Primary Care, Doctor Shortage - Big Doctoring in America

Big Doctoring in America

The time comes in the life of even the most dedicated logger to admit that someone has said what needs to be said better than you can. Such is the case with Fitzhugh Mullen, MD, practicing pediatrician in inner city Washington, D.C, professor of pediatrics at George Washington University, and contributing editor to Health Affairs.

Here is his take on primary care (Big Doctoring in America: Profiles in Primary Care,” University of California Press, 2002).

The rationale for building the base of primary care in this country is compelling. While many Americans like their doctors and are proud of the scientific progress of the medical system, there is current dissatisfaction with the system as a whole and a realization that its considerable cost does not match up with its more modest outcomes. Many realize that our system is exceedingly expensive, lavish in its use of technology, and undistinguished in its results. ..By most measures, we have an enormously top-heavy, procedure-prone system dominated by a specialty model of care with relatively little investment in primary care. This system consumes an ever-expanding portion of our gross national product, increasingly competing with every other economic interest, personal and public. The health care reform movement in the early 1990s took on this problem but failed. The offensive of the late 1990s, touted at the “market solution” to this same conundrum, has not worked either, affronting patients and physicians alike and controlling costs only briefly. And innovation – new pharmaceuticals, diagnostic devices, and treatments – seem only to complicate the decisions that are necessary to craft a system that uses our science effectively, satisfies patients, and is fair.

Primary care built on the broad based of generalism, as practiced by big doctors, offers the basis for a reconceptualized, rebalanced system of health care in America that move us beyond the expensive and dispiriting medical swamp that we have found ourselves in recent years. Towards that end, I offer the following thoughts on the future, a gentle manifesto for the role that primary care can ply in improving American health.

Two characteristics of our health care future seem predictable, since they are obvious extrapolations of powerful current trends, continued technological innovation and the ubiquity of information. Together they are going to affect medicine in ways that will underscore the importance of the generalist approach to health care