Is it too expensive to be a primary care doctor?
In an article on Boston.com, Debra Geihsler, president and CEO of Harvard Vanguard Medical Associates and Atrius Health, asked this very question. Her answer? Yes it is. There is a growing shortage of primary care physicians, leading to delays in care and increasing costs needlessly. Geihsler writes:
A shift from the current care model to a more coordinated care model centered on primary care is one potential way to help stave off the healthcare dilemma. The traditional approach treats patients with chronic illnesses. In fact, 75 percent of the country's healthcare spending goes toward treating people with these conditions. A coordinated care model, however, is geared to keep patients healthy and is part of a long-term plan to thwart the onset of chronic illnesses.
Medicare is working on a means of paying physicians based upon quality and outcome, rather than simply on the quantity of services. There is evidence that suggests that moving back to the older model, where primary care physicians ran the show for their patients, would improve care and costs. When I was in grad school we delved back in time to a 1961 book by Herman and Anne Somers, once the leading observers on the US health care system. In this book, “Health and Health Care”, they wrote of the physician as the captain of the team. HMOs – real HMOs, such as the Kaiser of old (very different from the one of today!) emphasized preventive care. The theory was that investments in preventive care would reduce or prevent other, expensive and debilitating conditions later on. People were likely to stay with their health plan AND physician for years, so investments in primary care could pay off. The number of people in such plans were small, so the potential impact was limited.
Your planning needs to position yourself for this shift in emphasis and direction. If you are a specialist, your income may be topping out and may even decline – at the very least, demand is likely to drop by varying degrees. In shortage areas, pent up demand may fill much of this decline. Into this mix is the ultimate wildcard – new techniques and technology, which can change your practice in any number of directions. Yes, it will be an interesting ride.
