simply sticking up for themselves was seen as greedy, crass, and uncaring. Meanwhile, specialties who refused to let others define their value, and demanded value for value thrived while primary care went down.

I recall a discussion I had with a guy 20 years ago in which I argued that they were doing patients a disservice because in the future the kind of care they were delivering would be unavailable if they did not defend it’s value and their autonomy to set their value and prices. I imagine he is dead now–but I wish I could say “See, I was right”.

The turning point was when physicians failed to respond to the limit on balance billing with massive non-participation.

In other words, PCP’s of old had a martyr complex–but screwed the patients of the future because the martyr biz is always begging for applicants.

Another point about all this. Why do people need insurance for primary care anyway? A few thousand dollars worth of primary care every year for a family is not an unexpected expense that one must insure for, it is an expected expense that one must budget for. Pershaps the solution to the primary care shortage is to reverse the process that has created it–to reduce insurance. Once primary care is thrown back to free market between the doctor and patient, I think a lot more docs will like it, people will not be calling around looking for someone who “takes” their insurance, and the shortage will evaporate. Doctors will be seeing people who value their service, not using them as a gateway or form filler. Those in it, free to charge a fair fee to most, will be more willing to be flexible with the poor.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/07/primary-care-or-trendy-restaurant.html/comment-page-1#comment-86725 Anonymous Tue, 22 Jul 2008 03:46:00 +0000 http://clients.emmense.com/kevinmd/2008/07/primary-care-or-trendy-restaurant.html#comment-86725 It is good to know that while PCPs may not have much, they still have their dignity as professionals. <br/><br/>And they are not going to play nice with the totalitarian bureaucrats and corrupt politicians. It is good to know that while PCPs may not have much, they still have their dignity as professionals.

And they are not going to play nice with the totalitarian bureaucrats and corrupt politicians.

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