Posted by Damozel
“It is a fundamental truth — which we are learning the hard way in Massachusetts — that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February. (NYT)
You think? Well, naturally it would be. And one reason it's a problem is because medical specialists have more 'prestige' among their kind than the average family practictioner, and make much, much more money.
Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice. (NYT)
Of course, doctors in general loathe universal health coverage for all sorts of reasons which they can explain to you themselves. They hate the idea, but you and I and most people need it, including all the ones who smugly believe they can do without it. Every civilized nation has it; this one needs it too..
But how do we ensure that we have enough old fashioned family doctors to make it feasible? Under Massachusetts' universal health care system, it's a problem.
Clinic administrators in western Massachusetts report extreme difficulty in recruiting primary care doctors. Dr. Timothy Soule-Regine, a co-owner of the North Quabbin practice, said it had taken at least two years and as long as five to recruit new physicians.
At the University of Massachusetts Medical School in Worcester, no more than 4 of the 28 internal medicine residents in each class are choosing primary care, down from half a decade ago, said Dr. Richard M. Forster, the program’s director. In Springfield, only one of 16 third-year residents at Baystate Medical Center, which trains physicians from Tufts University, plans to pursue primary care, said Jane Albert, a hospital spokeswoman.(NYT)
And family practitioners end up feeling embittered and hard-done-by, it seems:
Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.
“I calculated that every time I have a Medicare patient it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”(NYT)
I'm sorry; did you really think your doctor went into medicine out of a selfless devotion to curing the sick? Dream on, my impoverished friend. You might have barely enough money to pay for groceries for your family, but for a doc, $110,000 a year really is chump change. Fair play, though: they do come out of all that training with a hell of a lot of debt. And there's a reason that Medicare costs are so high that the article doesn't mention.
The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs....President Bush has proposed eliminating $48 million in federal support for primary care training programs.(NYT)
(You just knew that President Bush would come into it somewhere, didn't you? Anything to worsen things for people who are barely scraping by---or who just lost their jobs to the recession. Um, I mean to the economic 'slowdown.')
Anyway, unless they come up with a solution to the problem in Massachusetts, things aren't looking good for universal health coverage.
The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours.
Clinic administrators in western Massachusetts report extreme difficulty in recruiting primary care doctors. Dr. Timothy Soule-Regine, a co-owner of the North Quabbin practice, said it had taken at least two years and as long as five to recruit new physicians.(NYT)
[T]he solution would seem simple enough: tilt the system so that people who choose to enter family practice are rewarded for doing so.
Here in Massachusetts, legislative leaders have proposed bills to forgive medical school debt for those willing to practice primary care in underserved areas; a similar law, worth $15.6 million, passed in New York this week. Massachusetts also recently authorized the opening of clinics in drug stores, hoping to relieve the pressure.(NYT).
Of course, in the long run, the best way to ensure that more people go into primary care is to ensure that they are amply rewarded for doing so. Certainly offering scholarships and other financial aid to people who are willing to go into primary care would be a good start, instead of waiting to forgive the debt only of those who go into under-served areas. I can think of other solutions as well. If the system is going to work, one off the first priorities must be finding people who want to be doctors because they want to be doctors and ensuring that they can afford facilities where they can practice.
It's doable for sure, and do you know how I know? My husband is English. My father-in-law, who had kidney cancer, had three surgeries over Christmas, performed by Oxford's finest. He was in the hospital for weeks and is now in a convalescent home. But he's coming home in two or three weeks. Meanwhile, my mother-in-law was reimbursed for the gas money she had to spend driving to visit him every day.
Is their system perfect? No, absolutely not. There's a much longer waiting period for specialist care than you'd have here. But is our incredibly-expensive-to-the-consumer perfect? It isn't even perfect if you have insurance or can afford to pay for it. You still get treated like a spilled urine specimen by half the practitioners and their minions. It's faster and to that extent better, but only if you can pay for it.
What about the ones who can't, or who can't without ruining their families? A friend of mine just got the co-payment on her insurance for her husband's hospital bill following a slow death. I won't even tell you what she---on an of $40,000 and with little else to show---is going to have to pay.
The English, the Canadians, every European country, and many elsewhere have much to teach us. And we clearly have much to learn.
Memeorandum discussion is here.
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