Posts Tagged ‘Primary Care’

Wanted: Primary Care Physicians

August 10, 2009

Let’s talk Healthcare Reform.

Don’t get discouraged, and please don’t leave. We’re going to stay away from the Red vs. Blue rhetoric, and (hopefully) neither side will be called a bunch of loons. Since we’re friends, you and I, we’re just going to take a look at something we really need. If we don’t fix this problem, any healthcare system could come crashing down like a house of cards.

Most of the plans being discussed formally establish a “Medical Home” for patients. We can go see any doctor we choose, but the Medical Home system would establish a Primary Care doctor as our automatic first stop – we see him/her first. If we need specialized care, they’ll refer us to a specialist. Chronically ill patients need a primary care doctor anyway; I write often about finding a good Cardiologist, and that is important, but life happens. CHDers turn ankles and slice our fingers while chopping onions just like everyone else. We need a Primary Care doctor for those times when the problem isn’t heart related.

Problem is, for the Medical Home plan to work, we need more Primary Care doctors. We’ve got a shortage on our hands now, so much so that older doctors can’t retire. They aren’t paid as much, so more doctors choose to be specialists. The Primary Care docs we have are already being asked to work harder and harder; some of them are choosing to relocate to facilities where the pace isn’t so frantic. One of the reasons the Universal Healthcare system introduced in Massachusetts is in such trouble is the shortage of Primary Care doctors. The system is simply being overwhelmed.

Even if we could somehow make Primary Care the most attractive job in the world, we’d still need six years or more before the number of new doctors would begin to climb. One way to deal with the problem now is to expand the role of Nurse Practitioners. NP’s are nurses, but they have had extra training and often have Masters degrees. Some states already allow a Nurse Practicioner to diagnose and treat patients; they can even prescribe medication. Some states don’t.

We need Federal legislation to get all the states on the same page, with a national standard of care. Then we can talk about Universal Coverage, insurance, coverage, and who pays. But let’s fix the doctor shortage problem first.

Fix the right problem

March 2, 2009

It’s going to be a wild few weeks in Washington, as Congress begins to debate President Obama’s first budget. I can’t even begin to predict how it will turn out. And while I do have my opinion, I won’t share it with you – I try to  avoid discussing politics here. Every now and again it is necessary, but for the most part this blog concentrates on Heart Defects.

But today we have to talk politics, just a little bit. Part of the budget involves rethinking our health care system. Admittedly, cost are getting out of control, private insurance makes you grit your teeth, and Medicare is a pain. You think an encounter with the Internal Revenue Service (IRS) can ruin your day? The IRS are rank amateurs when compared to to Medicare!

But before we start to run around and make things worse by trying to fix it, let’s look at what we have:  Somewhere in America a cell phone rings. Its owner, an Emergency Department nurse for a major hospital, is being called to duty. A child was born with a Congenital Heart Defect in a rural hospital just an hour ago;  the patient is stable and is being brought in for evaluation followed by  surgery. She takes one final sip of her coffee, tosses the cup, and heads back to Emergency.

Meanwhile, in the Republic of Vietnam, just over 1000 children have recieved lifesaving operations to combat their heart defects. The program is ending, and it has been such an accomplishment that the State President and the city’s Party Committee Chairman both attend.

And the Children’s Heart Fund of Ethiopia finally has an operational hospital… 22 years after being officially recognized. As of February 17, they had already performed fifteen surgical procedures and ten catherizations.

My God… can you imagine living with a Heart Defect – or any chronic illness – in one of the countries of the world that doesn’t have the resources to provide the level of medical care that Americans are used to? Or in a country like Zimbabwe, where Cholera is rampant, inflation is eleven million percent (11,200,000% as of August 2008) and the President seems to be plumb fool crazy?

Trust me, America has one of the best Health Care systems in the world. The debate shouldn’t be about trying to make it better… just about paying for it. True, every system can be improved, but when you try to do too much – try to fix health care and the payment system, and tie the two fixes together – that’s when the problems occur. So let’s do one segment at the time.

We need for every American to have a doctor – someone they can see for “little things”. Coughs, sprains, a broken finger, the flu… the day to day things that you might need to see your doctor for. These doctors can also pass us on to a specialist if that is what we need. To accomplish this, we naturally need more primary care doctors. We ain’t got them right now, so there’s a good starting point: Figure out how to get more people into Primary Care medicine.

And we need to figure out how to pay for this medical care. Going to the doctor is not cheap, as we all know. It doesn’t matter if you have private insurance or Medicare/Medicaid (or neither), we need to figure a way to make medical care affordable – without drowning ourselves in the paperwork. We also need to make sure the medical staff is fairly compensated. “The workman is worthy of his hire,” the scriptures say, and certainly a trained physican, nurses, and medical staff are much more than “workmen.”

And we need to figure out how to do this without bankrupting individuals or our government.

We’ve got quite a challenge ahead of us.

Hey doc, where are you?

December 22, 2008

You enter a long, difficult, and expensive (very expensive!) educational program. During this educational program, you choose from one of two options: Option A means that you will serve a lot of clients, but you will only be able to charge each one of them $100. With Option B, you serve fewer clients, but will be allowed to charge each client $500. Which option would you choose?

The “educational program”, if you haven’t figured it out already,  is a very simplified version of medical school. Option B are the doctors who choose to specialize: Cardiologists, Neurosurgeons, Orthopedics, etc. Option A are the doctors who choose Primary Care.

Less work and more money? It’s a wonder that anyone chooses Primary Care. But these doctors are the people we usually see first. Medicine’s “Jack of all Trades”, they seem to know a little bit about everything. And with our insurance companies almost demanding a Referral Form before you can see a specialist, these doctors are usually the ones who can get that process started. The problem is – and it is a major problem – there are fewer and fewer of these doctors.

One of the reasons there is more specialization is financial: all those medical school student loans have to be paid back, you know. Two percent of medical school graduates choose primary care, and the debt incurred by a young doctor could be one of the reasons why. Beverly Hills may be full of  “swimmin’ pools and movie stars”, but the Primary Care doctors there are up to their ears in debt.

It’s almost as if these doctors are just disappearing into thin air. The crisis is already building in Idaho. And if you think the Primary Care shortage is confined to rural areas, think again:  A Primary Care shortage is overwhelming Massachusetts. Statewide health care reform increased the number of insured, as intended, but now those new patients are looking for a doctor. One hospital reports that 1600 people are on the waiting list and it takes about four months to get an appointment. Four months is a bit long, don’t you think?

When you think “Health Care Reform”, most Americans usually think of Universal Healthcare and/or various  payment options. But that’s only a part of it. President-Elect Obama’s proposed health care plan will increase the workload of our Primary Care Physicans. Where will we find these doctors?