What issues are facing primary care physicians in the near future? A nice article by Eugene Rich and Anna Maio discusses just this topic in their paper “Late to the Feast: Primary Care and US Health Policy.”
Some issues discussed are:
- How FFS payment systems compare to prepaid-group practice with regards to the type of care provided to patients.
- The increase in HMO popularity in the early 90s lead to an increase in the popularity of generalist career choice among medical students, but the subsequent HMO backlash has reduced the number of graduating medical students choosing primary care specialties.
- Medicare and most private payers do not reimburse telephone or email conversations, and thus valuable, low-cost primary care services are not preformed.
- The paper broaches the possibility of the primary care physician as ‘a medical home’ or a facilitator of care coordination. “The United States faces rapidly growing numbers of older individuals with multiple chronic illnesses. The benefits of increased access to specialized physicians may be subverted by failures in care coordination among multiple independent specialist offices.”
- Some hypothesize that American cultural norms favoring high-tech treatment explain the paucity of primary care expenditures. Rich and Maio claim that this argument is false. Germany and Switzerland both have experienced a rapid increase in the amount of medical technological advances, yet “…primary care physicians in these countries are more prevalent and better compensated when compared with specialized physicians.”