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?

Obama is Serious About Healthcare Reform

It certainly appears that President Elect Obama is serious about healthcare reform with his selection of former Senator Tom Daschle as his Secretary of Human and Health Services. Now the good news is that unlike his future boss, Senator Daschle recommends individual mandate, that is everyone is required to purchase health insurance. (President Elect Obama only mandated that children have coverage). Daschle's other big idea is to create a healthcare board to manage healthcare much the same way the federal reserve does for the economy.

It seems that everyone is pushing hard for healthcare reform. If it can occur for about $125 billion, relatively cheap compared to the $700 to $800 billion desired by the Treasury department, then it might occur sooner than I expected. A look over the past week revealed the following.

An excellent op-ed piece by Shannon Brownlee (author of the book “Overtreated“) and Ezekiel Emanuel (an oncologist, NIH bioethicist) dispell various myths of our dysfunctional healthcare system. In the same Washington Post, columnist David Broder feels that there is a rising hope for fixing healthcare.

Uwe E. Reinhardt is an economist at Princeton has written in the Economix section of the New York Times various articles about why the healthcare system costs so much, which also shatters widely held, but inaccurate beliefs including the issue of administrative costs.

Even NPR's Marketplace had a piece today about healthcare reform.

Of course, I neglect to mention proposals offered by Senator Kennedy or Senator Baucus. It seems like healthcare reform is THE topic to discuss, until of course Senator Clinton is formally introduced as the President Elect's Secretary of State.

I for one was certain with all of the economic uncertainty that we could have kissed healthcare reform good bye. It appears from all the news reports, op-eds, and discussions by various senior politicians that I may have underestimated their desire to see this through. Thank goodness.

I hope, however, that our leaders think carefully about how to reform our healthcare system otherwise unintended consequences will surely occur which may do far more harm than good.