Primary Care Physicians Are An Endangered Species by Dr. David Lipschitz on Creators.com

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Primary Care Physicians Are An Endangered Species

Almost daily, I receive an email from someone who cannot find a physician willing to accept Medicare.

New patients frequently make appointments with me because their primary care physicians have retired and no one will take on Medicare patients. Whether it's an internist, a family practice physician, or a specialist, the number of physicians who refuse to see Medicare patients is astounding.

But it is not simply a lack of interest in the 65-plus population that is forcing these physicians to turn patients away; rather, it is the abysmal reimbursements for primary care that handcuffs doctors and hinders patients.

This general reluctance to care for the Medicare population indicates a much bigger problem in American health care — we are losing our foundation of primary care. In the field of medicine, pediatric cardiologists and sports medicine surgeons have almost celebrity status, while the bread-and-butter care of geriatrics and family practice falls sadly to the bottom of the heap. For the 77 million baby boomers approaching old age, this spells disaster.

Today, the average age of a primary care doctor practicing medicine is well beyond 50 — they are baby boomers themselves — and their retirement is also on the horizon. Of much greater concern, no one is coming to replace them. Very few medical students are electing to practice primary care.

Speak to a first-year medical student and invariably the student will have charted a path to specialty medicine. With enormous debts saddling the average medical student, graduates generally make career decisions based on lifestyle and the potential of a high salary that will allow the rapid repayment of debt. The competition to enter a residency in dermatology, ear-nose-and-throat surgery, orthopedics and cardiology is fierce, while family medicine and internal medicine residencies remain unfilled.

Specialty medicine, where physicians can practice cutting-edge procedures and find cures to disease, is exciting and rewarding to aspiring doctors. On the other hand, practicing primary care is hard work.

Primary care physicians must see many, many patients per day to accumulate a good salary.

Many primary care physicians become "burnt out"; they often work 10 hours a day or more, have huge overhead expenses and have difficulties making ends meet. Facing threats of litigation or jumping through hoops to get tests approved is a very frustrating process.

In a recent edition of the New England Journal of Medicine, a panel of experts offered some solutions to make primary care a more attractive career.

Possibilities suggested include "reinventing the field," emphasizing the rewards of being fully involved in all aspects of caring for patients and their families; increasing reimbursement for primary care and considering models of health care that are practiced in most European countries, where the disparities in pay between primary care physicians and specialists are not as wide as in the United States. Other alternatives suggested include abandoning the primary care physician altogether, allowing nurses or physicians assistants to assume the responsibilities of ground-level care.

As a geriatrician, I believe the primary care physician is critical to health-care reform. A successful and empowered primary care physician coordinates care and avoids unnecessary procedures, actively assures that care is practiced on the basis of sound scientific evidence of benefit, and minimizes referrals to specialists — all proven ways to reduce health-care costs.

We must strengthen the role of the primary care physician and embrace policies that promote quality of care, not quantity. As medical schools increase class size to meet the needs of an aging society, we must have incentives to assure that a majority of trainees enter primary care.

This can be accomplished through loan forgiveness programs, higher salaries, reducing the availability of specialty training programs, or making a long-term commitment to primary care a requirement for acceptance to medical school. Specialist physicians play crucial roles in American health care, but we can no longer afford to ignore primary care.

In the coming years, healthcare reform will be front and center. If true change is to come, we must include the primary care physician as a centerpiece of the plan.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

11-30-08