Opinion: Keep doctors from disappearing

BY GARY S. MIRKIN
http://www.newsday.com

Health care reform and the increasing cost of medical care have been widely discussed for years, but recent reports point to a fundamental flaw that could overshadow the political rhetoric – the doctors who perform the majority of checkups and everyday care in this country are rapidly disappearing.

According to a study released by the Physicians’ Foundation in November, nearly half of the nation’s primary care physicians, including pediatricians, plan to stop practicing or reduce the number of patients they see over the next three years. The reasons include “increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations.”

Not only are PCPs leaving the profession, fewer U.S. medical students are pursuing primary care as a specialty today. The American College of Physicians reported last month that from 1997 to 2005, the number of U.S. medical school graduates entering family medicine residencies dropped by 50 percent. An August 2006 commentary in the New England Journal of Medicine notes that “the fortunes of primary care are dictated not by the health care needs of the country but by a specialty-rich, quantity-based reimbursement system.”

Even the effort to help correct this growing primary care shortage in our area, with the recent formation of a medical school at Hofstra University, is, in my view, quite unlikely to succeed. Time has proven that no medical school, no matter how excellent it may be, is any match for the powerful economic forces that lead doctors into the better reimbursed medical and surgical specialty fields such as dermatology and plastic surgery.

Many PCPs are making cut-backs. Patients are finding it difficult to get an appointment. Some may also find they now have fewer treatment options. A survey published in the journal Pediatrics found one in 10 doctors who vaccinate privately insured children are considering dropping that service because they are paying more for the vaccines than the private insurance companies will reimburse.

I’ve seen it in my own practice. While the cost of malpractice insurance and the expenses of running a practice have risen considerably, especially in our area, reimbursement rates from New York area health plans for the services that make up the bulk of primary care practices have been virtually stagnant for nearly seven years.

In fact, national studies have found that the income of PCPs, adjusted for inflation, dropped by 10.2 percent from 1995 to 2003, while the amount of work increased.

Primary care providers play a central role in improving the overall health of patients as well as reducing the costs of medical care. Numerous studies continue to demonstrate that those patients whose personal physician is a primary care provider have lower health care costs, fewer hospitalizations and live a healthier life – even after accounting for age, risk of disease, etc.

All of these reports confirm what I’ve been seeing as a pediatrician in private practice on Long Island for several years. Most of us chose private medical practice because we want to work one-on-one with families. We want to spend our time on the gratifying task of caring for them. We are the primary line of defense against dangerous communicable diseases such as measles, whooping cough and meningitis as well as chronic illnesses like heart disease, cancer and stroke. For those complex cases that require the care of specialists, we serve as the “conductor,” orchestrating health care so that it is delivered in an efficient, coordinated, timely and caring manner.

Can we ever get back to a time when doctors spent the majority of their time doctoring, rather than pushing paper in an increasingly futile effort to deliver that care and to cover our burgeoning overhead?

While turning back the clock may be impossible, some PCPs are working toward a more patient-centered approach. My group has taken some initial steps. First, by integrating the business practices of 70 pediatricians on Long Island, we have reduced the administrative burdens of primary care and freed up more time for good quality, old-fashioned patient care. We also recently joined the Patient-Centered Primary Care Collaborative, a coalition of major employer and physician groups, representing more than 300,000 PCPs across the country. Through this organization, we are approaching groups as diverse as Congress, AARP and employers to begin to transform how primary care is organized and financed.

The public debate over health care coverage will continue, probably well after my generation retires. But, we can’t wait any longer to make the kinds of changes necessary to hold on to our primary care doctors and pediatricians, while also encouraging the best and brightest new doctors to seriously consider a career in primary care. After all, if there aren’t enough doctors to care for our families, it won’t matter how good our insurance coverage is. We need the personal primary care doctor to ensure the quality of our health care and to responsibly reduce the expense of providing that top-notch care for our patients.

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