Health reform needs more than money to save primary care

My recent op-ed, co-written with pediatrician Rahul Parikh, was published today on CNN.com.

Entitled, “Family doctor is key to reform,” we discuss how it takes more than money to revitalize primary care:

Many solutions propose to rectify the economic factors, such as lower salaries, that discourage medical students from pursuing careers in primary care medicine. But there is scant discussion of rebuilding our health care system around the primary care doctor-patient relationship. To achieve this, three ideas are essential: teamwork, technology and integration.

Yes, pilot projects embedded within the proposed health bill, like the patient centered medical home, promise some of these ideas. But a more sweeping commitment needs to be made.

I’ve written before that money is only one reason why primary care is dying. Improving the professional life of a primary care doctor will encourage more students to consider the field and strengthen the relationship these physicians have with their patients.

Enjoy the piece.

Comments

http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
I agree that it’s not about money. It’s about what a physician brings to the table being valued for the important service that it is. And the bottom line is, that in a whole lot of places these days, it’s not. Doctors are cogs on somebody else’s wheel.
CNN’s chief business correspondent was just in my hometown of Asheboro, North Carolina this week – doing a piece on how people cope with Christmas in a struggling economy.
Mr. Velshi inteviewed a group of local “expects” – the same bunch of suits whose expertise steered the town to its current predicament – the very same leaders-with-self-professed-small-town-values who treated who me like dirt going-on eleven Christmases ago for standing up to their threats and putting a patient first. I walked their talk and was professionally crucified for it.
I’m not supposed to talk about that on Kevin’s blog, so I’d invite anyone who is interested in how primary care providers/public servants are really regarded/treated in this country to visit http://www.drjshousecalls.blogspot.com and read the top two links in the sidebar.
This happened in America. Land of free speech. Land of due process. Land of fair play. Best care anywhere.
Yes, indeed. Money isn’t the only reason primary care is dying in America. And it would be REALLY nice if our journalists and leading bloggers would start featuring and telling some of these stories as we talk about reform.
Doc99
Can you say “Tort Reform?” I knew you could.
Patient
I have had good doctor-patient relationships with the specialists I have seen for long term, difficult health problems. They took the time to get to know me, my fears, my values and were able to create an effective treatment plan. If needed, a place is found for me in a busy schedule to make sure my urgent needs are taken care of.
I have not found a primary care physician that provides this level of care. When I was afraid, I was offered Prozac. When it was urgent, I was directed to strangers for care. When it didn’t fit my values, I was told I was difficult. When my illness affected my whole life, I was told I could only discuss one problem. When I was in tears, I was told that my scheduled appointment time was over.
Family doctors only seem equipped to handle the simple problems. The complicated I leave for the specialists and the internet.
Ed Pullen
Good points but money is a big part of the problem too. I have yet to read any real commitment to how primary care physicians will be paid in the anticipated public plan. If it is 5% greater than current Medicare rates, the only primary care physicians left will be employed as loss leaders by groups looking to “capture” patients for referrals for profitable procedures and hospitalizations.
http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
I’m not a “family doctor”. I’m a Pediatrician. Primary care. Bottom of the food chain and all that.
Very respectfully, “Patient”, it does not sound like what you needed could be provided by a “family doctor” . . . especially the way our current system works.
And instead of blaming the “family doctors” (who, as medical “gatekeepers”, apparently did ultimately help get you where you needed to go), perhaps you too should look at the entire system – in the same fashion that you expected them to look at your entire life (in the allotted ten to fifteen minutes before they had to move on to someone else in their slam-packed day) and urgent needs.
Healthcare needs desperately to be fixed. But no one wants to talk about what is really wrong.
It’s all entitlement and sound bites.
Patient
“(who, as medical “gatekeepers”, apparently did ultimately help get you where you needed to go), ”
My medical insurance allows me to self refer to specialists. After suffering debilitating symptoms for over a year, my family doctor decided I needed Prozac. She never saw me when my symptoms were at their worse-that was something for urgent care. I picked the specialist, made the appointment, and gathered medical records. So no, my family doctor didn’t get me where I needed to go.
http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
“Patient”, you say your symptoms were debliitating and your medical problems were “difficult” and required “urgent care”. But you don’t say what the problem was.
Your medical insurance allowed you to self-refer, to pick a specialist and make the appointment. I’ve been there and done that myself. I suffer from trigeminal neuralgia (aka “the suicide disease” – there’s very good reason to call it that), and was mis-diagnosed for years. I’ve also dealt with doctors (including specialists) who clearly did not listen. I didn’t stay with those doctors. Sounds like you didn’t either.
I certainly agree that all doctors in primary care are not created equal. But that does not mean that all primary care doctors are bad ones.
And the point remains, good primary care physicians are a desperately-needed resource who historically (at least since managed care got its strangle-hold on medicine) have been taken for granted and treated very badly by the powers-that-be.
Over time, that cannot help but trickle-down to the patient – be it in terms of quality of care (your beef with your FP) – or simple access to care.
Patient
“I didn’t stay with those doctors. Sounds like you didn’t either.
I certainly agree that all doctors in primary care are not created equal. But that does not mean that all primary care doctors are bad ones.”
I never received a diagnosis for my disease. I have an effective treatment plan, thanks to the care of a specialist and lots of research on the internet. My PCP had nothing to contribute-no help with the secondary issues that arose. When I was losing weight, when I wasn’t sleeping, I found my answers on the internet. Of the four primary care doctors I have seen (before you accuse my of doctor hopping, I moved, one retired, one was fired), each one has treated as I have written above. The best experience I have has with primary care is with an independently practicing nurse practitioner. She went above and beyond what I ask of her.
When I deal with my kids’ health care needs, I am awed by the care they receive from their doctors. I could call right now and get an urgent appointment with my child’s doctor within a few hours. For a non-urgent appointment, within a few days. I took my kid in for a well-child and he needed a minor (non-urgent) surgical procedure. I offered to make another appointment, not wanting to impose on the doctor’s schedule. He took care of us.
http://www.drjshousecalls.blogspot.com Dr. Mary Johnson
“Patient”, as I indicated before, I am a Pediatrician. We’re primary care too (for all that we’re generally treated like scum by everybody). And the care your kids sound like they get is the kind of practice I would want to work for – indeed, it’s the kind of practice I tried to build in my own hometown . . .
. . . before I was fired by a “non-profit”, because I defied the threats of clueless executives, and intervened in a case that a FP was mis-managing, and saved a baby’s life.
It launched an eleven-year medico-legal nightmare that has yet to be resolved by the government I served – a government that dived under its desk – a government that could have stopped what was happening with a few well-placed phone calls and threats of their own.
But by all means, let’s give the government MORE to do.
I cannot recommend Pediatrics as a speciality to newbies – or primary care as a path for medical students to consider until something is done to (1) resolved my situation and (2) plug the holes I fell through – huge black holes that “reform” has so far failed to address.

Health reform needs more than money to save primary care

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