The End of Primary Care As We Know It - Part III

Are Fully Educated and Trained Medical Doctors Needed as Primary Care Providers?

All medical doctors go through the same four year medical school education, plus a minimum of three years of residency training. At the end of the seven years, the now educated and trained doctors have incurred similar costs and have earned roughly the same amount from their residency stipends. So, aside from those with independent means, upon graduation, all newly-minted doctors are in the same financial position, facing a staggering debt ranging from $150,000 to $500,000

From this point on, the economic and practice differences take shape. A fresh out of residency orthopedic surgeon will command compensation at least twice that of an experienced primary care physician. At the same time, the orthopedic surgeon will immediately be called upon to use his/her highly honed technical skills to treat orthopedic conditions, while the primary care physician may see a variety of patients, including healthy people coming for an annual physical exam, as well as others with minor, easily treated medical conditions. A small fraction may have a serious illness that requires significant medical intervention such as medication and or other non-invasive procedures.

The focused attention and time of the primary care physician is required no matter where on the complexity continuum the patient falls. However, insurance companies reimburse at a lower rate for less complex medical issues, based on the theory that such care does not require the full extent of the primary care physician’s skill, and is therefore worth less than if the patient presents with a high level of complexity.

Is there a way to match patient needs with provider competence, reduce costs, increase compensation for primary care physicians, and expand availability of primary care resources? The next blog post will address this question and propose a new paradigm for providing primary care.