The specialist-heavy physician organization says all the right things regarding the proposed primary care medical home, but will their support withstand “budget-neutral” payment reforms?

An emergency physician comments that “current compensation mechanisms for health insurance in federal plans . . . doesn’t place any significant value at the physician spending time at the bedside,” and a urologist proclaims “the concept of the medical home is, on first blush, very intuitively right.”

As always, the problem comes down to money. Many AMA members are expressing “considerable anxiety about the details associated with promoting the medical home as a model for patient care and physician payment,” meaning that it’s unlikely they’ll support any primary care payment increase at the expense of specialist salaries.

On another note, Buckeye Surgeon chimed in on whether specialists should spread the wealth. He contends that if primary care doctors were paid more equitably, they would be less inclined to rush through visits and outsource care to specialists. The result would be “a reduced demand for specialists and market forces alone would make it unsustainable for graduating residents to flock like lemmings to subspeciality fellowships.”

Interesting take, and I like his “specialists are the quarterback, generalists are the offensive linemen” analogy.

topics: ama, medical home