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.