The demise of primary care as a profitable area of specialization under our third-party payor-dominated health care finance system is a frequent topic on this blog. Dr. Robert Center picks up on that them in this recent KevinMD.com post in which he passes along what he sees happening in the marketplace for primary care services:
I believe primary care docs are rebelling against the system. The system has made primary care physicians suffer emotionally and financially. The system has taken the greatest form of medical care – that consisting of continuity, comprehensiveness, complexity and completeness – and denigrated it.
Now I talk about “the system” in an anthropomorphic sense, but “the system” is virtual. “The system” has no conscious, it is not deliberate, rather it represents the constellation of ignorance that the insurance companies, CMS and policy works have wrought. [. . .]
So what do primary care physicians do? They do what any sensible economic citizen would do, they alter the rules to their benefit. [. . .]
So decreasing numbers of primary care physicians are taking Medicare or Medicaid. So primary care physicians are leaving their jobs to do hospital medicine. So many primary care physicians are leaving the CMS/insurance company grid and retreating to retainer practices or cash only practices.
The rebellion is a quiet one. No one has declared this rebellion. This rebellion has no Glenn Beck or Sarah Palin; no Abbie Hoffman or Che Guevera. This rebellion occurs one physician at a time, as that physician finds continuing their practice undesirable. [. . .]
I believe the rebellion will continue. Every anecdotal sign that I see tells me that the rebellion is gaining speed and power. . . .
One day the wonks on Capitol Hill will realize the problem. AAFP and ACP (amongst others) have tried explaining the problem to the politicians. Until they understand that their constituents are angry because they cannot find a physician, they will not focus on the problem. . . .
As doctors flee from primary care (see earlier posts here, here and here), the vacuum will be filled by nurse practitioners and medical assistants, who are far less trained than primary care docs in key diagnostic procedures.
Make sure those payments on the concierge practice account are current!
Make that
“the vacuum will be filled by nurse practitioners and PHYSICIANS ASSISTANTS, who are…….”
I don’t think we are quite to the point of medical assistants practicing medicine.
dr. center has it about right.
as a primary care internist, i went to cash payment more than ten years ago when declining reimbursement made it not possible to take adequate time for history and physical needed to get the job done well.
i have watched colleagues grow ever-more frustrated with going too fast and/or seeking other sources of revenue while getting more fatigued.
the obvious answer is opting out of so much low-paying insurance but most have been slow to go there, whether out of lack of business confidence or good-heartedness, i am not sure—in either case it does not look sustainable to me.
i think the number of patients who can/will pay cash is limited and therefore, the model of one doctor overseeing multiple assistant practitioners, with declining quality of care, will continue for decades.
It’s high time for the U.S. to reform our out-of-control, inefficient medical care approach and move to a “medicare for everyone” system.
Let the medical insurance industry find a new ponzi scheme. ditto most other insurers (auto etc.)
bill,
“medicare for everyone” means the consumer has no limit nor incentive to reduce use nor costs. medicare patients, in a lifetime, only pay 33 cents per dollar of care rendered and the other 67 cents is paid by cost shifting to other patients via higher prices and/or increasing debt for the next generation to pay—your idea is 100% unworkable, medicare being how we got into this mess in the first place.
your assertion insurance is a ponzi scheme is nonsense–it is insurance–if you dont want it, dont buy it.
the system did not go “out of control” till 1987 when republicans allowed medicare to dictate price caps to doctors and hospitals, causing medicare patients to have no skin in the game and costs were shifted to the working man—till then, american health care was envy of the world and for that matter, still is.
wanna fix it? get rid of protecting people who have had 65 years to get their affairs in order, get the kids educated, house paid for and put aside some savings so they can be proud americans who provide for their own health care instead of sponging off of working people and the next generation–that is a low-self-esteem inducing form of elder abuse in my book.
We have a fundamental disagreement about this, but I imagine we would agree that you don’t advocate
ending all or any of the tax deductions and other benefits that rich folks enjoy courtesy of Uncle Sugar.
More competition in the entire healthcare industry
would doubtless benefit us all. Maybe the AMA, Rx industry, and even some rich people will get
“religion” and become less greedy and less selfish, but I’m not gonna hold my breath waiting for that to happen.