Primary Care

| Mon Dec. 15, 2008 2:15 PM EST

PRIMARY CARE....The LA Times writes today about Tanyech Walford, a primary care doctor who finally gave up her practice because she couldn't make a living at it:

Walford is not alone in her struggle. Relatively low earnings, rising overhead and overwhelming patient loads are sending veteran primary care physicians into early retirement and driving medical students into better-paying specialties, creating what the New England Journal of Medicine recently called a crisis.

....Much of the problem lies in an endangered business model: the one- or two-physician general practice....Small general practices afford doctors autonomy to practice medicine as they see fit and can produce strong doctor-patient bonds. But these physicians have little or no clout to leverage better payments with insurers; they have no economy of scale, which makes overhead more burdensome.

Across the country, Pauline Chen writes in the New York Times about the general scope of the problem in primary care:

The news got worse in September, when The Journal of the American Medical Association published a study showing that just 2 percent of graduating medical students are choosing to enter general internal medicine. The students surveyed were concerned in part by what they perceived to be a more difficult personal and professional lifestyle, compared with other fields. They felt that the paperwork and charting required of primary care physicians were more onerous, and they were not eager to care for the chronically ill in a health care system that focuses on acute care.

....The Physicians' Foundation, a nonprofit organization that supports physicians' work with patients, last month published the results of a survey on current medical practice conditions in the United States. Some 12,000 doctors responded, the vast majority of whom were primary care physicians.

Nearly half of them said they planned in the next three years to reduce the number of patients they see or to stop practicing altogether....Only one-third felt they had the time to fully communicate with and to treat all patients, and 60 percent felt that paperwork demands resulted in less time spent with patients.

Italics mine. This is the result of our current Rube Goldberg medical system. Private insurers pay lip service to primary care physicians, but demand massive amounts of paperwork from them at the same time that they've reduced their payments for office visits so much that GPs can't survive on fewer than 30 patients per day. And with a patient load like that, you simply can't afford to spend more than a few minutes per person. This creates a vicious cycle in which both doctors and patients become increasingly stressed and increasingly less satisfied.

In fairness, it's not as if Medicare pays princely sums for office visits either, so this is hardly a problem that magically goes away just by installing a different funding mechanism. But it might be a start. More GPS, fewer dermatologists, please.

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