Is there a primary care crisis?

And yet, Medicare and even our own association (AAFP) is pushing PQRI “quality based payments” as if this will somehow help the problem.
Are they insane!

I have yet to see any reason that these “quality” measures or the expense and hassle that will be incurred by the physician will help healthcare.
I do see however, the poor, medically complicated, and elderly will have a harder and harder time finding and keeping a doctor.
does this help? well…. it certainly will save insurance companies and the government money.

Yet… no one is talking about this. Im incensed that our medical associations would back such idiocy.
What do we do when one of these “quality” measures that we push to obtain become obsolete or god forbid found to be harmful in the future? (which will happen.)
this is the practice of medicine. It is constantly changing. How can anyone justify practicing with a “it’s good for one, well it’s good for all” mentality.

DB,

Count me as one specialist who completely agrees with you.

Rich

i’m not sure massachusetts is a fair state to use as a basis. the volume of academic and specialists diminish the role of primary care docs in the community. the cost of living is absurd in many parts of the state. i certainly agree that the program seems unsustainable in its present form.

no one seems to be able to produce the hard data requested. so let’s assume that there is a shortage. is the shortage present in the sense that medicaid and other less financially desirable present people are involved in the calculation? if medicaid continues down the current road, and providers opt out or become non-par providers, will there suddenly be a surplus of primary care providers?

will the hospitals step in to fill the need? preventive screening seems to be something we can trust to physician extenders. already basically every patient in my hospital gets a pneumovax since none of them have any idea whether they have had it or not. i have to fill out a ream of forms if i don’t want my patient to have dvt prophylaxis despite documentation of h.i.t. or other clear reasons. i think we will see some insurers start to notify patients that it is time for some preventive care if it does indeed turn out to save them money.

so what we need is acute primary care physicians. if they don’t have primary care providers, they will seek out specialists in their acute care area of need. of course if the wait is six weeks that’s unacceptable, but the wait for primary care is 6 weeks in some places anyways. or they could visit the er. lest anyone think i am antiprimary care, i certainly am not. my wife is an internist. by that, unfortunately i mean increasingly she is a paper form filler outer.

I’m a medical student and I believe we have a primary care crisis but I’m really put off by the way it has been addressed by primary care physicians.

The crisis dates to the earliest days of modern American medicine. The entire ratio of primary care physicians to specialists is awry. But this isn’t something new and I don’t think that best evidence supports a ‘worsening’ of the crisis. Anecdotes and AAFP/ACP member surveys don’t sit real strongly as ‘evidence.’ The GAO reported in February 2008 testimony before Congress,

“A decline in the number of allopathic U.S. medical school graduates (known as USMD) selecting primary care residencies was more than offset by increases in the numbers of international medical graduates (IMG) and doctor of osteopathy (DO) graduates entering primary care”

In fact the per capita growth in primary care physicians outstrips that of specialists over the past couple of years. Other, older data also supports an increase in the per capita primary care physician population during the 1990s.

The per capita primary care physician numbers are growing, not shrinking. Where’s the growing shortage?

True, we need our best and brightest in primary care. But I’ve certainly met plenty of IMGs who fit that bill and I doubt you’ll find evidence that IMGs somehow provide some lower quality of care as primary care physicians.

We have long standing primary care shortage, but the point is that a NEW and worsening shortage of primary care physicians appears a myth.

And I think that isn’t just splitting hairs. As a medical student I am actually really put off by the attitude of primary care physicians. I’m put off by the rabidness of the complaints. I’m put off by what I perceive as an ‘us versus the specialists’ attitude. I’m put off by the constant complaints over compensation. I know primary care physicians are underpaid, that they’re doing more work for less than in the past but they still earn more on average (both in absolute dollars and as a percentage of average household income) than a primary care physician in any other OECD nation.

I’m not saying that many of the complaints you hear from PCPs aren’t valid. As I said, the ratio of primary care physicians to specialists is absurd in this country and the U.S. has a long standing primary care shortage. But it just seems that in the past 10 or 15 years PCPs have started to take the situation very personally. I know there was talk of the primary care crisis before that time, but it just doesn’t appear as vehement. It’s difficult to explain such a shift in attitude by the data but it certainly is disconcerting. Were primary care physicians just not complaining enough back then? Because while raising the issue is important the level of complaining nowadays just isn’t real attractive.

I now never hear anything but complaints from primary care physicians. Online, in my Family Medicine rotation, in my Internal Medicine ambulatory care rotation all I hear is the woes of primary care. Why would I want to go into primary care when I’m surrounded by that?

This is coming from a student who truly buys into the need for an entire rethinking of how American medicine is organized to put significantly more influence on primary care, the management of patient with multiple medical problems, preventative care. But man, as a student it doesn’t seem like the primary care community makes it very enticing.

p.s.

There’s an issue in debating primary care physician shortage that I didn’t address in my original comment. I realize we’re seeing an aging population and increased primary care utilization, but estimates by think tanks about how we’ll fall short of the number of PCPs we need in 2010 or 2025 or whatever date you pick are just that – estimates.

We all have witnessed these same prognosticators trying to guess at how many physicians this country was going to need over the past two decades. “Oh, better close off some medical school spots…no, wait…quick, start building some more schools!”