Good article and addresses many issues, including how to incorporate both the roles of the PCP and hospitalists together for better health care...PCPs have the weight of the world on their shoulders today...BD
Primary care physicians have an incredibly difficult job: trying to magically (in 15 minute visits) see complex, elderly patients with multiple medical problems, reconcile paper bags-full of medicines, and sort through stacks of Internet printouts that patients now helpfully (?) cart along. As I mentioned recently, one study found that just following recommended preventive practices would take a PCP nearly 8 hours a day, before dealing with any new or acute problems.
But we may have reached the point that primary care has become so unattractive for so many docs that the migration to hospital medicine truly is contributing to the PCP shortage.
In my judgment, three things will need to happen to resurrect primary care:
- Congressmen will need to be unable to find a PCP for themselves or their parents;
- All the primary care fields will need to band together and lobby with a single voice, rather than as general internists versus family physicians....
- Managed care will be resurrected, in some new garb, to deal with healthcare inflation. Two guarantees: It won’t be called “managed care” this time, and the inevitable strategy to promote primary care over more expensive specialist care won’t be called “gatekeeping”.
Can this get fixed? Since much of the crisis relates to changes in the payment system (not all, but much), and since physician payment is a zero-sum game, increasing compensation for PCPs will depend on significant cuts to highly-paid procedural specialists. The way to fix that is not by trashing hospital medicine – a rare generalist success story in medicine – but by continuing to work on making primary care viable again.
Hat Tip: Kevin, MD