Health reform depends on the availability of primary care physicians. Studies have repeatedly shown that systems with a strong primary care foundation rank higher than the United States in cost and quality measures.
Without an appropriate base of generalist doctors, newly insured patients will not be able to access timely care. That’s exactly what is happening in Massachusetts, and this drives patients to the emergency department, further escalating the cost of care.
To quote a certain NFL football coach: “That’s not what we’re looking for.”
Those that think that mid-level providers like nurse practitioners and physician assistants can pick up the slack are sadly mistaken, since these providers see the writing on the wall and want no part of the primary care morass. They’re not stupid.
Today comes a study that reveals that 49 percent of primary care doctors surveyed would consider leaving medicine, with many saying “they are overwhelmed with their practices, not because they have too many patients, but because there’s too much red tape generated from insurance companies and government agencies.”
Furthermore, medical students are not replacing those who leave, with the wide disparity in salary and lifestyle resonating with prospective doctors.
Primary care doctors that do stay in medicine are shifting to concierge, cash-only models, or closing their doors to low payers, with “over a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients.”
The biggest losers in the primary care crisis will be the patients.
Internist Robert Centor blames the payment system, wanting to “scrap our dysfunctional system and replace it with one that allows those who love and would love primary care to do their jobs.”
Family physician Doug Farrago doubts that any future reform plan “will ever work unless we make this specialty more palatable. Case closed.”
topics: primary care, reform
{ 6 comments… read them below or add one }
The hardest thing about being a family practitioner is, in my opinion, being treated poorly by the patients. Where does this come from? Why do they call on Saturdays with things going on all week? Why do they call afterhours for things that can easily wait until the morning? Why do they complain about waiting 30 minutes when that same patient goes to see a specialist, waits at least 90 minutes, and doesn’t say boo? Why do they complain that I just want their copay (like I’m going to send my kid to college with their stinking 20 dollars)? I can go on and on.
My office staff and I work very hard all week long trying to take care of people. Being taken for grant hurts most of all. I knew I was not going to make alot of money in family practice, I also knew I was going to put up with bureaucracy, be it from medicare or HMO’s.
I just did not expect to be treated so poorly by the people I am trying so hard to care for.
Signed, a disillusioned family practitioner
don’t half of all workers want to quit if they had a suitable alternative?
Hell, I want to quit healthcare and I am a nurse, not a primary care physician!!! I am disgusted by our healthcare system. How, in just the past 25 yrs did our healthcare system get hijacked by gov’t officials, insurance nuts that have no clinical education or experience and worse, all of these numerous consultants and companies that charge tons of money to come in and teach us how to play games (oops! do business) based on the lastest laws passed by our elected officials. I feel sorry for doctors. We need to blow up healthcare and start over!
Dear Disillusioned,
People feel entitled, because they are told they are entitled. They pay little for your services, and value them accordingly. I believe that the only way you change this behavior is to directly charge the patients a realistic fee for service, leaving the insurance companies out of the loop. If the patients don’t appreciate the service, they can go without. Sorry, it’s the only way to change the behavior you see: make them bear the cost of good health care directly, and let them experience the alternatives of no care or poor care.
Comments seem to be dropping a lot.
"Being taken for grant hurts most of all . . . I just did not expect to be treated so poorly by the people I am trying so hard to care for."
It's a lesson I learned young and the hard way. But here's the thing: In order to change anything, doctors are going to have to stop being afraid of speaking their minds/sharing their experiences, and start signing their names.
Anon, 6:31, all the talk about "fee for service" would be amusing if it were not so misguided. With entire generations feeling "entitled" to medical care for their children that they cannot afford anyway, your concept (of making parents bear the cost of care) would not work for Pediatricians - many of who rely on Medicaid patients for a large portion of their income.
And Medicaid as a safety net isn't going anywhere. So there's really no way to make the dent that would change behavior.
As things stand, we Peds may not be "a dime a dozen", but our services are clearly not be worth much in the public's eyes (no matter how much the politicians pontificate & pander about children being our future).
Over the last year, I've watched Pediatrics colleagues lose their practices and their homes. It's just wrong. And no one is doing anything to stop this rape/de-valuing of the profession.
Meanwhile, the businessmen of medicine (who have treated many of us so badly) continue to skim off the top and laugh all the way to the bank.
I personally don't think that part is going to get ANY better with a former hospital administrator in the White House.
“A Harvard-educated lawyer on leave from her $300,000 job as a hospital administrator, Michelle Obama…” http://www.sbpost.ie/post/pages/p/story.aspx-qqqt=NEWS+FEATURES-qqqm=nav-qqqid=37389-qqqx=1.asp
Michelle Obama makes more than most PCPs affiliated with the hospital.
I hear a lot of complaining yet there seems to be much more organization, complaints, and demonstrations about the fact that gay marriages were defeated in several states than I have heard about the poor compensation of PCPs vs. the high compensation of specialists. In Israel doctors have gone on strike. Perhaps it is time for PCPs to go on strike so that their compensation is more equitable than it is. If PCPs went on strike nationwide until they were promised a higher percentage of the physician compensation “pie” then maybe we’ll have a better health care system.