Friday, May 1, 2009

Time to get real on primary care

As I've written in many blog posts, policymakers seem all to be in agreement that primary care is essential to a high performing health care system. Capitol Hill is alive with the sounds of lawmakers promising to enact major reforms to increase the numbers of primary care physicians, a goal that is expressly mentioned in the budget resolution passed yesterday by Congress.

The problem, though, is so far the modest policies being considered don't seem to be equal to the stakes involved. In a new policy paper, ACP lays out in stark terms why primary care medicine is in crisis, and what needs to be done now to reverse it. The now must include substantial changes in Medicare payment policies to make primary care a viable career path compared to other specialties.

My concern is that the legislative process could result in minimalist policies that throw a few dollars primary care's way, but not enough to make a difference. Politicians might then think they've done something to solve the problem, while meanwhile, young physicians will continue to vote with their feet and pursue other specialty fields. Deeply disheartened established primary care physicians will wonder why the political system has once again left them behind. And patients will wonder why they can't find a primary care doctor.

Politicians need to hear from voters that saving primary care demands a wholesale revamping of federal policies, including paying primary care doctors what they are worth. Happy talk about primary care is well and good, but happy talk won't get more doctors to go into primary care or keep struggling primary care practices from closing their doors.

Today's question: Do you think politicians understand what is really needed to save primary care? If not, how do we get them to understand?


Jay Larson MD said...

Politicians do not know how to save primary care. The primary care crisis may have to reach epic levels (which is not too long in the distant future) to get the fix it needs.

"America will always do the right thing, but only after exhausting all other options."
Winston Churchill

jonas said...

A few of them get it, but most do not. Without spending an extended period of time (years) in a direct healthcare setting, it is almost impossible to do so. One cannot lead the fight on poverty without spending time in poor neighborhoods, likewise one cannot reform healthcare without spending time there.

Many politicians don't understand it though most say they do -- really some pretend they do, some think they do. But their impressions are limited, and their opinions often fed to them. They have been taken in by special interests (some believing in earnest what they hear, some less so).

Imagine if doctors tried to reform the legal world!

Rich Neubauer MD said...

In the title of the Senate Finance Committee Options paper is the word "Transform". There is one single metric that politicians can and should use to determine if their efforts at transformation are working: how many newly trained physicians are choosing and continuing in primary care careers. Right now it is a vanishingly small number. Our government, through their policies including CMS payment policies, has clearly been failing at this for some time and their current proposals listed in the Senate options paper pretty clearly will not work. ACP needs to continue to press for measures that will actually work. The Senate Finance committee should lead the way by not passing off continued incrementalism as transformation.

DrJHO7 said...

At our local medical society it is said,"you won't see legislative reform in health care until there's blood in the streets."
That mantra applied to tort reform at the time, but it could apply to the primary care medicine (PCM) work force issue as well.
When patients are saying "I can't find a primary physician" in loud enough voices and in large enough numbers, the situation will get more attention, but then it may take 4-7 years for effective legislative interventions to stem the tide.
ACP's solutions paper is excellent - it's thoroughly researched, well referenced, very specific with regard to recommendations about payment reform that would be likely to have an impact on PCM in the forseeable future. It seems the only thing that needs to worked out is - well, where to get (take)the funding. I wonder if this and other papers actually get read in WDC?

gmcl48 said...

hI - just a few comments, thanks for the opportunity to do so. The problem ariculated is really a patient centered problem, not an ACP problem - that is "how do patients get their health care" is the question. The first recommendation of the comprehensive report from the ACP is for the Federal Govt to establish a commission to look into this. In general this sounds good, but will likely mean no action, or action over the next few years. It is very likely that universal health care reform will be developed very quickly based upon what has clarity - right now what has clarity are economic models, not the patient centered medical model. So the ACP in my view needs to articulate a practical vision to compete and complement the economic models of health care - and the report as written is good. ( and not get lost in some national committee). Since different groups in the medical model might want different things to satisfy their groups, the medical system is seen as fractured, and has no universal vision that articulates clearly fundamental principles of health care. To me the appearances are that the medical profession really has not had much of a role in the health care debate, and likely will remain irrelavant apart from a little window dressing. So i would think that major changes in approach, form and function are required for the medical profession to come out as a winner in the continuing major shifts in health care. I would be happy to be wrong. However, need to "get real" about being relevant to the health care changes at all.