Having read the Affordable Healthcare Act (ACA) the consistent theme
throughout the document is the rise in importance of Primary Care. To
fully understand how the law might work, recognizing that many many
details of "how will this be done" and "How will this be paid for" are
absent, the role of Primary Care appears preeminent in the plan.
If
you have followed the course of Primary Care providers over the last
several years; several things are glaringly in opposition to the
bringing of Primary Care into the forefront of patient care.
"Faced
with skyrocketing training debt, few Physicians now opt to make
significantly less, so the percentage selecting primary care has
plummeted. Between 1990 and 2007, the percentage of internal medicine residents becoming generalists dropped by 80%. The growing inability of primary care physicians to succeed in private practice has precipitated a wholesale flight to health systems, where many doctors become “feeders” for outpatient and inpatient services. In 2010 the Medical Group Management Association reported that the share of practices owned by physicians had dropped from two-thirds to half in only three years. That trend continues."
While
the ACA speaks of incentivizing medical students towards Primary Care;
how the industry will suddenly shift gears away from specialists and
towards Primary Care is not a clear nor easy path.
If one looks at
the European models that obviously some of the language in the ACA, the
role of the GP (UK equivalent to Family Practice) is the primary role
in that health care system. And herein lies the rub........can the US
emulate that European model to achieve cost reduction and favorable
patient outcomes without a greater emphasis on Primary Care?
"The average GP makes about 20% more
than the average subspecialist (though the specialists sometimes earn
more through private practice.). This is important in and of itself, but
the pay is also a metaphor for a well-considered decision by the
National Health Service (NHS) nearly a decade ago to nurture a
contented, surprisingly independent primary care workforce with strong
incentives to improve quality."
Many changes will be taking place
in the healthcare arena in the next few years (barring the over-turning
of the law), but one wonders how the industry will turn the ship of
health care towards Primary Care or even it has the will to do so.