Even without passage of Obamacare, we have a growing shortage of primary care physicians. This means that it will be increasingly difficult for us to find a new doctor when we want one–a real problem in Canada, for example. Making matters worse, the federal government caps subsidies for residency training, with the purpose of limiting the number of new doctors–utter insanity–while the HMO system of capitation requires primary care docs to work harder for less money. And with the prospect that Obamacare will only worsen an already bad situation driving some docs out of the field–if it isn’t repealed and replaced with something better– the PCP shortage needs urgent attention.
There are plans in the works. From the story:
Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.
A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most. “A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,” says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.
It kinda reminds me of an assembly line, the end of personalized medicine. But Marcus Welby is dead–and we killed him. Nurse practitioners and physician’s assistants can very capably monitor chronic conditions and do annual physicals, freeing doctors for more urgent concerns. But it is all too bad. I think we seeing the end of the “art” of personalized medicine, but if we are to avoid an implosion, adjustments will have to be made.
March 29th, 2010 | 10:30 am
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March 29th, 2010 | 11:38 am
Who is Marcus Welby?
Wesley J. Smith Reply:
March 29th, 2010 at 1:59 pm
AAAUUUGH!, safepres. I am so old. He was a warm, television doctor back in the 70s (I think), starring Robert Young. He made house calls.
March 29th, 2010 | 11:56 am
Smith’s analysis is, again, incorrect.
The bargaining chip here is Medicare. You, hospitals, want higher/adequate re-imbursement? Fine, get more primary care residents and then you’ll get your money. Otherwise, we’re capping it. The American people are calling the economic shots now, not the AMA or insurance companies.
[BTW, not all GPs go to hospitals for residency]
Personal care went out years ago, when we started denying people for pre-existing and left 37 million uninsured.
There’s no shortage of qualified students to become physicians in this country. Med schools/hospitals – you want your money from the people – start training our doctors.
March 29th, 2010 | 1:48 pm
David,
It’s simple economics. We’re going to be increasing the demand for medical services from doctors, but we’re not going to be increasing the supply of them at the same rate if we continue disincentivizing them. You’re right, there is no natural shortage of bright and eager minds, and if all we did was increase demand the greater profits would draw more people eager to take advantage of the opportunity. But if you make it less attractive to enter a profession, less people will. Cutting reimbursements and adding barriers to entering the market through regulations and new powers for the HHS does not encourage more doctors.
The end of personalized care is because of our society’s views toward others (as evidenced by the death of customer service) and greater demands on time. In the end we’ll likely see even more programs and subsidies created to encourage doctors to enter the field, or penalties to individuals and institutions for not doing it. In the end we are creating an artificial shortage AND taxing and taking more resources to overcome it. Your example of toying with Medicare reimbursement won’t fix it, and it definitely isn’t the people calling the shots; it’s the bureaucrats that never get elected by them telling others what to do… or else.
You can keep being mad at insurance companies, but they can’t grow money on trees to pay for more expensive new treatments that everyone is expecting to receive. We will never all have the medical care we want, because we live in a world of finite resources. 300 people in DC with limited knowledge can’t allocate those resources in a smarter and more just manner than 300 million.
March 29th, 2010 | 2:30 pm
Wesley,
I remember Marcus Welby, M.D. and Drs. Ben Casey and Kildare too! Not to mention Dr. Richard Kimble!
Wesley J. Smith Reply:
March 29th, 2010 at 3:45 pm
Jeffrey: Ha! Perhaps the one armed man was an Obamacare bureaucrat.
March 29th, 2010 | 2:40 pm
Robert Young & James Brolin were the stars of Marcus Welby.
March 29th, 2010 | 3:33 pm
JustChris,
Look, if one prefers the status quo and doesn’t mind that many fellow citizens (assuming US) are struggling with health care – just say so. If one doesn’t want to pay more in taxes to ensure regulations are enforced or people have a change, just say so.
Don’t be a hypocrit, though, either (not saying you are).
Coming late to the game with obvious economic concerns, though untested, is hardly impressive.
Of course it won’t be easy, pain-free, or cheap. Never said it would be.
We seem to like our schools, Medicare, military, roads, and police. I have no problem adding health care to that list and sacrificing a little more and cutting back on stupid things – like wars in Iraq. I’d love to see environmental regulation added as well. I don’t plan on living on Mars.
So, if health care is too big a deal for someone, go ahead, walk out on your country and maintain the status quo. Rolling over and doing nothing seems to be the default position of conservatism, anyways.
Speaking of society’s views towards others, I find it interesting how many “Christians” oppose health care reform yet love military campaigns. Odd.
March 30th, 2010 | 9:22 am
aww, what a neat show. Sounds like something I would have liked, had I been around back then ;)
March 30th, 2010 | 3:54 pm
Yes, once upon a time there were many “Marcus Welbys.” When I was a child my family had a doctor who even looked like him. He made house calls at all hours of the day or night and once, in an emergency, he even took my brother off to the hospital in his own car. Eventually he moved off to Appalachia and opened up a clinic for the needy.
There were many Marcus Welbys in those days, who practiced medicine because they wanted to heal people, not because they desperately needed to boost their egos with new BMWs. Unhappily, most of them were plowed under in an epidemic of greed back in the 1960s when financial advisers pointed out how much more doctors could be making if they didn’t waste so much billable time on house calls. Eventually the breed became extinct.
The television show featuring Robert Taylor was a nostalgic tribute to them.
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