Reader take: Ganging up on primary care

The following is a reader take by an anonymous primary care physician.

I am a primary care physician who is less than a decade removed from residency, and at a recent medical staff meeting, I witnessed the beginning of the end of primary care in this rural Midwestern town.

I work in a town of about 50,000 people roughly an hour outside of a major Midwestern city. There is one hospital in the entire county of over 100,000 people, which employs the vast majority of physicians in the area. Being a Healthcare Provider Shortage Area, they are able to offer some student loan forgiveness, but the warm fuzzies end there.

Physician retention has been a chronic problem. A malignant administration reveals itself almost before the ink is dry on signed contracts. They have recently forced increased unassigned call duties upon primary care doctors with no additional compensation. To our faces, administration promised us hospitalist coverage for not only our own patients, but also for the admissions for patients without physicians (a substantial percentage of the population).

The city itself has none of the charms of a small town and all the disadvantages of one. Having practiced in many parts of the state and country, the sense of entitlement, payor mix, tobacco abuse, sedentary lifestyles and obesity rates of our current patient population are nothing less than breathtaking. At best, it is a painful population to care for.

Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.

At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol.

After weathering repeated attempts to renegotiate our contracts in a blatantly deceptive fashion, our administration has dealt yet another demoralizing blow to the community’s primary care physicians. Subspecialists have an enormous return on the investment of “physician extenders” and do not surrender any of their autonomy. As a result of the awesome greed and narrow-mindedness of the proceduralists, primary care physicians will now have little recourse when the hospital offers insulting compensation packages.

What will motivate the system to improve the lives of doctors who have mortgages, children in school, and contractual “gotchas” when they can threaten to replace us all on the cheap?

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