The ACP Advocate Blog
by Bob Doherty
Wednesday, November 19, 2008
The worst of times for primary care?
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?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- Health care reform is all about affordability
- The "It's a Wonderful Life" approach to "scoring" ...
- Who Will Guide Us Out of Health Care Turbulence?
- Senator Baucus' Answer to Who Should Pay for Prima...
- Senator Baucus' health reform proposal
- Who should pay for coverage?
- Who will pay for primary care?
- Will single payer advocates get behind Obama-style...
- What do we do now to bring about health care refor...
- The 2008 election and health care reform
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.