It has often been bandied about that the shortage of primary care physicians could be a “stealth” factor in the overall reform of healthcare delivery in access in this country. There’s no doubt that the debate on health reform is multi-faceted, but left out of that debate (at least in the mainstream media coverage of it) is the role that primary care plays in economy of the general healthcare marketplace.

Each year of this decade has seen shrinking representation in the primary care specialties — most notably in the discipline of family medicine; rather ponderous medical school and training debt is often given as the reason for dwindling representation in the specialty as medical students opt for much higher paying, procedure-rich subspecialties. No surprise there. Faced with the prospect of paying back a mortgage-sized loan while trying to build a successful medical career leaves very little room for the cash-strapped novice physician to consider primary care alternatives that bestow a comfortable lifestyle and a repayment plan that won’t take another 30 years.

This scenario is playing out before our eyes all over, and in Massachusetts, it has even been cited in a recent survey based study which reports that the healthcare reform enacted in 2006 creating universal coverage to all of that state’s residents did practically nothing to alleviate emergency department (ED) overcrowding and wait times. At the same time, family docs are having a difficult time recruiting in a market that not only averages, well, an average family practice salary, but also one of the highest per capita concentrations of subspecialists in the country.

The stark results indicate that, even with coverage, access to care remains a huge problem. Patients’ answers to the primary care shortage appear to be to choose the ED doc as the primary care provider. As a result, costs continue to spiral out of control. Universal coverage has been the low-hanging fruit in the reform debate, echoed constantly by the president. Perhaps that’s the problem. It is easy to pick a circumstantial issue and magnify it as a potential solution to a serious public policy problem, but as the numbers continue to roll in from the Great Massachusetts Experiment in Universal Coverage, we are starting to see a troublesome trend: the threatened unsustainability of a healthcare economy whose reform owes much to the presence of primary care physicians but whose reality encourages otherwise. | LINK

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