Thursday, October 30, 2008
Primary care shortage dooms universal health care
Guest blogger Toni J. Brayer, FACP, of ACP Internist's Editorial Advisory Board, offers her comments on how the primary care shortage will doom attempts to reform health care. She writes:
Senator Obama wants to provide universal health care coverage to all Americans, but the physician shortage will stop it dead in its 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.
Labels: health care reform
posted by Ryan DuBosar at
9:29 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
Zackary
Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
doctor-patient communication, bioethics, and systematic reviews.
CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
prevention of chronic disease, and an internationally recognized
leader in integrative medicine and patient-centered care.
db's
Medical Rants
Robert M. Centor, MD, FACP,
contributes short essays contemplating medicine and the health care
system.
DrDialogue
Juliet
K. Mavromatis, MD, FACP, provides a conversation about health topics
for patients and health professionals.
Dr.
Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal
medicine for more than a decade and is an Associate Professor of
Medicine at an academic medical center on the East Coast. His time is
split between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
changes in science, medicine, health and healing in the 21st century.
FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
Medicine Residency and Assistant Dean of Scholarship & Discovery
at the Pritzker School of Medicine for the University of Chicago. Her
education and research focus is on resident duty hours, patient
handoffs, medical professionalism, and quality of hospital care. She
is also an academic hospitalist.
Glass
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of hospital care, illuminates the emotional and cognitive aspects of
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primary care physician, and offers behind-the-scenes portraits of
hospital sanctums and the people who inhabit them.
Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
at the University of North Carolina School of Medicine, and the
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specializes in diseases of the esophagus, with a strong interest in
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I'm
dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
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Richard Just, MD, ACP Member, has 36 years in
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Kimberly Manning, MD, FACP,
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Neil Mehta, MBBS, MS, FACP,
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White
Coat Underground
Peter A. Lipson, MD, ACP Member, is a
practicing internist and teaching physician in Southeast Michigan.
The blog, which has been around in various forms since 2007, offers
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Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
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Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
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medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
written by an emergency room physician.
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