Contemplating medicine and the health care system
So we have presidential candidates promising universal health coverage and increased access to primary care. Great rhetoric they espouse, but they have forgotten one important point – we do not have enough primary care physicians, and we will not have enough unless they address payment for primary care.
Primary Health Care Needs Fixing Before Universal Care Can Work
The author is a family practice physician who understands the problem well.
Low payments to primary care doctors are discouraging those of us in practice and are dissuading new doctors from entering the field. Medicare’s proposed 0.5% fee increase to family doctors like me for the remainder of 2008 is well below inflation. None of my office expenses will rise less than 0.5% this year.
To me, universal coverage looks like an empty promise. Just nationalizing health insurance by declaring Medicare for all isn’t going to get the job done. Medical insurance coverage without a doctor to see is another big health problem — not a solution.
An expanded insurance program based on Medicare or state Medicaid, another stingy payer, will prompt many doctors to opt out if they can. If doctors are forced to participate in a program with fees lower than their cost of doing business, I expect primary care doctors in private practices like mine will close up shop.
Once displaced, they’ll probably work in ERs, continuing to provide high-cost care for diseases that a properly designed and financed health system would have prevented or nipped earlier and more cheaply.
Massachusetts, the state with mandated insurance coverage most like Sen. Hillary Clinton’s health plan, has suffered a painful shortage of family doctors the last two years. More people signed up than predicted and higher costs have led to premium increases. It’s apparent to me there is no increased access to care with this plan in many areas and no cost savings have materialized.
That tells me that physicians in any universal coverage program will have to weigh the personal and financial risk of an access crunch. When a bad outcome arises, I expect lawyers will come after the overburdened primary care docs instead of the politicians who promised more than could be delivered.
But then why should we expect politicians to consider the entire problem when a catchy sound bite will suffice. If they would just listen to the bloggers they would understand. Perhaps they should invite a group of bloggers to explain our health care problems.
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5 Responses to Not enough primary care physicians
CK
March 26th, 2008 at 2:15 pm
I had a peer from undergrad who secured a job in “health care policy” in DC right after graduation. She was a political science major.
Perhaps that is why our government has such a poor grasp on the problem?
Ed
March 26th, 2008 at 11:03 pm
The government has created an intentional shortage of PCPs, as a passive aggressive cost savings strategy, IMHO. Canada is their role model.
anonymous
March 27th, 2008 at 5:47 am
is there a primary care shortage? i read about less us graduates going into primary care. but are the total number of graduates down, if they are filled with international graduates? it seems like there certainly are more people headed to hospitalist positions so i’m going to guess yes, but i don’t actually see the volume of the decrease. i’d also like to see how many people provide primary care despite doing a specialty fellowship, and lastly how many primary care docs go to do a fellowship later.
Dr. Incognito
March 28th, 2008 at 4:36 pm
DB,
You’ve made the honorable mention list on redscrubs.com’s Weekly Wrap-up for the second time in the last three weeks. I enjoy your writing, and look forward to future posts. I have no doubt that you’ll get the Scrubby Award (which includes a free set of red scrubs) at some point in the near future. Thank you for your contributions to the medical blogging world.
Sincerely,
Dr. Incognito
John
June 8th, 2008 at 5:34 am
Socializing medicine is only going to make the pay-out to doctors even less. It’s a long road ahead to make universal health insurance work.