Reader letters: The primary care crisis – don’t take my word for it

Occasionally, I’ll publish some of the reader mail I receive. Here’s one from a former PCP in California. Fed up with the downward spiral of primary care, he chose to leave primary care altogether. I assure you he’s not alone:

“I am an Internist for over 20 years, and I recently closed my primary care practice as I cannot make a living at it. I made $23K in the last 11 months. And, my departure from practice is only the beginning of a tsunami of closures of primary care practices due to: defections by doctors to the likes of Kaiser (as is already happening here in northern California); or to ’boutique’ practices serving just a few wealthier patients across hi-rent areas like California, New York/East Coast, Florida etc.; and early retirements of an aging Internist work-force. For a population of >250,000, Santa Rosa, CA now has 15 practicing Internists (outside of Kaiser) of which only 3 are under 55 years old. More choose early retirement each day and will not be replaced in the current regulatory and economic climate. Medical students are not going into primary care specialties as they are not idiots. Given the unhappiness of current primary care docs, the huge debt accrued by medical students and the paltry return on investment in Internal Medicine/Family Practice and Pediatrics, the collapse is inevitable and will be truly frightening in its scope and degree.

Our medical & political leadership are still not getting it either. They say they want to address primary care’s survival; but I’ve seen no real action in all the years I’ve been practicing. They couch the crisis in primary care with terms like ‘may’ or ‘will be’ as if the crisis were not already upon us and worsening by the day. They offer ‘pie in the sky’ solutions like the ‘medical home’ while oblivious of the up-front costs of these programs and the EMR’s that would be necessary to implement them.

And to the policy wonks that say; ‘oh, universal single payor will fix everything’, let me remind you all that it was the government run, entitlement driven system for all Americans over the age of 65 that has put me out of the business of seeing my patients.

I am apparently supposed to shuffle elderly and/or complex/complicated patients in & out of my office every 10 to 15 minutes, or I cannot make a living. Alternatively, I can bring them back every week to address one more of their multitude of problems. Frankly, this is not a solution that I, or these debilitated patients can live with.

Primary care is unraveling around us. Indeed, all of the articles about the inordinate strain & crowding of emergency departments across the U.S., overlook the obvious – the impending failure of primary care is going to completely overwhelm emergency rooms. There is no way to prepare for this other than to save primary care.

The whole house of cards has begun to collapse, and all the articles and discussions fail to put it in terms with sufficient emphasis. All of the ‘universal’ systems that actually work are built on very strong and well-funded foundations of primary care. Everything else in health care is built upon that foundation, and that is precisely what is failing across the country. Why are emergency rooms overcrowded? Why are the wait times increasing even for the seriously ill? Because primary care is failing!

Just remember, I told you so.”