Excellent piece in Boston Magazine detailing the primary care crisis:
According to the MMS, in 2007 just 42 percent of patients were able to get an appointment with their primary care doc in the space of a week (down from 53 percent a year earlier). Those patients who didn’t already have regular doctors had it much harder. The average wait time for them was 52 days, and that was assuming they could find doctors who were willing to take them on at all: Half the primary care doctors surveyed weren’t accepting new patients.
Nothing new fact-wise to regular readers of this blog, but it’s encouraging to see more mainstream media outlets are catching on and trumpeting the ramifications of the problem.
I see this going two ways. One is that mid-levels and foreign-trained doctors will take over. The other is that primary care physicians will get paid more, bringing an influx of new doctors to the field.
The ultimate decision will come down to patients. No disrespect to my NP and PA colleagues, most of whom do an excellent job, but there is a segment of the population who simply want a physician for primary care. Will they be happy with a mid-level as their primary provider?
If so, then my days are numbered.
If not, it will be up to the patients to exert enough pressure to reform the payment system.
Related posts:
- Where’s the money to better pay primary care doctors going to come from?
- Primary care and the elderly
- Primary care doctors face burnout, and how that affects health reform
- Primary care docs "in the middle"
- Medical students avoiding primary care, is it more than money?
- Pay primary care by the hour, again
- Primary care from a med student perspective
{ 4 comments }
It’s nice that the problem is getting recognition but they’re going in the wrong direction by trying to reintroduce capitation. That’ll make things worse for us and just hasten the aggregation of those too young to quit into larger, more tightly regulated clinics.
The only thing I didn’t like was that the writer really doesn’t seem to understand the differences between Family Medicine, Primary Care Internal Medicine, and Primary Care Pediatrics (and no I’m not counting OB/Gyn, they aren’t PMDs!) She might have dedicated a few sentences to explain who does primary care and who doesn’t.
This is really just a natural evolution that occurs in a capitalist economy. When you aren’t competitive, even though you are able to lobby heavily to keep your monopoly, competition will eventually force you out. That is fair and just. The American people deserve better in terms of primary care that what physicians are willing to provide for a fair price. Primary care docs make too much money for what they do. They don’t run their practices efficiently.
11:43:
Your analysis is superficial and misses the point. And your assertion that somehow Americans “deserve” better smacks of pandering rather than serious thinking.
Many Americans want to be able to have a visit of a certain length of time with their doctor. They just don’t want to pay what that has come to cost.
The service isn’t merely an “appointment” with prescriptions or a scheduled surgery. You fail to see the conflict between expectations of time–in this case for a non-homogeneous “product”–a physician’s consultation, an expected level of quality–time with someone who is trained and uses that training– and the desire to meet a specific price.
Like the engineer’s triad, (good, cheap, fast, pick any two) there will always be a difficulty with accommodating all of those requirements. Pretending that there is some answer to be had in the inevitable march of economic forces that will leave the resistant doctors in the dust is just ignoring the reality that expectations of patients will have to bend as well. Maybe that means you will have to expect less time with a well-trained doctor. There are inherent limits to where this can go. Maybe you will have to be satisfied with less well trained providers, “mid-levels” rather than physicians whose training isn’t as exhaustive but whose time isn’t as costly. Maybe you will just have to pay more for qualified professional time.
Simply saying Americans demand something is really irrelevant. Demand has to be backed by resources (and that isn’t the same as “insurance” resources). I might want a great house and lot for $50,000 and a great new car for $5,000. I can trumpet my indignation and demands all day long, and it isn’t going to matter. No one has to give me what I demand at my price.
And your calling medical practice a “monopoly” is really off the mark, unless you pine for the days when any huckster and sociopath could tout cures with impunity. The restrictions on who can practice have been imposed on the many professions–not a monopoly– and the many competing individuals in each of those professions, again not an monopoly. I don’t see those requirements being lifted, and in fact the requirements grow greater as time goes by. I figure that is the will of the lay public speaking, because it sure isn’t me. Compliance costs me money. If you aren’t one of the many who support the public will that only the qualified should practice, well I hope you can be content being on the outside of the majority’s opinion. I don’t see things changing your way ever.
Do you even understand what a market is? Are you able to understand what the conditions of a non-market are? Demands don’t always have their natural resolution in their being met with satisfaction.
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