Blog | 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.