Primary Care Doctor Shortage
I am a primary care doctor. Today I saw a young woman who was afraid she might have appendicitis. I thought enough of the possibility to order a CT of the abdomen — which was negative — but I did not admit her to the hospital. She got better, and chances are the problem was due to a virus.
With primary care doctors rapidly becoming extinct, I think it is worth pointing out that if I didn’t exist, this young woman might have been admitted to the hospital for a few days, and possibly faced an unnecessary operation — at the very least it would have been a big expense to our health care system.
With only 2 percent of medical school graduating classes going into primary care medicine these days, and with 50 percent of primary care providers in a recent study saying they would quit if they could, I think it is worth considering what we could do about the shortage of well-motivated primary care doctors going forward — since we are the quarterbacks of any well-maintained health care system.
Here are some of my ideas:
- Subsidize education for primary care physicians on a state and national level with a payback of several years. As opposed to the National Health Service, which was disbanded in the 1980s, this service will inject primary care docs into urban and suburban centers with the goal of introducing a preventative strategy that can then be adopted by trained nurse practitioners and physician assistants.
- Reimbursements should favor primary care visits, and de-incentivize overuse of specialists and their procedures — especially tests (like EMG) or elective procedures (like cosmetic surgery), which do not lead to crucial treatments.
- Reimbursements (including Medicare and Medicaid) should reward preventative strategies such as weight loss and smoking cessation.
- With primary care physicians more in charge and more accessible, it might then make sense to increase insurance copays and deductibles, which would make patients hesitate before overusing their health insurance (studies show that most ER visits are currently from the insured, often for minor complaints).
- A new infusion of primary care doctors would help emphasize the principle that physicians and patients should be in charge of health care, rather than insurance companies. This could improve efficiency and decrease costs. Insurance is intended to be “just in case” rather than the primary controlling payer for all health costs. Insurance should carry over state-to-state, and insurance companies should be liable for forced medical errors — especially when they refuse to cover tests. Records should gradually be converted to electronic medical records, to improve efficiency.
Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth about the Epidemic of Fear
Tags: doctor stortage, education, Electronic Medical Records, National Health Service, Primary Care
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With primary care doctors rapidly becoming extinct, I think it is worth pointing out that if I didn’t exist, this young woman might have been admitted to the hospital for a few days, and possibly faced an unnecessary operation — at the very least it would have been a big expense to our health care system. With only 2 percent of medical school graduating classes going into primary care medicine these days.
I have to agree with your comment about making medicine more proactive instead of reactive. I think having a doctor that working to keep you healthy now and preventing serious illnesses down the road is the way to go. I wish insurance companies would get this message.
My primary care doctor is very proactive. I was prehypertensive and now with medication, my BP is 100/70. My liver enzymes were high, indicating Fatty Liver disease. With his help and diet/exercise we have gotten over that crisis before there was any long term damage.
The one thing I like the best about my primary care doctor is the fact he is interested in all of me and is keep tabs on all of it. He was one the one that helped me through menopause, not the GYN. The specialists do not look beyond their area, or even recommend you talk to your primary when they find something else. I have all my specialists give me copies of labs, tests and any procedures for my primary’s records on me.
Many doctors going into high paying specialities because of the mountain of debt they are in in just becoming a doctor. Plus, the cost malpractice insurance is insane. We have to find some solutions or we will not have any more primary care doctors and we will really be up the creek then!
I’d be lost without my primary care physician. I didn’t have one for years but was referred to this one when I took myself to the ER because of stomach pain. My PCP keeps tabs on everything about me, requests all reports from other medical providers and is very caring. I hope something can be done to improve the percentage of doctors going into primary care practice.
I hear the concerns but you all seem to forget there is another group… PAs & NPs. They are trained to do 90%-95% of the same job your primary care doctor is performing and at a lower cost to the system. If this country could just wrap thier minds around other ways of doing things and stop dreaming about the “good ole days” they would be able to see what is already right there in front of them. You don’t need a MD/DO degree to treat a “common cold” or refer to another doctor.
Dr Siegel,
I started in primary care, but after 13 years gave it up. I made house calls and practiced in a rural community. Now as a Radiologist I see many unnecessary tests ordered by physicians who lack the time or skill to properly access a patient.
The biggest waste I see now is in offices that have self referral and order many unneeded tests. But I fear the system is too corrupt…
jeff lash
How timely! I’m about to call my doctor’s office to find out what blood test(s) he was planning in Mar.; he’s closing his clinical practice in Jan. to become a “hospitalist”, whatever that is. I have three weeks to find another PCP who accepts medicare patients, and I had trouble finding this one.