The recent news is certainly grim.
Almost half of primary care doctors want to quit. Only 2 percent of internal medicine residents want to enter the field.
Yet, I think there will be a turnaround ahead, if only because we’re close to the bottom.
Here’s why. The powers that be, President-elect Obama, and influential Democrat Max Baucus, have shown that they seem to understand that primary care is the pillar that will support their health reform initiatives.
By almost any metric, systems that utilize more primary care services operate at lower costs and have better quality outcomes. Both those factors are key buzzwords that will get attention in the current economic and political climate.
Access to primary care is already at a premium, with the influx of Medicare patients yet to come. Seniors seem to understand the impact of the primary care shortage, as the AARP has allied with doctors in protesting Medicare pay cuts.
For medical students brave enough to enter the field, they are finding that the shortage is working in their favor, and are able to dictate their terms in a buyers market for primary care.
Nurses and mid-level providers, who some feel are able to “replace” primary care doctors, have shown absolutely no interest in doing so.
The ACP feels the same way. They have released a white paper (seems to be in vogue these days) that in lobbyist Bob Doherty’s words, “makes the positive case that primary care will improve outcomes and lower the costs of care.”
That’s important. Physician complaints about being underpaid will not resonate with the public, who seem to think that all doctors are millionaires.
Generalist practice has to be framed in such a way that it will benefit patients, lower health care costs, and improve quality outcomes. It should not be difficult for primary care to make the case on these points.
Bottom line: should you buy, sell or hold primary care? While it may be overly optimistic to suggest “buy,” I think future generalist practice warrants a solid “hold.”
topics: primary care, acp
Related posts:
- Why primary care is important
- Primary care and the elderly
- How should we pay for primary care?
- Op-ed: Shortage of primary care threatens health care system
- Will a 10 percent bonus for primary care be enough?
- Expect more primary care work under an Obama health plan
- Why not a down payment for primary care, and problems with the medical home?
{ 12 comments }
I wouldn’t yet recommend Internal or Family Medicine to a medical student choosing a residency. Talk is cheap, raising payments enough to save cognitive generalist care will cost money.
Medicare is going broke and the commercial insurances cannot further raise rates significantly without many employers dropping them. That means most of the extra money for primary care would need to come from reducing payments for procedures or from reducing defensive medicine. Both of these would encounter fierce opposition from the specialists or the trial lawyers.
I’m afraid our government reformers will opt for replacing us with midlevels. They’ll need to find out the hard way over several years how much more midlevels will cost in extra testing and referrals.
Finally, the recession weakened finances at most hospitals will limit expansion of their subsidized primary care clinics.
The best option for the few physicians still entering primary care may be niches such as cash only practices.
“That’s important. Physician complaints about being underpaid will not resonate with the public, who seem to think that all doctors are millionaires.”
Amen! The workaround is simply education and one of the great things about physician blogs is the unfiltered, no-need-to-BS view of how REAL financial problems are for physicians. Getting in front of a congressional panel and saying “boo hoo” will only make it worse. Grass-roots education on reimbursement realities is the way to go.
This is one of the most cogent pieces I’ve seen recently on needing to maintain a positive, financially beneficial tone when trying to appeal to policymakers. Nice read.
We need more freedom; freedom to bill for telephone calls and completing forms, and freedom to control our diagnostic testing.
More freedom would make a big difference.
The new HHS secretary is Tom Daschle, who has made it clear that his solution to primary care does not include incentivizing it to encourage more medical students to enter it. He recommends having it taken over by midlevel practitioners. Considering that HHS is the key to healthcare in this country, I would say that primary care physicians will not be better off with the new administration.
I have an unorthodox idea: the primary care lobby (such as it is) should actually argue for the SGR cuts to go through for once. The public needs to see what “nuking the system” looks like.
I think it will look like this: Medicare beneficiaries will encounter real difficulty accessing cognitive services, but they will have no trouble accessing most procedures and imaging services. Then the solution will be clear: increase the RVUs for the difficult-access services.
Let this process repeat itself many times, and we’ll see a rational quasi-market-based reduction in the income discrepancy between cognates and procedurist/imagers.
Will be interesting to see if we get an “it’s the economy, stupid” answer to the primary care problem too. As less people can afford specialists, there will be less demand, and some can sense a massive workforce trimming in healthcare. Will the sudden abundance of jobs in primary care be met with a sudden abundance of job seekers?
Yes, indeed, Peter. As a Pediatrician once burned in service to USDHHS, the Daschle pick made me want to cry:
http://drjshousecalls.blogspot.com/2008/11/why-michelle-obama-in-white-house-does.html
Anon 9:43 : The market is already taking a big step to acually cut specialists out of the picture completely. As of Jan. 1, 2009 Wellpath will be offering patients the option of having joint replacement surgery in India for nothing versus a significant copay in the US. By the way ( I am a surgeon) surgeons do cognate alot!
What we need is more doctors in legislative positions who can advocate in the best interest of patients. Sometimes (well, more often than not) it seems lawmakers have little insight as to the consequences of their decisions. I wonder if doctors got to make these decisions–or at least were heavily involved– whether the medical field and the problems it currently faces (from medical education to clinical practice) would be any different.
You’re dreaming if you look to the government for bail-out. Sell, and fast.
“Yet, I think there will be a turnaround ahead, if only because we’re close to the bottom.”
I’ll say this for you Kevin -while you’re not much of a realist, you’re a hell of an optimist!
Increasing reimbursements would not change my decision to leave primary care for its cousin, urgent care. I made a decent living at the former occupation. What scares me about current utopian propsals is the continued erosion of autonomy and being held hostage to guidelines promulgated by “experts” who, in my opinion, lack any recent experience in the trenches of medicine and who seem to believe that the primary care physician owns lifestyle problems of patients of the non-compliant persuasion.
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