Friday, February 28, 2014

Dead Men Talking and Revival of Primary Care

We have been relentless advocates for universal health coverage and the Affordable Care Act (ACA).

Molly Cooke, MD, president, American College of Physicians, “Dead Men Walking,” Correspondence,  New England Journal of Medicine, February 27, 2014

I’ve been a puppet, a pauper, a pirate, a poet, a pawn, and a king, in and out, and I know one thing. Each time I find myself flat on my face, I pick myself up and get back in the race.

Lyrics to Frank Sinatra song, “That’s Life”

Primary care doctors have been called a lot of things  -  puppets of the AMA,   paupers by  the SGR formula,  pirates by critics,  poets (see William Carlos Williams, MD),  and keys to the greater health care kingdom, but never as “Dead Men Walking,” as highlighted in a letter to the editor in the  February  27 New England Journal of Medicine.

Much of this talk is unfair.   Compared to specialists, primary care physicians have less income and less respect, and their morale, as evidenced by multiple surveys is low.   

But through it all, their professional associations – The American College of Physicians, the American Academy of Family Physicians,  the American College of Pediatrics, the American College of Osteopathic Physicians – have steadfastly supported the Affordable Care Act.    

For the most part, this support has not filtered down to the membership of these organizations, who,  by majorities of 60% or more,  are advising their children not to choose medicine as a career.   Furthermore,  only a minority of medical students,   25% or less,  are entering primary care residencies. 

In his annual budget,  just released,  President Obama , has stepped forward  to  support primary care with:

  • ·         $5.23 billion over the next 10 years to train 13,000 primary care residents in high need communities, and in team-based care, as in accountable care organizations.

  • ·         $5.24 billion for higher payments to Medicaid primary care providers, including physician assistants and nurse practitioners.

  • ·         $3.95  billion over the next 6 years to expand   the current 8,900 primary care physicians in the National Health Service Corps, which provides care in under-served and under-doctored areas, to  15,000 in 2015.

This “booster shot” for primary care, as described by Mary Wakefield, HHS administrator,  is  not necessarily  a good thing in the eyes of primary care physicians  now in practice.    

It is tailored to smacks of  government programs – accountable care organizations,  team-based care, and nurse practitioner care -  not to the needs of private primary care physicians.   It does not help with  government regulatory burdens,  the complicated new ICD-10 coding system,  or the expenses of installing and maintaining dysfunctional electronic  health record systems.    

Furthermore,  many of these physicians are not fans of accountable care organizations,  nurse practitioners  in independent practice,  and team-care.

Still, federal financial support for primary care is welcomed, and President Obama  deserves credit for offering that support.    Government aid is start towards  revitalizing primary care and reducing the primary care physician shortage of roughly 50, 000.

Tweet:   In his budget,  President Obama  has proposed spending $14.4 billion to train more primary care doctors, pay  more for PA and NP Medicaid providers, add doctors to the National Service Corps.

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