Primary Dare
War, taxes, unemployment, an energy shortage, natural disasters, a polluted environment, general discontent, and, if that were not enough, now a decline in the number of primary care physicians to go along with the decay of health care coverage. I dare you to get sick! When you do, a 10-cent packet of dried chicken broth is going to have to sustain you in lieu of the antibiotics you can’t afford. The money you put away for that well-deserved vacation must now be redirected to an emergency room, where a “short” visit is tantamount to a loss of diurnal wages and a counting of pennies or a credit extension. Whatever happened to the understanding family physician who held your hand, asked how the family was doing, cracked a few off-color jokes with a glint in the eye, and sent you on your merry way, feeling better even before your trip to the pharmacy? The fact is, the primary care physician or family practitioner is going the way of the dinosaur, and low relative salary, poor job satisfaction, and a 13+ hour workday are the viruses corroding the heretofore protected inner sanctum of that hallowed profession.
Patients are just plain fed up, and medical students are choosing more lucrative specialties of medicine. With primary care physicians unable to master the skills required to exercise the profession competently in the limited time available to them daily, with the potpourri of languages currently spoken in the U.S. hindering effective communication, and with reimbursement to physicians for services rendered based on quantity rather than quality, it is no wonder that medical shingles are getting tarnished or pulled down entirely, for that matter. If the average primary care physician were to provide all the recommended care and preventive measures currently mandated by professional medical associations for the average 2,300 patients in each physician’s medical practice, the workday would amount to a ponderous 18 hours. That’s hardly what an experienced physician would call lifestyle medicine, especially in those golden years of established practice free of professional debt.
Depression, diabetes, headache, heart failure, hypertension, osteoarthritis, and other chronic conditions have become inadequately treated, not only because harried, overworked medical practitioners are rushed for time but also because half of all patients leave the office without having understood what the physician said. Add to this mix the fact that brief diagnostic, surgical, or imaging procedures often pay as much as three times more than an average office visit, and one begins to understand why it is becoming extremely difficult to replenish the primary care ranks. Internists, pediatricians, and family practitioners are at the bottom end of the financial totem pole, giving a shoulder up to the diagnostic radiologists, orthopedic surgeons, gastroenterologists, and anesthesiologists looking down. With inflation taking a larger chunk of the lower salaries of primary care physicians than specialists, the sinking ship is being abandoned for more lucrative specialty practices. Even nurse practitioners and physician assistants are opting out of the primary care workforce.
Optimism is low and tedium high among family doctors at a time when studies have shown that primary care is the answer to rising medical costs and quality degradation. When the proportion of generalist physicians to specialists rises in a given population, overall Medicare expenditures are seen to decrease as general health improves. So, perhaps there is nothing “special” about specialists, after all.
Long waiting room times are no fun for anyone, and they contribute to patient frustration with a broken medical mechanism. A clock’s monotonous ticking may be easily dismissed, however, when a continuing relationship of trust has been established between physician and patient. That pat on the back or gentle squeeze of an arm goes a long way to smooth ruffled feathers and patch up worn psyches, contributing in some intangible yet significant way to the power of pills, potions, and prods.
It would be a mistake to banish primary care physicians to the locomotive graveyard, leaving the tracks ruled by streamlined specialists. Both are needed, and both have their place, although, contrary to misguided conventional wisdom, it is the former not the latter who safeguard the crown jewels, i.e., the health of a nation. Much like a sultan who selects the largest eunuch to protect that which he holds most dear, we, too, must dare to choose the largest links in the protective chain of our health care system, relegating the “small” to the specialists who must learn to seat themselves farther from the host at the dinner table.
© 2006, Albert M. Balesh, M.D. All rights reserved.
Patients are just plain fed up, and medical students are choosing more lucrative specialties of medicine. With primary care physicians unable to master the skills required to exercise the profession competently in the limited time available to them daily, with the potpourri of languages currently spoken in the U.S. hindering effective communication, and with reimbursement to physicians for services rendered based on quantity rather than quality, it is no wonder that medical shingles are getting tarnished or pulled down entirely, for that matter. If the average primary care physician were to provide all the recommended care and preventive measures currently mandated by professional medical associations for the average 2,300 patients in each physician’s medical practice, the workday would amount to a ponderous 18 hours. That’s hardly what an experienced physician would call lifestyle medicine, especially in those golden years of established practice free of professional debt.
Depression, diabetes, headache, heart failure, hypertension, osteoarthritis, and other chronic conditions have become inadequately treated, not only because harried, overworked medical practitioners are rushed for time but also because half of all patients leave the office without having understood what the physician said. Add to this mix the fact that brief diagnostic, surgical, or imaging procedures often pay as much as three times more than an average office visit, and one begins to understand why it is becoming extremely difficult to replenish the primary care ranks. Internists, pediatricians, and family practitioners are at the bottom end of the financial totem pole, giving a shoulder up to the diagnostic radiologists, orthopedic surgeons, gastroenterologists, and anesthesiologists looking down. With inflation taking a larger chunk of the lower salaries of primary care physicians than specialists, the sinking ship is being abandoned for more lucrative specialty practices. Even nurse practitioners and physician assistants are opting out of the primary care workforce.
Optimism is low and tedium high among family doctors at a time when studies have shown that primary care is the answer to rising medical costs and quality degradation. When the proportion of generalist physicians to specialists rises in a given population, overall Medicare expenditures are seen to decrease as general health improves. So, perhaps there is nothing “special” about specialists, after all.
Long waiting room times are no fun for anyone, and they contribute to patient frustration with a broken medical mechanism. A clock’s monotonous ticking may be easily dismissed, however, when a continuing relationship of trust has been established between physician and patient. That pat on the back or gentle squeeze of an arm goes a long way to smooth ruffled feathers and patch up worn psyches, contributing in some intangible yet significant way to the power of pills, potions, and prods.
It would be a mistake to banish primary care physicians to the locomotive graveyard, leaving the tracks ruled by streamlined specialists. Both are needed, and both have their place, although, contrary to misguided conventional wisdom, it is the former not the latter who safeguard the crown jewels, i.e., the health of a nation. Much like a sultan who selects the largest eunuch to protect that which he holds most dear, we, too, must dare to choose the largest links in the protective chain of our health care system, relegating the “small” to the specialists who must learn to seat themselves farther from the host at the dinner table.
© 2006, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
9/20/2006 05:34:00 PM
|
0 comments
