Monday, February 2, 2009

What is the State of the Nation's Health Care?

This is the time of year when the President usually makes his State of the Union address. Although President Obama has not yet announced when he will make his report to Congress, ACP didn't wait to release its own assessment of the state of the nation's health care.

At a briefing this afternoon at the National Press Club in Washington, ACP President Jeff Harris, MD, FACP, and I presented the report, Assuring universal access to health coverage and primary care: A Report by America's Internist on the State of the Nation's Health Care and Recommendations for Reform, to reporters.

The report challenges policymakers to ensure that every American has access to health insurance coverage, and to a primary care physician. It proposes the following policies:

- Enactment of legislation to help people keep their coverage during the recession followed by a comprehensive plan to guarantee affordable coverage. As coverage is expanded to more persons, there should be simultaneous, sufficient and sustained policies to grow the primary care workforce.

- Develop specific and measurable goals on the numbers and proportions of primary care clinicians needed and benchmarks to evaluate the impact of federal policies to attain those goals.

- Take immediate steps to make primary care compensation competitive with other specialties. For instance, Medicare payment increases of 7-8% per year over five years would be needed for primary care compensation to be at the 80th percentile of all other specialties. Right now, the average compensation of primary care doctors is 55% that of other specialists. Commercial payers would need to implement comparable increases.

- Expand the Patient-Centered Medical Home model to more states, more practices, and more patients.

- Conduct a systematic review of paperwork burdens.

- Increase funding for primary care training programs and create new programs to eliminate medical education debt for primary care physicians in a critical shortage area or clinic.

Finally, the report recommends that President Obama issue an Executive Order on Increasing Primary Care Workforce Capacity to ensure that all federal agencies are working together seamlessly to design, implement, measure, and evaluate programs to increase primary care workforce capacity.

A presidential executive order would send a powerful signal to young physicians and medical students - as they are about to make life-time career decisions - that the federal government is serious, really serious, about making primary care a competitive career choice. It would also send a powerful signal to primary care physicians in practice that they need to hang on, that better days are ahead.

I urge you to read ACP's report and the supporting materials included with it.

Today's question: Do you agree with ACP's assessment of the state of the nation's health care and our recommendations for reform, including increasing primary care compensation to be competitive with other specialties?


Jay Larson MD said...


Unknown said...

As a young private practice, double-boarded Internal Medicine/Pediatric physician, it heartens me to hear the blogs noticing how tough our current practice climate has become. I love what I do, and see the results of "relationship doctoring" every day. It certainly isn't easy, but it's tremendously gratifying. Here is a sampling of my 30 patients I saw today (which started with hospital rounds this am). A 46yo with Parkinson's and a severe streptococcal cellulitis, improved enough to send home today (without an ID consult), to the overwhelmed, depressed mother I started on an SSRI (without a psychiatry consult), to the executive with Type 2 diabetes and an LDL of 202 I explained that pathophysiology of statins and cholesterol metabolism (without an endocrinology consult), to the actinic keratosis I removed from the face of an elderly patient (without a dermatology consult), to the 2 year old asthmatic with a 104 fever and pneumonia treated as an outpatient (without a pulmonary consult). I certainly don't mind working hard and seeing the breadth and depth of cases I see, but I shouldn't have to worry about the sustainability of my practice. I look forward to ensuring I can continue to pay my 200K+ student loans, be there for my patients, and provide for my family over the next 30 years. I appreciate this forum. I hope the people who can make a difference have the political will to stand up for our ability to provide for our patients. My patients deserve as much.

Ken - said...

How DO THE 100,000 recently unemployed pay when they get sick?