Primary care -- the basic medical
care that people get when they visit their doctors for routine
physicals and minor problems -- could fall apart in the United
States without immediate reforms, the American College of
Physicians said on Monday.
"Primary care is on the verge of collapse," said the
organization, a professional group which certifies internists,
in a statement. "Very few young physicians are going into
primary care and those already in practice are under such
stress that they are looking for an exit strategy."
Primary care -- the basic medical care that people get when they visit their doctors for routine physicals and minor problems -- could fall apart in the United States without immediate reforms, the American College of Physicians said on Monday. (Lee Celano/Reuters)
Dropping incomes coupled with difficulties in juggling
patients, soaring bills and policies from insurers that
encourage rushed office visits all mean that more primary care
doctors are retiring than are graduating from medical school,
the ACP said in its report.
The group has proposed a solution -- calling on federal
policymakers to approve new ways of paying doctors that would
put primary care doctors in charge of organizing a patient's
care and giving patients more responsibility for monitoring
their own health and scheduling regular visits.
U.S. doctors have long complained that reimbursement
policies of both Medicare and private insurers reward a
"just-in-time" approach, instead of preventive care that would
save money and keep patients healthier.
"Medicare will pay tens of thousands of dollars ... for a
limb amputation on a diabetic patient, but virtually nothing to
the primary care physician for keeping the patient's diabetes
under control," said Bob Doherty, senior vice president for the
The ACP plan called for innovations such as using e-mail to
consult on minor and routine matters, freeing up expensive
office visit time for when it is needed. Doctors would be
compensated for an e-mail consultation.
The proposals include incentives for doctors to work more
efficiently and to provide better care, ACP President Dr. C.
Anderson Hedberg told a news conference. "ACP proposals would
provide patients with access to care that is coordinated by
their own personal physician," Hedberg said.
Young Doctors Avoiding Primary Care
The ACP cited an American Medical Association survey that
found 35 percent of all physicians nationwide are over the age
of 55 and will soon retire.
In 2003, only 27 percent of third year internal medicine
residents actually planned to practice internal medicine, the
group said, with others planning to go into more lucrative
"Primary care physicians -- the bedrock of medical care for
today and the future -- are at the bottom of the list of all
medical specialties in median income compensation," the ACP
The group, which represents 119,000 doctors and medical
students in general internal medicine and subspecialties, joins
others that warn the U.S. health care system is untenable.
"If these reforms do not take place, within a few years
there will not be enough primary care physicians to take care
of an aging population with increasing incidences of chronic
diseases," said Dr. Vineet Arora, chair of the College's
Council of Associates.
Dr. Sara Walker, a Missouri physician, said she believed
doctors were leaving general practice because of drops in
Medicare reimbursement to doctors.
"A drop in Medicare payments will not only force me to stop
taking Medicare patients but could force me out of business,"
agreed Dr. Kevin Lutz, a solo practitioner in Denver.
Copyright © 2006 Reuters Limited