More in the primary care shortage

I received a nice variety of comments on the primary care shortage. KevinMD has blogged on primary care much recently. Today he links to this article – Editorial: Doctor trends by the numbers

45

Percentage of California doctors who say they’re spending a “great deal” less time with their patients than they did when they started practicing medicine.

62

Percentage of California doctors who believe “a deteriorating quality of life” is a “major” problem for doctors

Many readers know that I dislike the term primary care, not because of its intended meaning, but because of the semantic drift which has occurred in the meaning. Perhaps we no longer need primary care as currently interpreted, rather we need comprehensive care.

Perhaps retainer medicine has the right idea. Those physicians seem happy; their patients seem happy; their outcomes may even be better.

We need a reimbursement model which does not depend on increasing the number of widgets (er, number of patients seen) each day. Physicians should be paid for their time, their access, and their cognition.

Being someone’s physician requires many skills. Being an excellent physicians requires sufficient time.

I believe that we should invest more money in obtaining excellent generalist care. If we made this choice, we could design a practice model which attracted medical students again. Attracting students will require reasonable money (and we could argue about the definition of reasonable) and reasonable lifestyle. I believe that excellent generalist care would improve outcomes and decrease total expenditures. Sometimes you have to invest money to make money. I believe that to be the case with regards to generalist or primary care.