In shopping for a PCP recently, I found that even getting an appointment was a struggle. One practice told me they could see me in a couple of weeks, UNLESS I WANTED TO SEE THE MD, in which case it would be five months. (The two weeks entailed seeing a PA.) I eventually booked with a practice that offered me a real MD, but still required a month lead time. At that appointment, after briefly seeing the internist, they took blood–it required a FULL MONTH to get the results back. They also scheduled a physical exam, which required five months lead time. So, obviously, the PCP shortage has hit us hard here.

I would go for retainer medicine in an instant, were it to be made available in this area. Alas, its acceptance has been slow in this state, where “social engineers” claim that it unfairly skews good health care toward those who can afford it. (Cadillacs for all; buses are discriminatory.)

Short of retainer medicine, from a disenfranchised consumer’s perspective, it would be wonderful if primary care practices could return to the fee-for-service system that seemed to work quite well when I was a lad. I hope that the optimism expressed here in this thread about the potential return of primary care to that type of payment system is not misplaced.

–TNT

I could look for some hard numbers. Insurance cost is a common topic with my friends, often health insurance is costing them over $400 per month plus co-pays for a family plan. My wife is a state employee and under one retirement plan insurance will cost $800 per month plus co-pays.

pj has a point. My last physical cost $400 in co-pays and found nothing wrong. My former doctor’s solution was to do the whole thing over again. A little cost transparency would help.

Any data on that?

Steve Lucas

1) Allow foreign doctors to flood the country. There are literally millions of them waiting and the govt can just let them all in if the american docs start dropping out of primary care

2) Continue to allow NPs to do primary care medical jobs. NPs already have full autonomy in many states and can script meds, order lab tests, and do exactly the same diagnosis/treatment that primary care doctors do. The government will use this and expand their scope of practice even further.

as the number of uninsured is growing by the millions annually, a low cost cash only primary care office will proabably do fine.

If you look at the overhead costs associated with insurance companies ( computer based billing systems, annual software licences, hired employees to type in the data and review the denied claims, office manager to keep up with contract changes by HMO’s and PPO’s and endless medicare rules…. if you take cash only certainly the the numbers of patients.day seen might decrease by half, but so will the overhead expenses.

I think there are 2 possible solutions:

1. Govt controls a lot of the reimbursement, just shift part of the payment pie back to primary care & decrease the amount of paperwork. But, the pie won’t shift because of subspecialist’s/AMA preventing that and the government just adds another layer of hassles & paperwork every 2-3 years (HIPAA, EMTALA, OSHA, etc.).
2. Go back to cash up front & get out of the insurance business. That’s why dentists, optometrists, vets, etc. make more than primary care docs. Patients won’t like it because they seem to think health insurance should pay for absolutely everything. It should work more like other insurance & only pay for the catastrophic things. E.g., you expect car insurance to pay for your accidents, but not your oil changes.

NP’s aren’t the solution because primary care and chronic care are not near as easy as you think. Many FP’s & internists will tell you that they still wish they had more training for what they do even after 3 years of residency. Like the saying goes, you can’t diagnose it if you don’t know what it is. Patients & diseases don’t always follow the textbook and there are always lots of complicating variables.

I suspect one of 2 things will happen in the next 5 years. Either govt will wake up & start a universal health care system with basic primary care coverage, or primary care will abandon the current system & go back to the cash up front practice of the old days.

The physician piece of the pie is being held constant. I agree that this does not fit into your logical view of the world, but we are talking about Congressional funding and CMS. Logic occasionally provides suggestsions.

Thus, to answer your question, that is how the process works.