Primary Care vs. Specialists
Very few people will argue against the notion that our healthcare system is in shambles; however, even fewer people have a legitimate plan for resolving the problem. Yesterday afternoon, two Baylor Med MD/MBA students gave a presentation for the last health policy elective session in which they provided their insight as to how focusing on primary care is the solution.
Primary care has never crossed my mind as a career possibility as I’ve been set on neurosurgery for quite some time. Surprisingly, this inclination towards specialty residencies is shared by the overwhelming majority of my class, and in comparison to previous years, the number of residents in primary care is gradually dwindling. The New York Times published a fantastic article addressing this very issue which I highly recommend.
Now let’s consider a hypothetical scenario. You wake up one morning with unbearable pain localized to your upper left abdominal quadrant (stomach region). You’ve got two logical choices: visit a gastroenterologist (specialist) or your regular physician (primary care). You end up choosing the gastroenterologist because, after all, he/she has been trained to deal with abdominal symptoms for years. After a plethora of expensive tests, you’re diagnosed with a mild case of stomach poisoning. What if the primary care physician could have told you this same diagnosis for less than half the cost?
A few observations can derived from this:
- The specialist had to take time to examine a relatively simple case.
- The patient (and insurance companies) had to spend more than required.
- The primary care physician could have made this diagnosis… probably with less time spent scheduling an appointment.
An interesting proposition made during the presentation was using primary care physicians (PCPs) as a buffer between patients and specialists. In other words, a patient would always present to a PCP and then, if necessary, be referred to a specialist.
This suggestion implies that without an increase in PCPs, the current generation will be working extended hours to meet the increased patient inflow. At this point, an inevitable question must be brought up – how do we adjust physician salaries? The two students argued in favor of increasing PCP salaries (currently, one of the lowest paid physician salaries) while simultaneously decreasing specialist salaries. I’m under the impression that some specialists wouldn’t have been specialists if it wasn’t for the cozy paycheck, but in any case, we have to consider several factors.
- Specialists receive more training (and accumulate more debt)
- Specialists tend to deal with more risky cases (higher malpractice)
- Both specialists and PCPs tend to work roughly the same number of hours
Reducing the compensatory gap between specialists and PCPs is a touchy subject indeed, but what better incentive to attract aspiring medical students towards primary care than an increased salary? Why not focus on primary care physicians to lower healthcare costs from the get go – the patient coming in for treatment?
I really have no fair argument for or against this, but I thought it was an interesting perspective which I had never thought about before. Hence, a blog post. 🙂