I was eating lunch yesterday, and I think I came upon a good analogy. Primary care is the spork of modern medicine. It is very useful, very modern, but orphaned and maligned.

Unfortunately, the ability of those going into primary care is a mixed bag. Some of the best doctors I know are family docs, but unfortunately some of the worst docs I know are also family docs. I’m not sure which blog I read the comment from, but one of the more astute observations was from an ER doc asking “So, did you go into family medicine becuase your’re really smart or because you’re really stupid?”

As an FP married to an FP who teaches at an FP residency, I’ve seen this over and over. I’ve had residents on both sides of the coin. Given the payment disparities, we can’t always attract the cream of the crop. We’ve got some the brightest most dedicated docs you could want. On the other some of them make me want to go back into private practice after a night of backing them up on call (one of the reasons my wife did).

As db points out, the system doesn’t allow the better docs to get paid more for doing a better job. In fact, it does just the opposite. Those great docs who went into primary care for the right reasons make much less than the worst ones. That’s becuase the dedicated docs won’t drop their patients when they loose their job and end up on Medicaid or quit seeing them when there illnesses have forced them into bankruptcy and they can no longer pay the doc’s bill. The dedicated docs make less & less because they won’t kick out their patients with worse paying insurance plans, and the only way to increase your income is to only see pts from the better paying plans or run the patients through your clinic like a meat packing plant. So you have a situation where the best & most dedicated get paid the least and the less scrupulous prosper. As if the payment disparity b/w PCP’s & specialists weren’t bad enough, the payment system makes it even worse!

MY experience has been that people would use primary care a LOT more and justifiably so. if they had better access to the physician. Most people “only” go for a physical and maybe “one” other visit just because it is “to much of a hassle.” In reality, people often have questions and concerns about their health(especially in their 50s) that warrant a doctor visit (or at least a phone conversation) with their doctor. Not to mention this increased regular interaction massively improves the patient doctor relationship and the doctors understanding of their patient and their health concerns and needs.

I personally would like to see Family Medicine (and Internal Medicine) change th concept of what Primary Medicine is. We are not just for colds, basic prevention and to refill meds (all though that is important.) Primary care doctors serve the best roles and improve health the MOST when we are advocates for our patients to the healthcare system as a whole.

A True health professional and advisor.

To Anonymous, as a lawyer you should understand. people come and call upon you for your legal advice. if you were forced to “ration” your time with each client and paid in such a way that “volume of clients” was more important than the quality of your legal advise, do you not think that people would complain and see you “less often?”

If a Lawyer, Accountant, or even a plumber are not there and easily accessible when you need them… you would fire them a get another professional.
but in healthcare…. the system has trapped doctors and patients both i a bad situation.

Without giving primary care doctors more time, then there is NO reform. Whether you pay them better or simply do away with the TONS of useless and extremely time consuming and expensive bureaucracy forced upon doctors by the government and private insurance. It does not matter. you just have to give primary care doctors more time.

[...] Robert Centor continues to share his terrific insights on how medical quality being wrecked by how insurers deal with primary [...]

Solo Dr:

Based on my experiences with clients, I don’t think patients would have any problem at all paying $60/15 minute office visit. I think that’s quite fair and reasonable, actually. If the physician can pay the fixed costs of running the office (rent, utilities, staff), a fair salary for him/herself, and fixed costs of being a physician (licensure, CE, DEA), AND the patient is paying the physician directly so there’s no cost associated with insurance paperwork or billing, everyone wins. Especially if the patient is able to purchase catastrophic/chronic illness insurance “just in case” (hoping it will be used only rarely).

This also brings a degree of reality into the discussion of health care costs. Consider: I have car insurance, but I expect to pay for oil changes, tire rotation, and the occasional timing belt out-of-pocket. The insurance is just in case a drunk driver sideswipes my car and rips off the door, for example. I hope I’ll never need to use it. Health insurance should be more like car insurance, in my opinion.