Shortage of primary care threatens health care system

Kevin does a good job of explaining the difficulties of primary care in our system.  As a critic I suggest these modest additions:

1. I like the Dinosaur’s insistence that we use payment rather than reimbursement in our discussions.

2. Kevin does not explain that “fee for service” does not provide fees for all services. We only get paid for the visit, not for chart review, lab review, telephone calls or emails.  We do not get paid for discussing the problem with a subspecialists (curbside consult.)

With those modest critiques, I commend this article for your perusal.

How did we let primary care slip so far? The key is how doctors are paid. Known as “fee for service,” most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he’s reimbursed. Moreover, the amount a physician receives is heavily skewed toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient’s hypertension, diabetes or heart disease. Combine this fact with annual government threats to indiscriminately cut reimbursements despite rising office and malpractice costs, physicians are faced with no choice but to increase quantity to maintain financial viability.

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It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for spending time with patients, optimally managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked disparity between specialist and primary care physician salaries.