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 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."
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 ACP.
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 specialty jobs.
"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 said.
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.