It's too expensive to be a primary-care doctor By Debra A. Geihsler

[Guest guest]

It's too expensive to be a primary-care doctor

 

By Debra A. Geihsler | July 25, 2007

 

AS THE PRESIDENTIAL candidates formulate their healthcare platforms, they

need to acknowledge the growing scarcity of primary-care physicians. There are a

variety of reasons for this shortage, including the reimbursement model that

favors costly specialty care. The problem is complex and there needs to be a way

to treat patients in the midst of this drastic deficit. The healthcare community

has to act quickly but there needs to be a president, backed by Congress, who

will overhaul the system so that preventive care is rewarded, and forms the

foundation of the healthcare model.

 

A shift from the current care model to a more coordinated care model centered

on primary care is one potential way to help stave off the healthcare dilemma.

The traditional approach treats patients with chronic illnesses. In fact, 75

percent of the country's healthcare spending goes toward treating people with

these conditions. A coordinated care model, however, is geared to keep patients

healthy and is part of a long-term plan to thwart the onset of chronic

illnesses.

 

There is increasing support in moving toward this type of practice. Medicare

officials are trying to find new ways of reimbursing doctors, focusing on

quality of care rather than the number of tests and procedures performed. The

initial results of a recently reported three-year study of 10 physician groups

from across the country reveal that doctors can help reduce overall healthcare

costs by coordinating care and preventively managing chronic illnesses. Two of

the groups saved Medicare $9.5 million in the first year, and were paid $7.3

million in bonuses as a result. The project began in April 2005, so there is

more data to be collected, but the trend is positive.

 

Under the current care model, doctors are attracted to better-compensated

medical specialties so they can deal with rising medical-school debts,

inequities in reimbursement, and increasing malpractice insurance costs. Even

though patients receive 95 percent of their healthcare outside of a hospital,

it's just too expensive to be a primary-care doctor in America today.

 

State medical societies are warning that by 2020 the country could be short as

many as 200,000 licensed doctors. More than a third of physicians are older than

55 and are planning on retiring or reducing their caseloads in the next five to

10 years, according to the American College of Physicians. At the same time,

demand is increasing exponentially as the nation ages.

 

Massachusetts residents are feeling the consequences. More than half of the

community hospitals in the state are facing a shortage of primary-care

practitioners, while the wait time to see a doctor has increased. The number of

people who waited more than two months to see a primary-care physician jumped

from 10 percent in 2005 to 16 percent in 2006, according to a recent

Massachusetts Medical Society survey.

 

The situation has debilitating effects on healthcare costs and physical

health. And yet, replacements are not at the ready. In 2003, the number of

third-year residents planning to pursue careers in general medicine decreased by

half to only 27 percent in just five years.

To help plan for and alleviate this workforce shortage, all the presidential

candidates should incorporate preventive care and reimbursement model changes

into their healthcare reform plans. The bipartisan emphasis on electronic

medical records is a good start, since they support coordinated care and could

ultimately save the economy $1 billion annually. But there needs to be a hard

look at the healthcare and reimbursement systems so they are equitable for

primary-care physicians and specialists alike.

 

Locally, the state needs to address affordable housing and education so

Massachusetts continues to attract and retain qualified healthcare

professionals. The healthcare industry must push for a more proactive,

preventive approach to patient care.

 

There can be both cost savings and improved health for citizens. Of course,

changing the existing paradigm will not be easy. But that's why the next

president should take the lead on rewarding and recruiting primary-care

physicians whose specialty is the welfare of patients.

 

Debra A. Geihsler is president and CEO of Harvard Vanguard Medical Associates

& Atrius Health.

 

© Copyright 2007 Globe Newspaper Company.