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

The signs of a pending crisis in primary care, the true front line of our healthcare system, are all about us, and not much is being done to deal with this potentially explosive problem. In this and future blog posts, I will present a diagnosis of the problem and propose a potentially radical solution. The discussion will be built around the following questions:

• What do primary care physicians do and what is it worth?
• Are medical doctors needed as primary care providers?
• 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 shortage of primary care physicians has been well known for some time and the situation continues to worsen. The most recent survey of fourth-year medical students published in the Journal of the American Association reported that only 2% plan to work in primary care. This is down from 9% in 1990.

Google" "Primary Care" and dozens of articles appear regarding "the problem". In a nutshell, the shortage problem is attributed to two factors: compensation disparity between primary care physicians and specialty physicians; and lack of job satisfaction among primary care physicians.

Suggested solutions mostly deal with the compensation issue: putting more money in the pockets of primary care physicians will solve the problem. While compensation is an easy way to crystallize the issue, I believe it is only half of the problem. A complicated billing and coding system requires doctors to evaluate the value of each patient visit based on the complexity of the patient’s problem to justify the value of the visit for payment purposes, as opposed to the health care value of the consultation. One of doctors’ greatest fears is the audits and reviews by third party payers that often find that the doctor "over coded" claims and must refund money back to the insurance company. This creates an extremely unpleasant and often hostile environment for primary care and indeed all physicians.

Whatever the reason for the shortage, something must be done to change the system so that adequate primary care resources are available. In the next several blog posts, I will address the questions posed above and offer a possible solution.