changing the fate of primary care
Primary care doctors have become an endangered species. At one point primary care doctors composed the bulk of practicing physicians; when people saw their doctor, they implied that they were seeing their primary care doctor. Even today, patients value and trust their primary care doctors more than any other. But fewer people are entering the field, and even fewer are staying. In 1998 54% of medical students followed the path of primary care. Today that number is 20%, and falling. The average pay for primary care doctors is far less than that of specialists, something that was not always true. Today most primary care doctors earn half or less than the average specialists. Who determines that? A small group of specialty doctors in the AMA compose the RUC, a committee that recommends physician reimbursement to Medicare, which Medicare adapts and other insurances follow. In addition to lower pay, primary care doctors are burdened by a heavy dose of non-reimbursed work, from copious requests to communicate with patients and families, to filling out piles of forms, to responding to seemingly endless emails and messages, to fighting with insurance companies. That workload has accentuated under the Affordable Care Act (ACA, or Obamacare) and with new Medicare reforms, so now we are responsible for adhering to quality indicators that take huge amounts of time and effort in order to prove our compliance, we must spend hours trying to obtain for our patients simple items such as a wheelchair or some basic home health, we have to prove meaningful use of our mandatory computer systems, and we must type complicated progress notes into those computers that adhere to Medicare’s very strict guidelines, or else we may be audited by Medicare and potentially lose everything. On top of that, costs of running a practice are increasing, again much of that driven by the ACA and Medicare reforms, which push practices to spend more money on computers, tech services, and front line staff. Against this tide, primary care doctors have no defense. We have no organization that speaks for us. We are not united in any way; few of us have enough time to even think about fighting back. Hence, a few of us have taken the step of starting an organization that speaks for working primary care doctors, the Primary Care Action Coalition (PCAC). We are not an academic group or a group that represents thought leaders. Rather, we are an organization whose members are hard working primary care doctors who see patients regularly and who know, better than any other doctors, what is wrong with the system and what can be done to fix it. In fact, despite any political or geographical diversity we may have, we are amazingly united in our perception of the current health care environment. As this blog moves forward, we will discuss some of the barriers we face as physicians, why so few people are entering our field, and why we must be at the forefront of any effort to improve health care in this country. Right now we are being led down a very perilous and expensive path, a path that, in a few years, will be bereft of a quality primary care presence. It is time for us to finally take a stand and change that reality. That is what the PCAC fully intends to do.