The payment bigotry against primary care doctors

I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost.

Let’s take a somewhat corny example to help illustrate the point. Imagine there were federal regulations that limited a hair stylist to one low fee, no matter how fancy the desired cut, washing, blow drying, coloring, perming, frosting, or any other desired services by the customer. First, stylists would start forcing customers to make many trips to receive each individual service allowed under the one fee. Customers would tire of this and a chronic tension would grow between the regulated service provider and the customer. Customers would always try to stretch out the visit, “Couldn’t you just add a touch of color here? or “Could you blow dry my hair real quick?”

As stylists grow older and more weary of the chronic discomfort of the mismatch between customer expectations and what the stylists are allowed to be paid for, they would retire or change jobs, and few new stylists would want to be trained to take their place.

And what if a stylist was bold enough to charge a customer for a compete and fair list of services provided in one sitting? If Medicare was the payer, the stylist would be liable for penalties, fines, and jail time resulting from the accusation that she committed Medicare fraud. The penalties and fines would not just cover the discovered “abuse.” It would retroactively apply to the previous five years of Medicare claim submissions, based on a review of ten cases.

So now when American women (and a few men) can’t find a stylist anywhere to care for their hair, might they start to care about the role Medicare and other insurance company payers that caused the shortage? I would certainly hope so. So far it hasn’t seemed to happen much as patients try in vain to find a family physician taking new patients sooner than three months out, as they drive by an endless sea of urgent care centers and free-standing emergency rooms.

One final point: I realize bigotry is a strong word, but it is absolutely accurate. In classic thinking of bigotry situations, the issue is unfair pay or working conditions for similar work. In the case of family medicine, it’s even worse than this. Family physicians deliver better care at a lower cost, but make less than all other physicians. It’s not less pay for the same work; it’s less pay for better work. And Medicare, the insurance companies, and the American Medical Association are squarely to blame.

And patients and payers should begin to really care about this, unless they want to continue to pay exorbitant costs for crappy, inconvenient, impersonal health care.

Richard Young is a family physician who blogs at American Health Scare

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  • QQQ

    “And patients and payers should begin to really care about this, unless
    they want to continue to pay exorbitant costs for crappy, inconvenient,
    impersonal health care”
    I believe it is past time for the American people to get out in the
    streets and demonstrate against the direction our government is taking
    us and taking from us. What is this called? ( Affordable Care act? ) The
    discussions were that big dady government would take from the rich and give to the poor. The poor may be getting some of it, however it is coming from
    every person that earns a living and pays some taxes. They lie to us,
    cheat us and tell us they are helping us, we are not this stupid, are

  • joseph badolato

    Dr. Young you could not be more correct. However, insurance companies, hospitals and the feds have known all this for many years and still nothing has changed. And frankly I do not think it will. Primary care docs will simply be replaced by cheaper midlevel providers and the vicious cycle will continue. The one sure sign everyone will know that medical costs are acutally decreasing is when the salary gap between specialists and primary care docs begins to (significantly) narrow. Until this happens–same old, same old…..

  • James VanWinkle

    One thing that is never mentioned in this “pay gap” complaint is number of hours worked. I work 100 hours per week every week. I don’t see the pcp’s complaining about their extra time off compared to the specialist (I am a general surgeon). Also not sure of you guys know but you actually get MORE than a specialist does per office visit because you have to pick which one you want maximum reimbursement for office visits or procedures. The other is discounted. Instead of lamenting the “difference” between specialist and pcp’s just ask for what you are worth. Otherwise you are saying hours worked and years of training don’t matter and that’s the argument midlevels try to use to justify more autonomy and pay with less work and training.

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