that means less for you, and more for those delivering the primary care. And there’s ultimately nothing you can do about it.

That’s why it’s thriving. As far as leaving the program, that’s exactly what doctors are doing.

He’s right that primary care is in crisis, but misses that those docs see those 30 patients a day not so they can knock off early, but because they aren’t getting paid enough per patient to cover their expenses.

That means they can’t spend enough time with each one, which leads to some of the problems he complains of and many others with more serious consequences, like incorrect diagnosis and treatment. There’s plenty of data of the same problems at the specialist level, too.

Dr. Glauser compounds his error by describing his conclusions in a way that makes it difficult to engage in thoughtful conversation. That’s too bad, because he likely has valuable insights from his experience.

If the pot is the problem get rid of the pot. Until then, reform, will have to create winners and losers.

In the fixed pot where value is skewed towards procedural interventions, the reason specialists make far more than generalists on a time based axis, far exceeding the educational value of their contribution, is because their value comes at the expense of devaluing primary care. They collect what they do because primary care is undervalued. And when you undervalue one aspect of care in a fixed pot, the other aspect reaps the benefit.

Behold the massive procedural economic advantage of specialist medicine.

Arguing than my central lines are worth twice as much as my ICU work is ludicrous. But that’s the reality. That’s how RVU values things. Specialists make more because they train longer, yes. True. BUT, they make MUCH MORE because generalists make less. That concept escapes many specialists who choose to take a blind eye towards to inequitable treatment of procedural medicine on a time based axis, when compared with cognitive based medicine.

It’s all relative. Change the value of the pot, or change the distribution of the pot. One or the other or both has got to occur for reform to take shape. Or get rid of the pot all together. The pot was intended to control costs. It has done everything but. Why try and reform a broken system within the confines of a broken formula. That’s what Congress does best. I would expect nothing less.

Until Congress OK’s changing the value of the pot, the size of the pot, or abandons the pot, reform within the confines of the pot will always be a WIN-LOSE.

There is no other way to say it.

PCP’s are right though. Damn the AMA. Damn the RVS. Damn congress.

Primary care is 100% on the right side of this issue. The position of those who oppose meaningful payment reform is completely indefensible, and they will lose. If you’re with them, you will lose. (and buck up, if you’re a rich procedurist, “losing” means still making a very nice income…just not quite enough for the Ferrari)

So let’s double-down on the positions that have been articulated in this blog:
Down with the AMA, which has stabbed primary care in the back.
Down with the procedural and imaging lobbies who, in defending a corrupt payment system, generate enormous pain, morbidity, mortality, and waste.