Primary Care in Crisis

As the presidential election draws closer, many are watching the candidates to see how they propose to reform the nation’s healthcare system. Plans from Senator Obama and Senator McCain both involve ways to extend healthcare coverage to more of the nation’s 45 million uninsured. That’s a laudable goal, according to a recent NY Times report, but it may make another healthcare crisis—the critical shortage of primary care doctors—even worse.

Fewer medical school graduates are choosing to specialize as family physicians, internists, and pediatricians, and many younger doctors are leaving these specialties, according to a study by the American Medical Association. Among the reasons for the shift to specialties like cardiology and orthopedics is the low income levels for primary care doctors. One the reasons behind the lower incomes is the healthcare reimbursement system’s emphasis on paying for procedures.

A major function of a primary care doctor is to listen to his or her patients and to help them deal with chronic illnesses like diabetes and heart disease. But Medicare and managed care plans generally don’t pay for time spent listening to patients; they pay for procedures that the doctors perform or for the number of patients that a doctor sees. The result is a form of assembly-line medicine where the patient gets six to eight minutes of a doctor’s time—the average under managed care—to talk about health issues. Under these time constraints, doctors often focus on a patient’s primary illness and ignore any other problems the patient may have.