Cutting reimbursement to doctors saves some money, but it also leads to fewer doctors, less time spent with patients, lower quality. We need to get off this merry-go-round and value doctors and their time as we should.

Money is just one factor. It is not insignificant, but perhaps we should treat future doctors as intelligent individuals capable of making complex decisions.

If I am being treated by a doctor, I sure hope that this is the case.

1. Third party payment became the norm, and transformed the doctor-patient relationship from a sacred covenant to strictly a duty-entitlement relationship. That was bound to eventually destroy one of the age old rewards of real medicine and it has. The humanist part of the humanist-clinician-scientist triad died.

2. Both the society and the profession became obsessed with technology. The clinician part died.

3 . HMO’s gave generalists the role of gatekeeper and, while they retreated, the perception of the role of PCP’s as soley gatekeepers and protocol followers stuck–primary physicians as scientist became a dim memory.

All of this was predicted by “reactionaries” and “old-fogeys” upon the introduction of Medicare in the mid-sixties and the creation of managed care in the early 70′s.

The latter was a deliberate ploy to destroy the ability of medicine to resist government control–as was the flooding of the market with FMG’s from outside the Hippocratic tradition of the west. As these initial efforts were not sufficiently effective in deprofessionalizing medicine, they planted the time bomb of RVS, intended to bait us into turning on each other.

Primary care is not along in this, but it is the canary in the coal mine for the entire profession. Many specialties are equally devoid of personal reward and full of unenthusiastic demoralized plodders–but they get the money to keep them doing it. PCP’s find that for comparable effort, their are many things that they can do outside of medicine even with commensurate pay.

I send bountiful gratitude to the primary care doctors and generalists who took care of me during a recent medical situation. I applaud their meticulousness, their excellent problem-solving (due to holistic experience), their willingness to interview me and listen to my account, and, most of all, their humanity.
I had to be sent to the "expert" surgeons, who then did not record in my medical documents my specific instructions for conservative diagnostic surgery. the outcome of surgery was: no disease, a mutilated abdomen and pelvis, a maimed and disabled human being.

Speak the truth: physicians no longer seek patient care through service & humane practice; physicians seek research & teaching opportunities, prestige among colleagues (not patients), a swanky lifestyle and, for some, a celebrity image.

You can choose medicine for helping the ill, or for healing. OR choose it for your own benefit.

Many blessings for those who choose primary care and general services.

1) The perception that the future of the field is threatened by nurses expanding their practice and politicians willing to let nurses take over primary care to cut the costs of paying physicians.

2) The perception of “low” pay. Some nurses with half the education are paid more than some primary care physicians. (article here.) Mandated health insurance seems like it will lead to increased cost pressure to decrease physician payments.

3) The perception that the future of the field will be dictated by the government. What happened to physicians driving healthcare policy?

4) The perception that primary care is handled mostly by FMGs. (Personally, I can not remember ever visiting a primary care physician who was not a foreign-medical graduate.)

I’ve since come back to the field, but not until excessive research and conversations with other doctors. To sympathize with GPs,it’s tough to love what you do when everyone else decides how you should do it.