Matt writes
I asked that question – and not to be a smartass. But if the definition was as you state, you seem to be simply asking that society pay more money for this care. Where does this money come from? Who is it taken away from?
Society cannot change your practice model – only you physicians can. Society cannot change your reimbursement model – only you can. The only way society can change your reimbursement model is if we go to single payer. Although I suppose we could alter the tax laws to make employer provided health insurance less advantageous and thus push more people into HSAs and simply paying out of pocket for minor issues. But how likely is that?
At the end of the day, this comes back to you physicians. If you believe primary care physicians should be paid more, and they are truly valuable, stop agreeing to take so little from the third party payers for the service. The third party payers will value you more when you value yourselves more.
Matt is mostly correct, except I strongly believe that changing the model will save money. Having a medical home is cost saving. Some want to create medical homes under the present reimbursement scheme. I believe we (generalist physicians) must rebel against that model.
In fact many physicians are rebelling. Some physicians have gone to cash only practices with success. We have a steadily increasing number of physicians providing retainer medicine. This model succeeds because it fulfills patient needs.
Matt does provide important guidance. Generalist physicians should not continue to accept that status quo. Many general internists have voted with their feet – they have become hospitalists.
Market forces are starting to have the expected results. Generalist care provides important advantages – comprehensiveness, continuity, and the ability to consider the patient’s complexity. Patients are looking for such physicians.
As we have a growing deficit of such physicians, the insurers and patients will have ever increasing demand. We know what happens when demand exceeds supply.
Generalist physicians must take charge of redesigning their practices.
The biggest problem is that generalist physicians tend to be very nice. We tend not to “rock the boat.” I hope we have the courage to capsize the boat.
