Needed: More Primary Care Docs.

A thoughtful piece on healthcare reform appeared yesterday on the HealthLeaders website, www.healthleadersmedia .com.

In an article entitled “It’s Time to Pay Primary Care More,” Elyas Bakhtiari noted that at a time when Democratic leaders in Congress prepare to introduce healthcare reform legislation, the Obama administration is expressing concern about the growing primary care doctor shortage and exploring ways to increase physician supply.

Bakhtiari applauded the national healthcare reform architects for paying attention to previous efforts in Massachusetts, where the promise of universal coverage has fizzled somewhat, in part because of a primary care shortage. He writes that faced with inadequate primary care access, patients are showing up at emergency rooms and adding to overall costs-ED visits have risen 7% and the cost of emergency care has climbed 17% in Massachusetts in the past two years.

Causing the shortage in primary care docs, Bakhtiari points out, is that primary care doesn’t pay enough to lure many of today’s medical students. He notes that when presented with the options of making $180,000 as a family practitioner and $400,000 or more as a proceduralist, students are increasingly choosing the latter.

Bakhtiari then points to the large government-run healthcare programs as driving this shortage. The pool of dollars for reimbursing physicians for Medicare and Medicaid is limited, writes Bakhtiari. And, he says, that while the payment disparity has benefited certain surgeons and specialists, the damage caused by a lack of primary care physicians affects the entire healthcare system.

The conclusion that Bakhtiari reaches is that reforming the entire healthcare system can only be done by making some very hard choices such as increasing payment to primary care at the expense of some of the higher-paid specialists.

It appears that the Congressional architects of healthcare reform may have gotten this same message. On Wednesday of this week, the New York Times reported that Senator Max Baucus, (D MT), and Senator Charles E. Grassley (R IW), had unveiled a set of detailed recommendations intended to slow the growth of Medicare, hold doctors and hospitals more accountable, and improve the care of patients with chronic illnesses.

Key to this effort, The Times said, is a proposed 5 percent bonus payment for office visits and other “primary care services” provided to Medicare patients by family doctors and internists. General surgeons in rural areas would receive a similar bonus, but Medicare payments to many other specialists would be reduced.

Of course, this proposal has made many providers nervous, but it is, I think, a step in the right direction. Government programs like Medicare and Medicaid now provide coverage for about half of our population. If healthcare reform developed this year contains a “Public Plan” option that would be available to the working population, this percentage will skyrocket. It is time that these programs are used help shape healthcare delivery into a more efficient, cost effective system.

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