Wednesday, May 20, 2009

"This is the start of making primary care cool again"

So says Dr. Ari Silver-Isenstadt, a young pediatrician associated with the National Physicians Alliance. He was one of a broad spectrum of organizations - representing physicians, nurses, nurse-practitioners, and medical colleges - that joined today with Rep. Schwartz to announce support for the Preserving Patient Access to Primary Care of 2009, H.R. 2350.

"It is critical that comprehensive reforms to halt the crisis in access to primary care be included in any legislation to expand health insurance coverage," said ACP President Joseph W. Stubbs, in announcing the ACP's support for the bill. "Providing everyone with affordable coverage is essential, but coverage alone doesn't guarantee access if there aren't enough primary care physicians to take care of patients. And without primary care, the costs of covering everyone will be much higher and the outcomes much poorer."

Earlier in the day, Rep. Schwartz spoke to the 400 plus attendees of ACP's Leadership Day on Capitol Hill about her efforts to support primary care. She noted that the bill already has the support of nearly 100 members of Congress, and she asked for ACP's help in lining up more supporters. We also learned that within days, Senator Maria Cantwell (D-WA) will be introducing the bill in the U.S. Senate.

Would the Preserving Patient Access to Primary Care Act really make primary care cool again? My teenage girls would tell you I am the last person to know what's cool, but I think it would be cool if the U.S. Congress officially declared that primary care is essential to a better performing health care system.

It would be cool if Medicare started paying primary care doctors more, and giving them credit for helping to keep people out of the hospital. It would be cool if medical students who go into primary care could graduate without debt. It would be cool if primary care physicians could be compensated for providing patient-centered care through a medical home. It would be cool to reduce the cost barriers to preventive services. And how cool would it be to reduce the paperwork hassles associated with Medicare drug formularies and claims adjudication?

All these, and more, are included in the Preserving Patient Access to Primary Care Act of 2009.

I know that some will not agree with me on this, but I also think it is cool that the Preserving Patient Access to Primary Care Act has the support of both doctors and nurses. Rep. Schwartz believes (and the evidence supports this) that the United States needs more primary care internists, family physicians and pediatricians, and also needs more nurse-practitioners and physician assistants.

I fully understand that primary care physicians and NPs don't always see eye-to-eye on each one's respective roles in primary care or in the medical home. But as I have written about on other occasions, a political split between NPs and primary care physicians could be fatal to getting meaningful primary care legislation enacted. Wouldn't this be the most un-cool outcome of all for the patients who desperately need access to primary care?

Today's question: What do you think needs to be done to make primary care cool (again)?


Steve Lucas said...

From the outside looking in I would suggest a slight bump in pay, combined with a mandated decline in patient load, and a restructuring of student debt. The goal would be to get doctors off the treadmill and not looking over their shoulder at a large debt load. Doctors need time to think and interact with their patients.

I would also cut back on the payments to specialist. Granted, limited in number, but some doctors income bears little relation to services provided. Doctors are smart people who have a large investment in time and money in their profession. This is not a guarantee of success, but should provide them with an opportunity for a fair income and a realistic lifestyle, two things that seem to be missing in our currently distorted system. It would then be cool when a doctor can watch his kids grow up and spent time with his family

Steve Lucas

ernie said...

Stop calling primary care doctors "providers," and start differentiating between physicians and mid-levels.

Unknown said...

We are both providers MDs & NPs. There is 30 years of research data comparing the outcomes from NPs as equivalent to MDs. General accounting office found two differences not necessarily related to outcomes: MDs are faster; NPs are more well liked. One could do research that would indicate liking promotes compliance and thus improves outcomes.

The term midlevel is a term that in no way describes the multitude of services NPs provide. Nor is it representative of our education. PCP NPs have 3yrs RN, 2yrs BSN and 3 yrs NP school =8. PCP MDs have undergrad work then 4yrs Med school(2yr class/2 yr clinical) and 3yrs residency or on the job training =8.

NPs are by in large willing to work with MDs. Why the jealousy? Why not compete? Why not help people? Stop all of the whose is bigger nonsense and provide qualilty care. Tell the state medical associations to quit limiting the number of MDs available to the public.

If what MDs provide is so superior to NPs then there should be no reason not to compete and win.