Australian GPs (IMs or FPs) are reimbursed by the govt at the end of each day. No questions asked. No wrangling. No fighting with insurance companies or bureaucratic redtape.

These providers would be obligated to adhere to guidelines and – this part is key – would be immune from punishment if patient outcomes are less than perfect.

Diagnosis and management would be adequate at least half of the time, and that’s pretty good.

Kevin

Kaiser Permanente Colorado employs approximately 300 primary care physicians, 77% of whom see patients less than full-time. Despite extensive support, the workload and stress of primary care have rendered it “not sustainable full-time” for many physicians, said Smith, the associate director for primary care and service. Turnover among Kaiser Permanente’s primary care doctors is much higher than among specialists, and Smith struggles to recruit enough primary care internists to replace those who retire or leave the area, much less add physicians to keep up with demand. “We’re unable to fill our positions as quickly as we need to,” he said. Doctors’ “panels have grown, and we’ve been working really hard to get them back down.” It takes 10 months to fill a vacancy for a general internist, as compared with 2 months to hire a physician assistant, so in the past 6 months, the organization converted six physician positions into slots for nine physician assistants or nurse practitioners.

“Luddite” Doctors who are afraid that more cost effective care providers will drive down their salaries will quickly change their tune once they realize that you don’t need an MD to treat a cough, the flu or coach a patient on diet and that any cost savings in low end care could be used to compensate more complex coordination of care.