The Primary Need

If More Doctors Don't Sign Up To Be Basic Care Providers, Health Reform Can't Succeed

With all the plans to reform health care now careening around Washington, it's surprising that none addresses a remedy that is key to any genuine overhaul: the resuscitation of primary care medicine. Primary care today is in a state of profound disarray, with physicians leaving the profession in droves and virtually no students coming along to take their place.

At this rate, many Americans will soon no longer have a doctor to turn to - just the emergency room and, if they're very sick, a bevy of expensive specialists. To address health care reform without tackling the crisis in primary care is to waste our words and endanger our health.

Under our current reimbursement system, sickness is a lucrative business. Third-party payers, which include public programs (such as Medicare and Medicaid) and private insurance companies, are often required to pay large sums to companies and institutions after a person gets sick. The incentive, therefore, has been for the health care system to develop products and services to take care of sick people. There is little or no financial incentive to keep people well or to catch diseases before they require expensive medications or hospitalizations. But this is the very terrain of primary care physicians. Their holistic focus saves untold lives - and saves the reimbursement system a great deal of money.

Given the lack of incentives to go into primary care medicine (a field that includes pediatrics, general internal medicine and family practice) and the high cost of medical training, it is not surprising that students are choosing more lucrative specialties. In 1997, graduating medical school students filled 71.7 percent of available family medicine slots nationwide. That number fell to 42.2 percent in 2009, according to the American Academy of Family Physicians.

If this trend continues, life will be much more frustrating for patients. If you're lucky enough to have one of the remaining primary care physicians, you shouldn't be surprised if you can't get in touch with him or her when you need to. With continued reductions in reimbursement for office visits, physicians' only recourse to cover costs will be to further increase patient volume. Although the problem of reduced reimbursements is common among all physicians, it especially affects primary care physicians, who rely solely on offices visits for income and are the first responders to upward of 3,000 patients each.