I would like to introduce you a remarkable article by Edward J. Volpintesta, MD, a 65-year old solo primary care doctor in Bethel, Connecticut. Dr. Volpintesta is a veritable writing machine and has been published in The Wall Street Journal, the New York Times, medical journals, and other publications. His articles cry for a deeper understanding of primary care dilemmas.
In the October issue of Connecticut Medicine, Dr. Volpintesta hits the primary care dilemma on the head by simply recording a “typical day” in his office, in this case, a “half-day,” lasting 9 hours. The power of his entry is the simple recording of events of his day – including details of 7 office visits, 9 telephone conversations, and reviewing, signing, or taking care of some 25 documents, faxes, referrals, and other paperwork.
What struck me about his chronicle is how many of his activities were non-reimbursable. In Denmark and other countries, these activities tend to be reimbursed through a combination of management fees for serving a patient panel, fees for responding to telephone calls and emails, and fee for-service during office visits. Not being paid for telephone calls, which can take up to one-third of a doctor’s time, is a particularly egregious example of what should be paid for any reform measure to have impact in the clinical trenches.
Keep in mind doctors like Dr. Volpintesta are the workhorses of our health care delivery system. These physicians, which deliver most of initial care in this country, are generally in independent practice, are underpaid compared to specialist peers, represent a threatened species, and are short by 50,000 doctors, scheduled to reach 160,000 in a decade.
I have long maintained pundits like myself and health reformers in Washington should spend a day in the office of busy solo practitioner. Only then can we begin to appreciate travails of primary care – the hours spent on such non-reimbursable activities as paperwork, phone calls, and prescription writing and renewals.
These activities require knowledge possessed only by the physician. In my opinion, these activities, because of the time and know-how required, ought to be reimbursed. That would make primary care more rewarding and would close the satisfaction and monetary gap between primary care and specialty care.
The next big health reform crisis will be lack of access to primary care physicians. This will occur when 78 million baby boomers turn 65 in 2011, and, if and when, Obamacare reforms propel 25 to 30 million uninsured into the market in 2012 or thereabouts.
Primary care doctors, already overworked, will be swamped, and waiting times to see doctors will escalate. Waiting times have already grown to twice to three times the national average in Massachusetts, now three years into its universal coverage plan.
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