Tuesday, November 18, 2008

Heading for a Primary Care Train Wreck

From Reuters:

"Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.
And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.
"The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome," the Physicians' Foundation, which conducted the survey, quoted one of the doctors as saying.
The survey adds to building evidence that not enough internal medicine or family practice doctors are trained or practicing in the United States, although there are plenty of specialist physicians.
The Physicians' Foundation, mailed surveys to 270,000 primary care doctors and 50,000 practicing specialists. The 12,000 answers are considered representative of doctors as a whole, the group said, with a margin of error of about 1 percent. It found that 78 percent of those who answered believe there is a shortage of primary care doctors.
More than 90 percent said the time they devote to non-clinical paperwork has increased in the last three years and 63 percent said this has caused them to spend less time with each patient.
Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work. Seventy six percent of physicians said they are working at "full capacity" or "overextended and overworked". "

Why does this matter to you? Obama and the Democratic Congress will at some point address the issue of healthcare reform, and their plan is to provide insurance to 47 million new patients, including illegal immigrants. Most of these already get free care, although their primary care tends to come from the emergency room MD. Once these 47 million new patients are insured, they will get their primary care where the insured do- with a primary care doctor in their community. With PC's leaving the profession in droves, who is going to absorb all of these new patients?

There simply are not enough incentives for medical students to choose primary care as their profession. Most choose a specialty, which offers much greater pay (in many cases double or triple what primary care doctors make). Part of this choice is dictated by the enormous costs of medical education, which can leave a new doctor $250,000 in debt. That's a tough burden when you are 30 or more years old and are at the point where you might want to start a family and buy a house. Part of the choice to choose a specialty over primary care is that it is stressful, and requires one to keep up on a huge range of medical topics from infectious disease to cardiology. As the gatekeepers of medicine, they have to know enough about every disease in order to provide the correct care or triage to the appropriate specialist. Not an easy task. Over time, the burden and stress simply wears down even the most idealistic and enthusiastic doctors.

If Obama wants to reform healthcare, he'd better realize that electronic record keeping is not going to solve the problem of what is driving doctors from primary care. Because if he doesn't, we'll all be waiting in very, very long lines to see our doctors.

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