Seniors have become a privileged class of patients

Kristofer Sandlund, MD’s letter, “Primary care fixes come too late” (Medical Economics, February 10, 2013) demonstrates precisely, if unintentionally, the greatest flaw in our collapsing system. He notes the widespread lack of interest in primary care and laments that there is no one to “pass the torch to.”

Sandlund describes a growing disparity between his office overhead and what Medicare pays, resulting in seniors becoming a money-loser to his practice. He assigns the cause of this to the need to “expand my payroll to meet the ever-growing paperwork and administrative duties.”

The article correctly describes the huge bait-and-switch of the 1990’s, wherein promises of a stable and satisfying career in primary care actually suckered medical students into a grinding, poorly paid, paperwork, and penalty morass. I know, because I was one of those fooled. But I took away a very different lesson than that which Sandlund would teach.

Sandlund accurately describes the symptoms without acknowledging the root cause of the disease. He precedes his recitation of gloom with the observation: “Our patients over the age of 65 are those with the greatest health needs, and in my view, they are the most deserving of quality care” (my emphasis added).

It is that sentiment that unwittingly transformed elderly patients from individual patients to a commodity, and ultimately, to a liability in the author’s own words. On what basis do we assume that seniors are the “most” deserving?  It is seniors who are able to consume far more from the system then they contribute, handing the difference to the rest of us. It is their demographic that became the political bully which gave government license to force SGRs, EHRs, ICD-10, pay-for-performance, and audits threatening criminal prosecution of physicians, among other items in the rotten cornucopia that is government-sponsored compassion.

We created a privileged class of patients, empowered with endless wants. Politicians guaranteed satisfying these wants, abetted by physicians and hospitals that were happy with the easy flow of cash. It was this unbalanced equation, ignored by Sandlund, which has put primary care into a death spiral.

My solution is to first recognize this cause-and-effect as a way to salvage and rebuild.  Please spare me the reflexive accusations of “hating seniors,” which are merely a way to dodge the issue. What I hate is being lied to by politicians, bullied by bureaucrats, and taken for granted by those that put them in power.

Like Sandlund, I know the value of primary care as a discipline, and would like to make things better.  But until we acknowledge what went wrong, we cannot put it right.

Patrick Conrad, MD

Port Saint Joe, Florida