At our medical staff mid-year meeting we discussed in depth how primary care is so necessary to manage chronic illness, provide preventive services and keep health care costs down. One study showed that the more primary care doctors are available in an area, the lower the disease burden and mortality in that area.
The major barrier to providing good primary care to a group of people is that there just aren’t enough of us. Let’s face it, doctors are really smart people. If we’re smart enough to get into medical school, we’re definitely smart enough to figure out that going $300,000 into debt to pay for our education requires careful thought about our specialty choice after school.
Primary care compensation is at the bottom of the barrel as far as medical specialties go. The three medical specialties with the lowest compensation are, in order, family medicine, general pediatrics and general internal medicine. (Yes! I’m number one!!)
I’m an assistant professor in Case Western Reserve University School of Medicine’s Department of Family Medicine and Community Health. I work with students regularly and one of my goals is to show them why they should consider primary care. It’s definitely never boring!
I also tell them I completely understand why primary care is hard to sell to students who are paying $46,000 per year for their education. So how can we get more medical students to choose primary care?
The bottom line is that we need to pay primary care doctors more. We need to pay primary care doctors more, and specialty doctors less. And we need to insist that primary care level of care is provided by primary care doctors, NOT specialists.
What do I mean by that? I mean that care that CAN be provided by primary care doctors SHOULD be provided by primary care doctors. There is absolutely no reason for a patient to see a gynecologist for a routine Pap tests. I can’t get my patients in to see a gynecologist when they have an abnormal Pap test, fertility concern, excessive bleeding or pelvic pain because they are too busy doing routine Pap tests.
Endocrinologists are not needed to manage routine hypothyroidism. Patients think if they have high cholesterol they need a cardiologist, if they have migraines they need a neurologist, and if they’re depressed they need a psychiatrist.
These people ONLY need a primary care doctor. We manage ALL of this, quickly and in many cases better and in a more cost-efficient manner than the specialists.
So this is my suggestion for controlling health care costs and incentivizing medical students to see primary care as a more desirable option. First we need to increase payments to primary care doctors for the work they do. Then we can offset that spending by either refusing to pay specialists to do primary care work, or by paying them what primary care doctors make to do the same work.
If an endocrinologist gets paid what a family doctor receives to manage routine hypothyroidism, that will save money because, believe me, the endocrinologist gets paid more than I do to do that same job. If that causes endocrinologists to tell patients their family doctor can manage their thyroid, so much the better. Maybe then it won’t take me 3 months to get someone who needs a hormone workup for an unusual problem in to see the doctor they need.
With the current furor about the pay gap between women and men and between white workers and minorities, I would suggest the pay gap between primary care doctors and specialists is just as shameful. It is time for Medicare, Medicaid and private insurers to pay primary care doctors properly for the work we do. And if specialists choose to provide primary care services, they should get paid what we get paid for that.
QUESTION: Did you know there is a pay gap between primary care and specialty doctors?