Woody Allen once said, "More than any other time in history, mankind is at a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let's pray we have the wisdom to choose correctly."
Replace mankind with primary care and you get a good idea of how primary care doctors view their future. At least, this is the conclusion one would draw from a survey of 12,000 (mostly primary care) physicians released by the Physicians' Foundation:
- 78% believe there is a shortage of primary care doctors in the United States today.
- 49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.
- 60% would not recommend medicine as a career to young people.
Other surveys show less pessimism. The Center for Studying Health System Change found that 83.6% of primary care physicians surveyed in 2004-2005 said they were somewhat or very satisfied with their careers, only marginally less than the 84.7% of specialists who said the same. (A new CSHSC survey is in the field, and it will be interesting to see if primary care physicians have grown more dissatisfied).
Still, the Physicians' Foundation survey is a wake up call. Think of the impact on access if half of the primary care physicians in the U.S. reduce the number of patients they see or stop practicing.
It may be a mistake, though, to suggest that primary care is all about gloom and doom. I don't discount the very real concerns, but do we really want to tell young doctors and medical students that primary care is a dying field?
Today, the American College of Physicians releases a new white paper to make the case for primary care. The report doesn't mince any words about the dire circumstances surrounding primary care, but makes the positive case that primary care will improve outcomes and lower the costs of care.
Will policymakers listen? Last week, Senator Baucus aptly called primary care the "keystone" of a high performing health care system and proposed to increase Medicare payment to primary care doctors. During the campaign, President-elect Obama proposed "to expand funding - including loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve working conditions" for primary care.
Today may be the worst of times for primary care, but the best of times could still be ahead.
I say this not because I am hopelessly optimistic (I work in Washington, after all), but because I believe policymakers can be shown that primary care offers the best value in U.S. health care. Policies to support primary care will follow suit. Isn't this a better message to give medical students and young doctors than (only) telling them how bad things are?
Today's questions: Do you believe that this is the worst of times for primary care? Do you believe that the best of times for primary care could still be ahead?