Wednesday, June 06, 2012

A Perfect Storm - the first ingredient

So where to begin...what caused the demise of my practice was essentially various factors and elements that led to a perfect storm.  I'll blog about each one of these elements from one posting at a time.  Some of this, if you've been reading this blog already, may be old news but I'll figure it may be good to revisit them.

The first and important factor is physician pay for primary care physicians like me.  As you can see in this graph, this is the layout of average salaries for physicians in different specialties.  This was discussed to some degree in this blog post on KevinMD.

We must redesign our health care payment systems to value primary care

Now you're saying, "That doesn't seem so bad...", but keep in mind this is an average.  And most family physicians are in group practices and are subsidized by their parent organization (hospital, multi-specialty groups) to cover the budget loss due to insufficient reimbursement for primary care physicians.  The other part that is also not seen in this graph is that for most family physicians, to keep up their end of the deal to be a part of these larger organizations, is that they have to see more to get more.  It's still not enough, but it's better than nothing.  What happens when you see more in a finite amount of time?  Less time with patients.  I learned about this perverse system more than 10 years ago in residency and all I can say is that this has not changed at all.  In fact, it's getting worse.

Stepping back, and looking at that graph, wouldn't you agree that if we were to truly talk about preventative care and prioritizing the health of our children and young adults, shouldn't this graph be a mirror image?  In my opinion, our health care priorities are not in line of what we know to be true.  I understand that doctors who do very risky and complicated procedures should be compensated duly for their education and the work that they do, but at the very least, shouldn't we be prioritizing the work of primary care physicians who try to keep patients from being in a hospital, keeping them from major procedures to prolong their life due to easily preventable lifestyle changes and other less costly interventions?  Is there not an investment in keeping people healthy rather than spending billions of dollars on futile measures?  Wouldn't we be saving money as a society rather than paying more for things that do not provide an investment in the wellness of the society starting with children?

Think about it...

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