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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the prospect that Obamacare will only worsen an already bad situation driving some docs out of the field—if it isn’t repealed and replaced with something better— the PCP shortage needs urgent attention.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.

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