Friday, August 20, 2004

The Decline of the Family Doctor?

I came across an article that I had seen a while ago, but never finished (until now), troublingly titled, "The Decline of the Family Doctor". It offers a thoughtful and insightful analysis into why the United States health care system is in the trouble it is in, and how a large part of that is due to changes in how primary care has been valued as a society.
"In the early 1990s, managed care attempted to use primary physicians and nurse practitioners to improve access and quality while, at the same time, keeping costs down. There was talk of the primary physician as the coordinator of all medical care. It didn’t work, and the backlash resulted in a decline in prestige, job satisfaction, and income for primary physicians. Many of the young physicians who flocked to the field felt cheated and misled."

I remember that time in the early 90s when FPs were in demand, and were given the role of "gatekeeper". However, it was not a welcome role, as I and this author observed:
"Furthermore, naming the primary physician as a “gatekeeper” whose approval is required by HMOs before patients can see a specialist suggests more of an obstacle than a caregiver. Personally, I have never encountered rudeness like I saw from HMO patients who came to see me because they were required to do so rather than because they wanted to. This is especially true when they had no interest beyond obtaining a referral slip to see a specialist whom they had already chosen themselves. It is difficult to know how to feel toward such patients and to function properly as a physician for them."

I used to think that a single national healthcare system was the answer. But more and more, like this author, I'm thinking that a single-payer system isn't the answer.
"The first principle is pluralism. Imposed one-size-fits-all and one-fee-fits-all solutions are incompatible with the American tradition and will not work. Choice and diversity must be maintained if American medicine is to remain vibrant, creative, and attractive as a career."