Sunday, December 14, 2008

Universal Healthcare Doomed - No Primary Care Doctors

Dr. Pauline Chen writes another excellent NY Times article in her Doctor and Patient column called "Where Have All the Doctors Gone?" Specifically, where have all the primary care doctors gone, the backbone of the healthcare system.

What Dr. Chen fails to address and which often is the reason that the primary care crisis hasn’t been addressed is the current fee for service payment structure. It favors procedures and doing more rather than prevention and coordination of medical care. It isn’t just the paperwork and administrative hassles, the healthcare system as a whole doesn’t favor paying these critical frontline doctors in preventing complications and promoting wellness.

Current graduates aren’t dumb or greedy, they favor work life balance and are flocking toward radiology, ophthalmology, anesthesiology, and dermatology because they offer a more predictable lifestyle with relatively good compensation.

As a practicing primary care doctor, I understand the challenges and feel quite blessed and privileged to be in a practice that values my profession. However, I realize that I am in the minority to feel that way. For primary care to attract more medical students, it will need to transform the delivery of care to improve the doctor-patient relationship, as well as professional satisfaction in addition to significant payment reform.

Unless President Elect Obama and Secretary of Health and Human Services nominee Daschle reform the payment structure to favor prevention and coordination of care will the numbers of primary care doctors increase. But the real question is do they have the leadership needed to make the changes? To do so, that means someone else will lose, specifically specialists, like Dr. Chen. Will they be willing to give up some of their financial livelihood for the good of the healthcare system? What do you think?

I’m thankful that I’m primary care doctor because as an insider I know how to navigate the healthcare system. Without primary care doctors, who is going to help you?

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