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As a practicing physician, I have a view from the trenches. The current healthcare system is broken! I've seen people placed in horrible situations: a woman with multiple sclerosis who, despite her insurance, couldn't afford her medicine. The medicine would likely prevent progression of a disease that could put her permanently in a wheel chair. Another woman with rheumatoid arthritis faced a similar problem -- not being able to afford the medicine that could stop the progression of her disabling and painful disease. The stories of people without insurance are even worse! A few days in the hospital can bankrupt a family.
One of the biggest threats to our healthcare system is the quickly worsening primary care physician shortage. In my first blog entry on the subject of health reform, I'd like to discuss this issue. In communities with more primary care, people are far healthier and healthcare is delivered much more economically. Why is this so? There are several reasons. People with a primary doctor will have better health screening. Therefore, breast cancer, cervical cancer, and colon cancer will more likely be caught at treatable stages. Osteoporosis will be more likely treated before the hip or vertebral fracture. High blood pressure, high cholesterol, and diabetes will be treated better and therefore strokes and heart attacks will be prevented. And costly coronary artery bypass operations will not be needed as frequently.
To further explore how primary care can provide good cost effective medicine, consider a typical visit to a family doctor in which a patient discusses his headache, diabetes, depression, and asthma. Cost of this visit might be $70 to $150. Let's compare this to the price of that same person being inconvenienced by having to go to four separate doctors to deal with his problems. The sum of the consultant fees from a neurologist, endocrinologist, psychiatrist, and pulmonologist could easily add up to several thousand dollars. And if one of those problems gets out of control the resultant emergency room visit would likely cost several thousand dollars for one visit. If a hospitalization is needed the cost would quickly go to tens of thousands of dollars or even hundreds of thousands of dollars. All of the sudden, $70 to $150 seems like quite a bargain, doesn't it?
So here's the big problem: we don't have enough primary care doctors and the problem is just getting worse. As baby boomers age, the need for primary care physicians will markedly increase. As health care reform increases the percentage of the population with health insurance, more primary care physicians will be needed. However, if the current trend continues, there won't be more primary care doctors - there will be A LOT less! Doctors are leaving primary care. Even more concerning is that, according to a recent survey, only two percent of medical students plan to go into primary care. (Ideally 30 to 40% of physicians would be in primary care.) Why should medical students chose primary care? There is satisfaction with getting to know people and their families and caring for them. However, when medical students look at primary care, they also look at working harder and doing more paperwork than they would in another specialty. And their reward may be getting a fraction of the pay. Over the course of his career, a primary care physician may get paid 5 to 8 million dollars less than he may have if he chose another specialty (such as radiology, dermatology, ophthalmology, or many others). (The history of this pay discrepancy may be partially the blame of the RUC - a panel which made reimbursement recommendations to Medicare. Interestingly, only 3 of 26 physicians on this panel were primary care physicians and subsequently reimbursements for specialty procedures far outpaced those of primary care visits.) In order to avert a worsening primary care crisis, this pay discrepancy needs to be fixed. The current health care reform bill makes a small (but probably inadequate) step in the right direction.
A critical component of a healthy United States is to have a healthy primary care system. An investment in primary care will pay off many fold in improvement in both the quality and affordability of health care!
