An article from The Sentinel Effect last week addressed seven health care trends that should concern us all. All seven were good points, but lack of primary care providers caught my attention. I think that we could do a lot to solve this problem with a restructuring of our health care system. Doctors become doctors for a myriad of reasons. They want to help people. They want a challenging profession. They want to be well-respected. They want to be financially secure. The list goes on and on, but money has to play a part in it. Unless they’re permanent volunteers for Doctors Without Borders, they’re probably doing pretty well financially. The median salary for a primary care doc is just over $153,000. Not bad at all, unless you compare it with the median salary for a Cardiologist, who can expect to make nearly twice that amount. Now, Cardiologists play a vital role in health care, just like every specialist. But so do family practice doctors. Why would someone want to toil away for years as a slave-labor resident to become an FP when specialization would yield a much more lucrative career and help pay off all those student loans? I’m not saying that all doctors should receive exactly the same compensation – I realize it takes more training and skill to do brain surgery than it does to diagnose the flu. But by forcing primary care doctors to squeeze as many patients as possible into a day in order to command a salary that is still only half of what a specialist can make, we’re essentially steering doctors in other directions.
Good primary care doctors know their patients. They know their histories and the various ups and downs of their health. They see their patients for a wide variety of ailments, and are able to connect the dots when various conditions arise. But getting to know patients and accurately diagnose their troubles is a time-consuming process. Our current system rewards doctors for speed – the more patients they can see in a day, the more they can bill to private health insurance carriers and Medicare. It’s much more profitable to see a patient for 12 minutes and write a prescription (and repeat this process all day long) than it is to spend 45 minutes with the patient, putting together all the pieces of his health puzzle. A Colorado Springs Business Journal article describes the challenges faced by doctors who choose to spend time with their patients rather than squeezing as many patients as possible into a day.
If health care were to become a government program, family practice doctors could be paid a salary – the way teachers are, although I suppose it would have to be a bit higher than a teacher’s salary, in order to make up for the years in residency… The salaries would be set based on regional factors, along with training and qualifications, and would be subject to performance reviews. Rather than trying to maximize income by squeezing as many patients into a day as possible, FPs would be able to spend more time with each patient. There would be no pressure to over-treat patients, because salaries wouldn’t be dependant on the number of procedures performed or the number of prescriptions written. The doctors would be able to do what they do best – taking care of people – without having to deal with billing and health insurance headaches. The money to pay doctors could come from health insurance carriers and/or tax dollars, but it would be negotiated on an annual basis, rather than being pieced together on a daily basis depending on the patient roster and procedures completed. I think this would make the profession much more appealing to medical students.
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