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ABC normally uses in-house physician Timothy Johnson for a brief q-&-a of expertise on the breaking medical news of the day. So his A Closer Look feature on primary healthcare at Minnesota's Mayo Clinic was a rare example of detailed reporting--although, as usual, Johnson was given more leeway than a regular correspondent to voice opinionated advocacy. "Primary care is going down the tubes in this country," he asserted, citing statistics that only 30% of physicians are in general practice as opposed to specialties. Why is general practice so important? It is the least expensive, highest quality method of delivering preventive care and managing chronic disease.
So what did the Mayo Clinic do? It found that too much routine medical care in its plan was being delivered at the expensive emergency room. "The reason was simple. The ER was convenient." Mayo set up a series of six family medical centers, combining pediatrics, family and internal medicine; it opened an express care walk-in clinic at a shopping mall; nurse practitioners and physicians' assistants worked nights and weekends; it set up a 24-hour care hotline; all medical records were coordinated in an electronic database. Johnson compared the resulting cost with the national average of 5% to 8% annual healthcare inflation. Mayo has seen a 0% increase for the last two years.
Finally something on the impending, nay ongoing, failure of Primary Care. Insuring "everyone" without a Primary Care Doctor to see them is a currency without a marketplace - just like in Massachusetts.
Primary care is DEAD. Now is not the time for band-aids or oral Amoxil, rather intracardiac epinephrine & countershock.
I CLOSED my Primary Care practice in November 2007 having made $30,000 in my last year as a PMD in favor of Hospitalist work. At least I get paid now.
No one will follow me or my generation into Primary Care as it currently stands due to ruinous discounting by Medicare, Blue (double) Cross and the rest of the 4 letter words; HMO's, PPO's, etc. Medical Students aren't stupid, our politicians are.
Preventive care & coordination - particularly in the elderly with multiple chronic conditions on multiple medications - is best done by Internists; not PA's or FNP's. Yet this is precisely the group that has been most affected by the Insurance monopoly and Medicare's lack of support, neglect and out-&-out persecution.
All "universal" care system around the world, when they actually work, are based on a vibrant, well-paid Primary Care staff. All the studies support Primary Care as cost saving and life-saving. So why are we dismantling it here?
I.M. Primary Care is simply not viable currently, when specialties like Derm & Ophth are clean, easy and make 4-5 TIMES as much. Not to mention that there are VERY few times these Drs. get called to the E.D.
They have to make I.M. PROFITABLE (so you can pay back the huge debts AND have something to show for all those years of delayed gratification & wage earning for retirement) & on a par - if not better - than most sub-specialties.
Stop the ruinously low fees, stop the ridiculous bureaucratic overburdening, stop the insurance industry from making medical decisions without a license or consequences when (not if) it all goes wrong.
Save Primary Care now - or we will ALL suffer the cons
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