Below was a comment I made on a KevinMD blog post; I felt that I should post it as it really encapsulated what I wanted to say in my last few posts regarding primary care physician struggles.
Kristy, very important points and questions. What Dr. Schimpf and Mr. Qamar has suggested really is an adaptation to dysfunctional system, not a fix. By no means, is a direct pay model a viable, sustainable solution to the root cause of this dysfunctional system. It certainly gives breathing room for PCPs who have been suffering for so long (like me) that having a model like this is so refreshing and energizing. However, a direct pay model will not help those that cannot afford it (even $19 a month). I have patients who would like to see me, but can’t, because even though they have health insurance, it’s high deductible and they need to pay out of pocket with funds they don’t have. Ones without insurance, forget it. They’ll come when the problem is so severe that they can’t help themselves via Google, and then it’s too late or the condition needs such drastic, expensive measures to treat that the cost of treatment is so much more than what it could have been had they had easy access to a PCP in a timely manner.
It is all about equal access and the rights of everyone in the country (not just those that can afford it) for health care that really impacts health care expenditures in the long term.
It’s like trying to putting a tourniquet on a severed artery, but without a fix to the severed artery, we’re just stopping the bleeding. Eventually, the bleeding will go somewhere else or cause secondary problems that are just as life threatening as the initial injury.
The fix is comprehensive, starting with basic health care access for all and coming up with solutions to address the primary care physician shortage, both by prioritizing preventative services, increasing the workforce through medical education and restructuring cost allocations so that there is closing of the extreme gap between PCPs (including especially mental health providers) and subspecialist reimbursement rates. Although I’m sure these suggested fixes (or variations thereof) have been proposed before, I believe change in our healthcare system really will only change with a grassroots education movement in the value of primary care. We have plenty of data from here and from other countries’ experiences to back up our point.
We’re way past the point where primary care physicians can ask for change to the powers that be because the vested interests preserving this dysfunctional system are so strong and entrenched. My wake up call was when I was in the process of closing my practice, most of my patients didn’t know that a primary care physician gets paid for so little (less than a optometrist!); they felt that the value in their health care from me was so much more than that…they couldn’t understand how I was able to keep surviving on so little for so long. They kept saying, “If we only knew, if everyone knew, we would all be rooting for you”. It was too sad, but it gave me hope where our fight has to be directed, where our best efforts for change can be successful.