The concept that specialist/primary care MD is a dead horse.
The structure of training doctors is the problem.

More generalists, less specialists are the only answers.

I could see the need for specialists 20 years ago when information was less accessible.

Those days are gone.

If a sophisticated physician like Dr. Cheng has problems navigating through a broken primary care system, I wonder what it must be for the average patient with little or no experience about this system.

The burden of being saddled with too many responsibilities, coupled with a low regard for the services that they provide,
has made a lot of young physicians skeptical about a future in primary care. Along with all the hassles that they have to deal with from just about everybody, primary care physicians have reached a point where frustrations have replaced the traditional physician-patient bonds we value so dearly in our practices. And yet, little is being done to improve the situation at a time when primary care, not specialty care, is what we need most to
give Americans entree to our health system.

Years ago, when it appeared that more and more physicians were shying away from primary care, training programs were revamped to cut the number of those going into the specialties. That worked for a while but we are now back confronting the same situation. What went wrong, I believe, is reimbursements remain puny despite promises to raise these on an equal footing with the specialties,
compounded by a bureaucracy that is spinning out of control.

Some PCPs have reacted to these developments by joining VIP or concierge practices, or more recently, by switching to cash-only practices. While not widespread yet, both these kinds of practice will make access to primary care even worse.

The examples of Dr. Chen being tossed from one physician to another, and of her sick father being cared for by several specialists with nobody to integrate his care, follow-up, and medications speak volumes about a system that has gone awry.

Physicians can re-establish the primacy of primary care and re-create the traditional bonds with their patients by actions from the government, medicial schools, and training programs to increase their numbers, boost their reimbursements, and minimize the bureaucracy. It is a daunting challenge we must confront to meet the increasing medical needs of this country.

A cash-based practice does not decrease access to primary care. It INCREASES access. Now hey, if you are truly impoverished, that’s what Medicaid is for.

For the rest, those who have disposable income for a better car or vacations and all that, if you don’t feel primary care is worth paying for, you get what you deserve.

The cash-based practices I’m familiar with provide primary care for the farmers, the fishermen, the beauticians, the self-employed. Going cash-based REDUCES cost and reduces fees. The working-class people who attend such clinics do not have Medicaid, do not yet have Medicare, and do not have private insurance. They are ignored by the current system.

Such practices are NOT concierge practices with the annual fee and all that. Those opposed to the concept of consumer-directed health care deliberately confuse the two.

The physician author of the article could have continued to see her first choice of doctor, if she had simply paid him on an out-of-network basis. She would have retained coverage for testing, hospitalization, specialty care, etc. For maybe ten-twenty bucks more a visit with the higher copay, she could have stayed with her first choice of doctor.

I have working-class patients who choose to continue to see me on an out-of-network basis when their insurance changes. If the plumber and teacher’s aide can do it, the physician could have done it.

Problem is, SHE is the one who does not value primary care.

Primary care or family practice is not dead. If physicians are threatened by nurse practitioners or other mid-level “providers”, they have too narrow of a scope of practice. 2% of family physicians earn over $400,000 per year. What is the difference between this 2% and others who are predicting the demise of primary care? It is futile to change the system, so work in the system given to us. If you have a patient with cardiac symptoms, work it up. Do the stress test yourself – don’t be so quick to refer. GERD symptoms? Consider doing the EGD yourself. Cancer screening? You guessed it, do the colonoscopy yourself. The list goes on and on. There is a huge problem with family practice residencies – they are great at teaching residents to refer, but not so great at teaching basic procedures that belong in primary care.

As with any credentialing for the approval to do procedures in a hospital, you need first two things: evidence that you have been trained to do the procedure and documentation that you have done the procedure enough times to be considered adequatel experienced to do them in that hospital. Experience in residency or fellowship is what they are looking for, as well as post-training experience. You also will likely have to show evidence of malpractice insurance coverage that will cover your practice including all OR procedures.

salaries of primary care doc’s average about 120,000-140,000 many earn below this average. many above.

primary care is dwindling, just log onto
http://www.aafp.org/match and click on graph 5. the lack of interest by medical graduates is clearly seen.

As the numbers of primary care doc’s dwindle, demand is on the rise. time for primary care doc’s to dump third party payor relationships. demand will keep primary care busy,