Aug 25 2009
Commentary: Why primary care doctors are fed up – CNN.com
Commentary: Why primary care doctors are fed up – CNN.com
A well-written piece. No matter how you cut it, people will follow the money and lifestyle. Until primary care is reimbursed at a reasonable amount compared to your gastroenterologist or anesthesiologist or otolaryngologist, people aren’t going to do it in the numbers truly needed for a good primary care foundation.
That means revamping the reimbursement scheme – don’t pay so much for procedures, and so little for counseling. Limit PCP legal liability. Even procedure-based subspecialists would like to do fewer procedures at times (heard the words straight out of their mouths just last month), since procedures still have risks. They tell the patient they don’t need the procedure, and the patient gets upset, and finds somebody out there who will indulge the patient and do an invasive procedure, driving up costs to the system. At the same time, doing the procedure is “safer” in terms of covering the MD legally, since they can at least say, “Look, here’s the cath/path/pictures to prove there was nothing wrong” when there was no medical indication to do the procedure/imaging in the first place (again, see the above article).
Those 2 simple, yet difficult, changes would make a world of difference.
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What about leaving much of primary care to nurse practitioners? Or opening more of primary care to nurse practitioners? They are well trained and able to do much of what PCPs can do, and can take some of the strain off the system. Additionally, because they tend to be less debt burdened, they might not need the money incentives that doctors might.
I think opening primary care up more to mid-levels is a very good and under-implemented idea, especially when put together in a practice with full-fledged MDs (of course, this all depends on the state you’re in). I am not such a big fan of “doc in the box” urgent care clinics without actual docs, as it’s not truly primary care/medical home and lacking a full-fledged MD. I know I am biased in this, because there are just things that come with more in-depth training that many mid-level providers do not have until well into their career.
They do tend to be less debt-burdened, so they’re less likely to be looking for the money, although I have to say that in my experience, from a systems cost perspective, they’re just as inclined to order unnecessary tests because they’re less likely to be up-to-date on current guidelines/evidence base, since their training usually doesn’t emphasize this as much.
The hard part is how to ask patients to “take responsibility” for their primary care – do you ask them to pay more per PCP visit? Or less? How does that get people into see their PCP? How does it deter them?