Sunday, October 26, 2008

Universal Health Care Doomed to Fail Without Primary Care

Senator Obama wants to provide universal health care coverage to all Americans, but the physician shortage will stop it dead in it’s tracts. With less than 2% of medical students choosing primary care medicine as a specialty and the aging physician population that is ready to retire within the next five years, we have a crisis looming.

It is the primary care specialties who manage 80% of all health care needs of our population and who keep costs under control by knowing the patient and providing continuity and preventive care. As they retire or close their practices to new patients, there are no young physicians to take their place.

There is already a shortage of primary care physicians and physicians in some basic specialties like general surgery, neurology and rheumatology. Even large metropolitan areas are lacking in gerontologists, general internists and family physicians. Rural communities face challenges for primary care and specialty care.

Young physicians in training are turned off by the enormous unsatisfying paperwork and difficult practice environment of primary care. Our reimbursement system has disadvantaged these physicians for years and they are at the bottom end of the income scale, despite the fact that they are the basis for a healthy population. Primary care doctors spend more time talking with patients and managing health care without expensive procedures and tests. The reimbursement for these cognitive services are not keeping up with the costs of running a practice and young doctors are walking away from this type of practice in favor of better lifestyles and more pay.

Even in medical strongholds like Boston, Mass., where there are several academic teaching hospitals and wonderful medical care, there is such a shortage of primary care physicians that doctors and nurses can’t find a doctor to care for their own family. Finding a good primary care physician requires “knowing someone” who can open the door for you to be seen as a patient.

The proposal to provide insurance for the 45 million Americans who are presently uninsured will fall flat unless we address this critical issue of primary care and who is going to take care of people. Having insurance is not the same as having access to care.

Episodic, expensive, high-tech, specialty services have created a monetary health crisis that looms larger than the banking meltdown. It is time we look at the primary care crisis and begin finding solutions that will allow health care reform to succeed. Without considering the primary care piece, it is doomed to failure.


Anonymous said...

Finally someone gets it right. You are so correct about the need to make sure we have enough doctors to take care of everyone.

Quiact said...

Recently, others have appeared to express understandable concern about the apparent endangerment of primary care doctors (PCPs) in the United States.

This depletion exists both presently, as well as in the years to come due to a number of variables.

Less than 20 percent of medical school graduates go for primary care as a specialty as a residency program today, it has been reported.

In fact, this demonstration was just illustrated this year with medical students selecting their specialty.

Typically, the main reason believed for this shortage is lack of pay compared with other medical specialties.

Some anticipate a shortage of 60 thousand or so PCPs in the future within the United States.

Many of the PCP doctors who practice right now would not recommend their specialty, or even their profession, it has been reported.

I believe the tremendous value as PCPs has not been acknowledged to others as it should, nor do I believe their income where it should be for what they do.

It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the U.S. health care needs, who are the citizens, now and in the future.

Ironically, PCPs have been determined to be and likely are the backbone of the U.S. Health care system- they are specialists of everything medically.

Yet if this is true, it is not reflected in many ways compared with their peers of other medical specialties.

For example, PCPs manage the many chronically ill patients who benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them.

Nearly half of the U.S. population has at least one chronic illness- with many of those having more than just one of these types of these illnesses.

A good portion of these very ill patients have numerous illnesses which are chronic.

The chronically ill are responsible for well over 50 percent of the entire Medicare budget, who are largely cared and treated by PCPs.

The shortage of primary care physicians is possibly due to other variables as well- such as administrative hassles that are quite vexing for the physician vocation overall.

In addition, the PCP continues to experience increasing patient loads that is complicated by the progressively increasing cost to provide care for their patients due to decreasing reimbursements from various organizations the doctors receive for the services they provide.

For reasons such as this, it is believed that some PCPs are retiring early, or simply seeking an alternative career path.

Those in medical school now seem to be aware of the demoralization of this profession.

As mentioned earlier, the PCP specialty is not desirable choice for a late stage medical student, so this is quite concerning to the public health in the United States.

The number of medical school graduates entering family practice residencies has decreased by about half over the past decade or so, and this number continues to be progressive.

PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers with decreased pay, so I can understand if they are a bit demoralized.

Despite the shortage of these doctors, primary care physicians do in fact care for the populations they serve and are dedicated to their welfare and restoration of their health- as difficult as it may be for them at times.

Studies have shown that mortality rates would decrease due to increased patient outcomes if there were more PCPs to serve those in need of treatment.

This specialty would also optimize preventative care more for their patients if allowed to do so.

Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms.

This is due to the needed continuity in health care these PCPs provide if numbered correctly to serve a given population of citizens.

In addition, PCP care has proven to improve the quality of care given to patients, as well as the outcomes for these patients as a result are more favorable.

Most importantly, the overall quality of life for the PCP patients is much improved if there are enough PCPs.

Presently, PCPs are obligated to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty.

The American College of Physicians believes that a patient- centered national health care workforce policy is needed to address these issues that would ideally be of most benefit for the public health.

Policymakers should take this into serious consideration.

“In nothing do men more nearly
approach the Gods then in giving health to men.” --- Cicero

Dan Abshear