Saving Primary Care

The people who make health care policy are not too worried about getting into to see a doctor. They have insurance and know a lot of physicians or know people who know a lot of physicians who can make a telephone call. Not everyone has that access.

With the onset of the Affordable Care Act, many more people will have some kind of medical insurance. However, they might not have access to a doctor. The United States has too few primary physicians. There are many reasons for this, but like many problems this can be solved with money. Alan Sager, PhD, of Boston University School of Health has a proposal to make primary care more attractive for doctors: raise their incomes to match those of subspecialists. According to Dr. Sager, diverting 3% of healthcare spending to primary care would allow more parity in income. (Other countries spend 10% on primary care.)

This is very different than loan forgiveness, another proposal for enticing medical students to enter primary care. If a person owes $200,000 of medical school debt, that is only a one year salary differential between a general internist and an interventional radiologist.

An increasing number of primary care doctors are not accepting Medicare patients – funding is at the pleasure of the Congress. Private insurance company payments are highly prejudicial against primary care physicians even as the doctors are expected to (in addition to taking care of their patients) coordinate care, ensure continuity and appropriateness of care and hold down costs.

Primary care doctors are desperately treading water – and may soon be drowning. It doesn’t matter how many doctors one knows: the phone will not be answered.