Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time:
The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients.
There’s no easy answer, and worse, money isn’t even the root of the problem. Often left unaddressed is the burnout that primary care doctors face, practicing in unpalatable environments where the doctor-patient relationship is obstructed by bureaucracy and paperwork. Read more »
*This blog post was originally published at KevinMD.com*
DrRich entered medical school 40 years ago with every intention of becoming a general medical practitioner, and indeed he became one. But after only a year in practice as a generalist, he found himself so frustrated with the frivolous limitations and the superfluous obligations that even then were being externally imposed on these supposedly revered professionals, that DrRich altered course and spent several years retraining to become a cardiac electrophysiologist.
(Electrophysiology is a field of endeavor so arcane as to be mystifying even to other cardiologists. DrRich hoped that the officious regulators and stone-witted insurance clerks would be so confused –- and possibly intimidated –- by the mysterious doings of electrophysiologists that they would leave him alone. Happily, this ploy worked for almost 15 years.)
Still, DrRich has always held general practitioners (now called primary care physicians or PCPs) in the highest regard, if for no other reason than these brave souls –- unlike DrRich himself, who cut and ran at his earliest opportunity –- have stuck it out. Read more »
On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model.
Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. Read more »
*This blog post was originally published at KevinMD.com*
The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer-driven healthcare in the way of higher deductibles and copays. This is very worrisome.
Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. Though the article cited some examples of patients saving money by not seeing their allergist for a refill of medication and simply calling for one and getting an athletic physical at a local urgent care clinic for $40 rather than $90 at the doctor’s office, these tiny behavior changes aren’t going to bend the cost curve in medical care. Read more »
With medical students graduating, on average, with almost $160,000 of debt, it’s a major reason why they’re choosing more lucrative specialty practice, which can offer salaries multiple times more than those of primary care fields.
In this clip from The Vanishing Oath, medical economist Amitabh Chandra, Professor of Public Policy at the Harvard Kennedy School of Government, discusses that influence, which contributes to a drastic decline of primary care residency slots being filled by American medical graduates.
Of course, it’s not only money. Primary care practice has a litany of obstacles that can contribute to rapid physician burnout, compounded by the fact that good primary care role models are largely absent from academic settings.
But there’s no denying that the salary disparity is an influential factor, and for many students, often a deciding one.
A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, M.D.:
*This blog post was originally published at KevinMD.com*
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