Where is primary care medicine’s equivalent of Paul Revere?

Someone needs to find a way to send an urgent warning that will wake people up about primary care medicine. The doctors aren’t coming! The doctors aren’t coming!

In health care reform debate, the White House and the Congress talked about the great need for more primary care physicians.

Their steps, while worthy, are not a solution to primary care shortage. In fact, there is a tone-deafness to some of the language. In post-acute care (after hospital care) encourage bundling of services to encourage providers to coordinate across the continuum of care.

This wording suggests that legislators don’t know that the doctors won’t be there to do that. It would be great for the patients and the nation if they were.

Here is a rough recipe for how to make a doctor. It takes about 10-12 years to produce a doctor, counting undergraduate school. There shall be no quick fix when we wake up and realize what we are missing in the primary care physician department. It will be too late.

Legislators do not yet appreciate the crisis because in most places people (read voters) still can get doctors.

Every major, good change in medicine also is all but certain to have a downside. The arrival of the hospitalist is great for the hospital patient but this new specialty’s arrival is devastating to internal medicine in the community.

The hospitalist, an internist who works one eight-hour shift in a hospital and acts as the patient’s own doctor during that time, has it all. Predictable hours. Better pay. Patients for whom they know they are doing all that can be done. Bureaucracy, for the most part, takes care of the insurance paperwork. All of these factors come together to offer a better quality of work life for hospitalists. That is one reason why the fastest-growing medical specialty is hospitalist.

That rapid growth in this sub-specialty proves the case. It is not internal medicine our future doctors don’t like.

It is the low pay, the very long hours, the paperwork—pointless, repetitive and clearly a game to delay payment—that scares them away.

This medical blogger is a medical professor, academic administrator, an attending physician at the VA, a former primary care physician and a passionate advocate for primary care physicians.

He says it plainly. The job is broken. It has to be fixed. If it is not, patients will find themselves unable to get internists and, likely, family practitioners.

They won’t be anywhere to be found for any patient.

So, Dr. Revere, start riding the Internet and the halls of Congress.

Spread the word.

The doctors aren’t coming! The doctors aren’t coming!

DB’s Medical Rants

“As I wrote yesterday, the deck is stacked against internists (and apparently family docs) and yet most everyone believes that we need more of each.  As we say in the South, “if it ain’t broke, don’t fix it” – well it is broke and may not be fixable.

“As I have written before, we probably should migrate to either retainer medicine or cash based medicine.  We should either get paid by the patient or by the time of the visit, but not per visit.  Paying for visits make no sense for either patients or physicians. ( Emphasis added)

“I do not believe RBRVS can be fixed. I do not believe a white knight will come along to pay for primary care, and if someone offers I suspect it wi ll be a gray knight.  (Ed. Note: Resource Based Relative Value Scale (RBRVS) is the way Medicare and HMOs calculate what doctors should be paid.) (Emphasis added)

“Change the payment model then outpatient medicine can flourish.  It is a good job, if the physician has enough time to function properly.”

Source: DB’s Medical Rants, June 15, 2010