I realized that often in my blog I will say something and then say I will explain it at another time... but then I never do. I am sure lots of blog writers do this but I thought it might be nice to actually go back once in a while and give the back story on something that would have made a previous blog entry to lengthy.
In one of my posts, I mentioned how there is a severe shortage of primary care physicians in the United States. Being someone who wants to go into family medicine this shortage is obviously interesting to me. After going to some seminars and talking to classmates, I have come to believe that this shortage is caused not only by the way our health care system is arranged but also by how society views health and success.
In our health care system doctors are able to bill insurance companies not based on the time they spend with a patient but by the number of procedures they perform. A doctor is not paid to counsel a patient on disease prevention, to answer their questions about medications or to take a detailed history in order to understand how a patient's personal life may be effecting their health. And yet, these are all things that good primary care physicians must do. It is easier for a specialist to skip these steps. If you are in the hospital for knee surgery, it is not necessary that your surgeon know all the life choices that led to your bad knees. It is important for them to make sure you understand the surgery and the steps you will need to take in order to recover. The surgeon will spend less time with you and get more money for doing it. I understand why, there is a lot more training that goes into learning how to perform surgeries and there is a lot more risk involved. Still, it seems wrong that doctors can only get paid for doing procedures on sick patients and not keeping their patients well in the first place. This discrepancy in pay between primary care physicians and other specialties is what causes part of the deficit.
Some would say that this proves that doctors are simply greedy but I would disagree. Medical school is expensive, very expensive and there are students who pay for it all in loans and don't get help from family. For these students, when it comes time to pay the loans back it can actually be hard to make it on a primary care physician's salary especially in the first few years of practice (and if the student has a family of their own it only adds to the burden). So unless you have someone who is truly passionate about primary care, the financial security of a different specialty is all too tempting.
Then you have how our society views health. It is no wonder we have a payment system built on procedures because society as a whole cares little about the prevention of disease. The sad truth is that we have become a people who simply look to treat our symptoms without pausing to consider what might be the root of the problem or what might have prevented the condition all together. Both doctors and lay people are guilty of this. It is much easier for a patient to take (or for a doctor to prescribe) a pill to lower cholesterol once the patient already has high cholesterol than it is to put in the work to prevent the condition in the first place. If the campaign for prevention could be set in motion it would spread to future generations. I truly believe that if doctors could get more compensation for keeping their patients healthy in the first place then they would spend more time educating their patients on disease prevention. If this became the norm instead of the glory of procedures we would see more of a balance between those doctors who want to specialize in preventing disease and those who want to specialize in treating the inevitable.
I hold nothing against my classmates who want to go into surgical or other non primary care specialties. I just find it sad that we have created a system where that number is so high and those who want to go into primary care is so low. We need primary care physicians. Helping people with their basic health and preventing disease is just as important as treating major diseases and it is time our health care system reflected this. It shouldn't be all about procedures, money and glory, it should be about the patients. It should be about making people well and keeping them well. I hope little by little our system can change, but if not, I guess in the future I will be doing lots of little procedures in my office to make up for all the time I will spend talking with and educating my patients, even if I can't bill for it.
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