Tuesday, September 16, 2008

Primary Care Crisis Will Doom Universal Coverage and You

While it made the news all too briefly recently, a report in JAMA found that there still continues to be a primary care crisis. Even Dr. Dean Ornish commented on the problem in a recent Newsweek piece.

This is a big problem. Fewer US medical students wish to do internal medicine or family medicine because of the administrative hassles, decreasing compensation, and increasingly demanding workloads. It isn't necessarily because they are lazier or more money hungry than previous generations because doctors currently in primary care are retiring, leaving medicine entirely, or doing something else like hospital medicine or urgent care. Students are opting for fields that offer work-life balance which include radiology and dermatology. And why not? The way the healthcare system is structured, the more procedures you do the more you are compensated which isn't always in your best interest. Doctors, who are paid to be more cognitive, like primary care, as a result can spend much more time with a patient and prevent complications from happening, but because the specialty isn't procedurally based, they have continued to watch their income decrease. With increasing medical student loans, it shouldn't surprise anyone that the crisis is at hand.

Why is this a problem for you? It is expected that with the baby boomers that the nation will need to increase the number of internists by 38 percent or roughly add 2000 internists per year. As a nation, we only train about 1000 internists that will go on to do primary care and that number is falling rapidly. With a shortage of primary care doctors, it means you are more likely to get worse care, pay more, and wait longer. Research consistently shows that patients with a primary care doctor do far better healthwise and financially than those that don't.

Adding more stress is the goal of the nation to address the 47 million uninsured. While Senator Obama and Senator McCain both have healthcare plans, neither actually address universal coverage, which may be years away because if everyone is covered, not everyone can access the healthcare system. We don't have enough doctors. Take the Massachusetts experience where health insurance in mandatory. Although the state has more primary care doctors per capita than any other state in the union, the newly insured now are either unable to find an accepting doctor or need to wait an average of seven weeks to see one. Though legislators want to increase the number of students trained, the fact is students won't go into the field until the issues that are causing those to leave are addressed.

The problem is that no one is willing to address the fundamental problems anytime soon. To do so, specialists would have to give up some of their income. After all, we spend a lot as a nation and it is unlikely we can increase the total amount spend to make up for the deficiency, but will need to re-distribute some of the income. This is why it won't happen.

Get ready to get more fragmented uncoordinated care, increased costs and frustration, and worsening health outcomes. If you still have a primary care doctor, then give him or her a hug because they are disappearing rapidly and frankly their skills and expertise are priceless.

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