Brian Klepper, PhD


December 12, 2008


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Over the last couple decades, America's primary care physicians -- PCPs -- have been relegated to medicine's lowest caste.[1] But many employers, who pay for the waste that results from tying PCP's hands, now see them as healthcare's most probable saviors.

In 2008, cardiologists take home up to 4 times more than PCPs,[2] who often report they don't have time to properly talk with patients. Now just 7% of medical students enter office-based primary care.[3] Why not become a specialist and make more? Aging boomers will quickly outstrip our dwindling supply of PCPs.

PCP-specialist pay discrepancies are traceable to the AMA's secretive, specialist-dominated RVS Update Committee that has consistently advised Medicare to pay specialists more at PCPs' expense. Medicare heeded them and commercial plans followed, marginalizing PCPs and costs exploded.[4] Then employers noticed that more PCPs and fewer specialists produce more efficient healthcare.[5] America's PCP-specialist ratio is about 30/70, but in other developed countries it is 70/30; their costs are half ours; and their outcomes are often better.[6]

So how do we reempower our 250,000 community-based PCPs?

The Patient-Centered Primary Care Collaborative -- Fortune firms, business health coalitions, primary care associations, and health plans -- laid out steps[7] for leveraging primary care to change our larger health system.

Pay PCPs more to reduce their patient loads with more time for patients. Help them acquire patient management information technology tools. Update the PCP-specialist engagement rules to involve PCPs when their patients need advanced care.

Some will oppose these measures. Health plans are key, but if you're a PCP, show this to your community's business leaders. Suggest they pointedly ask their health plans, "What are you waiting for?"

That's my opinion. I'm Dr. Brian Klepper, a healthcare analyst from Atlantic Beach, Florida.



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