Two recent articles illustrate how healthcare policy consistently creates barriers to advancing primary care.
In the first, Debra L. Glasser, MD boldly declares that internal medicine primary care is dead, and she offers a powerful summary of the reasons for the decline:
"Why are they not choosing primary care? Primary care is the lowest-paid specialty at a time when medical education is not strongly subsidized (medical students can incur up to $500K of debt). It no longer offers professional satisfaction, continuity of care, and collegiality.
Primary care physicians are the most overburdened by administrative tasks. They are increasingly pressured to see more patients in shorter time slots, and it feels impossible to offer quality care. Many work for large systems where they feel powerless to effect change.”
The second article by Randy Dotinga reports on recent research documenting the excessive burden of numerous and diverse quality measures required of physician value-based programs. One physician group had 57 different quality measures across multiple insurers. The research concluded that “The magnitude of that number surprised us…Primary care physicians and their practices have a lot on their plate. Now we know one of those things is a very large number of different quality metrics to pay attention to, measure, report on, and implement.”
By the way, there is little evidence that using these burdensome quality measures improves the quality of care.
In summary, we have a severe and increasing shortage of primary care physicians to serve the growing elderly population, and we have intentionally created a health policy to make it worse. We need to immediately start creating health policy to promote and support primary care physicians. That policy needs to pay them better and dramatically simplify their work environment. My book The Journey’s End offers one path to make that policy a reality.
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