Can primary care survive?

I do agree. Primary care has a solid foundation and has great demand. I also agree that the current environment works against the patient/doctor relationship in a way that no other professionals would allow.

While many lobby for legislative fixes, primary care practices struggle under poor reimbursements and increasing costs. Medical students by the THOUSANDS are avoiding primary care and it is this phenomena that IS igniting change of practice style across America.

I applaud any efforts that a physician devises to preserve the doctor/patient relationship. Hence the multitude of practices that are downssizing, dropping HMO’s, spending more time with patients , and doing what most other non medical professionals do. (set a fee, provide a high quality service and let the patient decide if they want the services)

perhaps if primary care physicians can create working environments that are more sustainable for the phsyician and patient, we might see in a few years a turn around from the US medical school trends.

I would much rather see an “end to the stifling climate” that current primary care practices labor under than an end to primary care. Unless current medical students see examples of sustaining primary care practices, they will continue to vote with their feet and avoid primary care.

Those who would want more and better primary care have to realize that this is going to take real money. All the assertions as to the satisfaction of the primary care practice aren’t going to be enough.

Funds for care have always been limited. All managed care did in the end is invite a third party into the transaction that kept a portion for itself and doled out the rest to the doctors, sometimes, as others have noted, with perverse incentives.

Graduates today have heavy debt loads. Medical practice demands long hours of clinical time along with the burdens of administrative, clerical and business responsibilities. Then there is the issue of liability, always present. Practices that offer relatively lower reimbursement for the time worked, along with demands to act as a “gatekeeper” for some insurance company, work that is often not compensated, are going to find competition for talent difficult.

I don’t see an easy answer. I also don’t think it is reasonable for an insurer to impose gatekeeping duties on providers while at the same time demanding discounts from empaneled physicians. If anything, that extra duty should come with a premium, not a discount. And forget about the holdbacks for those who uphold the company’s utilization objectives.

Nobody is going to fight this battle for doctors, they are going to have to do this for themselves. The first step is to dump the HMOs and other entities that have brought so much of the state of dissatisfaction to the primary care professionals.