How quickly everything changes. I’ve written many columns
about the way things used to be. Everyday things pop up that
remind us all of what once was and how different it is today — how
things change and what the changes produce.
Some of those changes seem to be at the center of today’s
news about the medical field. Of great importance the fact
a family doctor — now called a primary care physician — (PCP
in medical shorthand) — is becoming hard to find. In
my own family experience, six doctors have left their practice
in the past few years. Some joined hospital staffs, some retired,
some moved to a distant area (where things may not be so demanding)
and some may have worked so hard trying to care for so many
patients — they became one.
In years past, the family doctor made house calls. They
actually came to your home, with their black bag, to
help an ill family
member. As medicine advanced, doctors developed office
facilities that quickly became so advanced it was impossible
to take
all the equipment needed to the patient’s home. It was determined
patients would receive better care by visiting the doctor’s
office.
Today’s medical fields are made up of specialists. Major
research hospitals are full of them and statistics indicate
most students in medical schools are studying to be one. There
are few general practitioners. Those that remain are overloaded,
overworked, underpaid and under appreciated. A problem exists
that in order to see a specialist you often need a referral
from your PCP. The specialists require you have a PCP for them
to report their findings to and many insurance companies demand
it, therefore responsibility for care remains with the PCP.
If you do the math, a conclusion is obvious: The number of
primary care physicians is diminishing yet demand for them
is increasing.
The
results of the present condition of overloading the primary
care doctors’ leads to a limitation of patients they
can see. One often hears the statement, “the doctor is
not taking any new patients.” The PCP has the
burden of specialists expecting them to evaluate their
reports, including
all tests such as x-rays, scans, labs then determine
diagnosis and treatment. At some point, the PCP also
must examine and
talk with the patient in the limited time insurance
companies demand. It appears to me primary care doctors
should be paid
a higher rate then specialists since they are expected
to serve as the referring doctor and doctor who determines
and acts
upon the results. Is it any wonder many family doctors
are unhappy with the medical field and are leaving?
In many cases, NPs and PAs are filling the gaps left
by departing PCPs. My family has experienced some
that are
great and we
were grateful to them, but we also suffered a great
deal of stress because of a few who really did not
measure
up.
As I see it, insurance companies are creating many
of the problems for doctors and their patients.
They limit
the
amount of times
they will pay for a visit, the number of days a
patient may spend in the hospital, how often a lab
test can
be done and
what types of drugs may be prescribed. Restrictions
on when preventive care, such as mammograms and
PSA tests,
can be
paid for are common.
The government pre-set fees for health care are grossly
unfair and ridiculous. How can someone sitting in a
politician’s
office or an insurance company’s office determine how
much a surgery should cost? Do they have medical degrees? How
can an insurance company dictate at what age a person should
receive preventive care test? How can they demand a primary
care doctor see a patient before any testing is done, then
dictate what test can be allowed and at what age?
Recent newscast revealed insurance companies are paying
$20 for one Tylenol and $300 for $90 forceps, yet
they dictate
strict limits on what family doctors may charge.
I have a question — if
an insurance company is charged $20 for a person with insurance
to get a Tylenol, how much does someone with no insurance have
to pay? I just don’t believe the Government Health Care
Reform bill will repair our problems with the system. If everyone
is forced to have insurance, will everyone be paying $20 for
each Tylenol?
Another question — if we lose our primary care physicians
and specialists require we see one before and after their consults — what
good is insurance going to do even if the government requires
everyone have it? The new health care law will not resolve
the problem of who is going to provide the needed care.
My advice is if you are fortunate enough to have
a PCP, treat him or her with great consideration.
When
you have
an appointment,
take a list of your medications, any test results
you may have along with a list of questions you
need answered.
Try to keep
your visit short because I’m sure there is another patient
waiting to see your doctor.