America already does not have nearly enough primary care physicians to meet current needs.

If the final health care reform plan, assuming one is passed, puts primary care at the center of the plan, the  immediate shortage will be even worse.

The reform plan will require a lot of work-arounds until new medical graduates can be lured into primary care and complete their training. If they can be. Primary care has not been an attractive specialty because of the long hours, lower pay and related issues, especially to students leaving medical school with debts in the six figures. The Obama administration officials say that they are working on incentives.

There could be some limited, short-term relief in the form of physician assistants (who can complete training much more quickly and extend the doctor’s ability to care for more patients) and nurse practitioners, those who have Master’s degrees and, in most states, can practice fairly independently.

Physician’s assistants and nurse practitioners are part of the solution. Patients generally respond well to having them available.

They are not the solution, though.

This is not a new problem, either.

The managed care revolution of the 90s seemed to be putting primary care physicians at the center of the action also. Back then they called them “gatekeepers,” their role  being care-giver and coordinator of patients’ use of specialists. They were offered pay-for-performance incentives.

It was a disaster. Primary care physicians were overwhelmed with patient requests for consultations to specialists they already had been seeing and others, too. They ended up being put in the bad cop position than the care-coordination position with patients and physician colleagues.

That scheme did not last long because it did not add value to care nor reduce it in meaningful ways.

What next?

Washington Post

“As the debate on overhauling the nation’s health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.”

…”Fifty years ago, half of the nation’s doctors practiced what has come to be known as primary care. Today, almost 70 percent of doctors work in higher-paid specialties, driven in part by medical school debts that can reach $200,000. (Emphasis added)

“We need to rethink the cost of medical education and do more to reward medical students who choose a career as a primary-care physician,” President Obama said in a speech to the American Medical Association on Monday.”

Source: Washington Post, June 20, 2009