President Obama has mentioned many times that the health reforms he is proposing will not alter the health care of those who already have health insurance and want to keep what they have. But this is NOT the view of most practicing physicians — myself included. I may be one of the most vocal, but I am not alone.

1.  First of all, there is a critical and growing shortage of primary care physicians. Only about 2 percent of the current medical school graduating class is going into primary care. Those of us who already practice primary care are overwhelmed and many are quitting. The public insurances have the most trouble. Surveys show that 50 percent of doctors don’t take Medicaid, and in 2008, the Medicare Payment Advisory Commission found that 28 percent of Medicare patients looking for a primary care physician couldn’t find one. This problem will only get worse under any Obama plan. You may have new government-provided insurance, but you may not be able to find the doctors who take it. And if you do, they may be buried under a pile of paperwork, or be too busy changing over to the new Electronic Medical Records system to spend time with you.

2.  More than 150 million Americans have employer-provided health insurance. But if there is a public option, your employer may stop providing you with insurance. You may be compelled to take the public option, which will probably provide you with less real health care choices.

3.  If the public option grows bigger, because private insurers find they can’t compete, expect care to be rationed, as the government makes choices to try to contain costs. Reimbursements to doctors will be cut, as they have been under Medicare and Medicaid, but also, you may not be able to get dialysis if you are over a certain age, or you may have to wait on long lines for procedures, as they do in Canada.

4.  Bottom line — extending a system that already has too few primary care doctors who are overworked to the entire population does not bode well for prevention or quality of medical care. The costs will continue to spiral upward, and access will decrease rather than increase. A better approach would be to work on re-organizing the health care system towards prevention rather than intervention BEFORE expanding it. One way would be to pay for the education of primary care doctors and create a task force to treat the uninsured.

For more on my take on public health insurance and how doctors view it, check out my oped in Monday’s NY Post.

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 the 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“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

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“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com