Politicians are wisely acknowledging that primary care doctors need to be paid more.
But will that be enough? DrRich, who’s practiced on both sides of the specialist and generalist fence, notes that the “litany of professional travesties has been visited upon the primary care doctors far more than upon the specialists,” and that “merely increasing the pay of PCPs would override all these other considerations” is absurd.
He points out that generalists have an ace in the hole that specialists don’t, which is the ability to walk away and practice cash-only retainer medicine.
topics: primary care, specialist
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- Will the current economic woes save primary care?
- My take: Dwindling primary care, spinal care, ratting out patients
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{ 6 comments }
Concierge medicine was forbidden under the provisions of Hillarycare ‘94. It is also currently illegal in Canada. The option of working outside the system might not be available to anybody under the reforms to be enacted by the democratic party. Sorry to take away that one glimmer of hope. The government is going to appropriate your time and your skills on its own terms.
I have no doubt that Pete Stark and friends will make cash practice even more difficult than opting out of Medicare is now. However, if they don’t improve the conditions in primary care, there won’t be many of us for them to control. For many of us, the pay per hour worked in primary care is such that it’s reasonable to look at alternative careers outside of clinical medicine (or retirement).
They can see how well they can control the midlevels.
If my PCP became a cash only practice, I’d be looking for a new PCP. If I’m going to pay ridiculous insurance premiums, I’m going to see physicians that accept my insurance. It’s sad, but it’s an economic reality for most patients.
Kevin – Are you an anomaly in this battered primary care environment? You sure publish a lot of posts in a day’s time! Where do you find the time?
Deron,
I write the majority of posts at night and before clinic, then time-release them q2-4hrs during the day.
Kevin
I buy insurance that is actual insurance–it pays the big expenses over 5600 a year. I am happy to deal with my PCP directly. I have owned and operated an insurance company as well as practiced medicine. One thing I learned is that I don’t want my insurance running my medical care.
I don’t think more money will save primary care from continued decline. The issue is control. Primary care docs feel that they have none. Neither the government or the insurance companies intend to give an inch on that issue. Plenty of Americans, like Devon above, are willing to either willing to give up control of their personal healthcare to third parties or fail to understand that is the result of a decision to only see company contracted docs.
This is one of the central reason that those few who still value freedom must fight for the right of both patients and doctors to have nothing to do with the insurance companies–even if they themselves would never go uninsured. It is a fundamental liberty issue. Force us to prepay our healthcare and you make us subservient to whoever has the money in our healthcare choices. Some chose that. Some don’t.
Actually primary care physicians can and are opting out of the insurance sector. I didn’t like this option when I first heard about it as they were the high end botique practices and I thought it would become like charter schools taking the healthy wealthy but in Seattle there is now one that serves low income people as well as those with serious conditions for a very low cost.
Qliance limits their practice panel to between 500 and 1000 and charge patients about $50 a month and serves a wide range of customer – patients.
People without health insurance. Taxi cab drivers, people with chronic conditions who can’t get insurance, small business owners with high deductible plans.
I only go to the doctor once or twice a year at most so this might not work with my insurance plan (450 a month with 500 ded) but if I had a high deductible plan I would sign up.
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