Is primary care in crisis?

Maybe. Income, when adjusted for inflation, has dropped for physicians as a group, but more so for primary care physicians. In an article published in the New England Journal of Medicine today, Thomas Bodenheimer, MD suggest that "primary care physicians are expressing frustration that the knowledge and skills they are expected to master exceed the limits of human capability, making it impossible to provide the best care to every patient." The expectations placed on primary care expand, yet reimbursement rewards procedures, creating squeeze play with the primary care physician at the center. Profit margins have dropped, so physicians have to manage the management of practices more closely to cover their overhead - and pay themselves. For decades, primary care physicians have been identified as the real center of caring for patients. Prevention and coordination of care from the myriad of providers is best done by the one person who knows the patient best, and sees the full picture - their primary care physician. Real HMOs - not the Wall Street funded bastardization of them - created their services around the primary care physician (PCP). PCPs became the "gatekeeper" as a means to quality care, not to stop spending.

As a society, change needs to happen, from increasing reimbursement across the board - and significantly - for PCPs, actively encouraging medical students to seek primary care as their specialty, and to curtail the growth of specialty care.

As for today - primary care physicians should be looking for ways to be more efficient in their time. Electronic medical records are not a panacea, and they are very expensive. Now, at least, hospitals can help fund them in your practice. Beyond that, however, the ease of access, the ability to organize and manipulate data will lessen your stress and time pressure, as well of that of your staff. The time and stress savings here may be small on each patient, but they multiply. Some practices, such as pediatrics, can use nurse call centers. Nurse practitioners can be a boon, although their salaries will also rise as the retail store clinics grow. Of course, you can also open one or more as well, or offer walk-in or same day slots. Finally, start using Internet based services- a web site, and email consults. Some insuranc carriers are beginning to pay for email consults, or are planning to. That day is coming very, very soon.

The real focus of running a medical practice keeps coming back to the same theme - focus on caring for patients. Better relationships with patients, better quality checks and better information - real information, not just data - will grow a healthier practice.