Medicine
A Graham Center Policy One-Pager in the April 1st issue of American Family Physician uses historical data to project the effect of the 2010 Primary Care Residency Expansion Program (PCRE). By its conclusion in 2015, the PCRE program will have funded an additional 900 residency trainees in family medicine, general internal medicine, and general pediatrics above the current cap on Medicare-supported residency positions. Based on historical trends, though, only 39 percent of internists in these particular programs will end up practicing primary care, compared to 51 percent of pediatricians and 92 percent of family physicians. As a result, only about two-thirds of these residents are likely to enter the primary care workforce. Of course, 600 new primary care physicians are better than none, but at an estimated $100,000 per year per resident, this well-intentioned federal program will also spend $90 million to train additional internal medicine and pediatric subspecialists that are already in plentiful supply.
In addition to modest programs like PCRE, big ideas are needed to transform U.S. health care to a patient-centered system, grounded in primary care, that delivers the best possible health outcomes for all. Corey Fogleman, MD and Thomas Gates, MD propose several in a recent article in the Journal of Lancaster General Hospital, including:
1) Making medical school free, and providing residency training stipends only to graduates who choose primary care programs
2) Direct primary care: "eliminating the middle-man of third-party insurance"
3) Single payer systems providing universal insurance coverage on the state level
Of these three big ideas, direct primary care (discussed in a previous guest post on Common Sense Family Doctor) appears to face the fewest political and logistical obstacles and is rapidly becoming a reality in communities across the country. Drs. Fogleman and Gates observe:
Advocates of this approach point out that insurance is meant for large unexpected expenses, while expenses for primary care are relatively modest and predictable. It makes little sense to pay for these through an insurance model, any more than it would make sense to buy auto insurance to protect from the cost of an oil change or new tires. Instead, patients in direct primary care contract directly with a primary care provider for access to a broad range of office-based primary care services, in return for a monthly or annual retainer fee.
Unlike “concierge medicine,” the fee is modest (usually on the order of $500-$1000 per year), and can complement high-deductible or catastrophic insurance (which would cover large and unexpected expenses like hospitalization). An element of competition safeguards consumers: practices that don’t deliver quality and accessible primary care will quickly lose patients.
- Primary Care Training: Follow The Money
Training any kind of doctor is time-consuming and expensive, but the way teaching hospitals are financed often means that it is more profitable to open a subspecialist residency program than one in primary care. In a previous post, I reviewed a Robert...
- Let's Get Creative In How We Provide Health Care To The Poor
When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled...
- Guest Post: Why The Direct Primary Care Model Would Benefit Poor Patients (2 Of 2)
This is the second of two guest posts by Dr. Marguerite Duane. Part 1 is posted here. ** What about specialty care? In the Direct Primary Care model, physicians have more time to spend with their patients to diagnose and treat problems appropriately;...
- Guest Post: Why The Direct Primary Care Model Would Benefit Poor Patients (1 Of 2)
Dr. Marguerite Duane is the past medical director at Spanish Catholic Center of Catholic Charities of Washington, DC; a member of the Folsom Group; and co-founder of the Fertility Appreciation Collaborative to Teach the Systems (FACTS). She will attend...
- The "single Payer" Should Be You
When some people say that the U.S. should have a "single payer" health care system, they're generally talking about a system in which government is the exclusive payer of all health care bills. It's tempting to think that in such a system, the...
Medicine
Direct primary care called one of health care's "big ideas"
A Graham Center Policy One-Pager in the April 1st issue of American Family Physician uses historical data to project the effect of the 2010 Primary Care Residency Expansion Program (PCRE). By its conclusion in 2015, the PCRE program will have funded an additional 900 residency trainees in family medicine, general internal medicine, and general pediatrics above the current cap on Medicare-supported residency positions. Based on historical trends, though, only 39 percent of internists in these particular programs will end up practicing primary care, compared to 51 percent of pediatricians and 92 percent of family physicians. As a result, only about two-thirds of these residents are likely to enter the primary care workforce. Of course, 600 new primary care physicians are better than none, but at an estimated $100,000 per year per resident, this well-intentioned federal program will also spend $90 million to train additional internal medicine and pediatric subspecialists that are already in plentiful supply.
In addition to modest programs like PCRE, big ideas are needed to transform U.S. health care to a patient-centered system, grounded in primary care, that delivers the best possible health outcomes for all. Corey Fogleman, MD and Thomas Gates, MD propose several in a recent article in the Journal of Lancaster General Hospital, including:
1) Making medical school free, and providing residency training stipends only to graduates who choose primary care programs
2) Direct primary care: "eliminating the middle-man of third-party insurance"
3) Single payer systems providing universal insurance coverage on the state level
Of these three big ideas, direct primary care (discussed in a previous guest post on Common Sense Family Doctor) appears to face the fewest political and logistical obstacles and is rapidly becoming a reality in communities across the country. Drs. Fogleman and Gates observe:
Advocates of this approach point out that insurance is meant for large unexpected expenses, while expenses for primary care are relatively modest and predictable. It makes little sense to pay for these through an insurance model, any more than it would make sense to buy auto insurance to protect from the cost of an oil change or new tires. Instead, patients in direct primary care contract directly with a primary care provider for access to a broad range of office-based primary care services, in return for a monthly or annual retainer fee.
Unlike “concierge medicine,” the fee is modest (usually on the order of $500-$1000 per year), and can complement high-deductible or catastrophic insurance (which would cover large and unexpected expenses like hospitalization). An element of competition safeguards consumers: practices that don’t deliver quality and accessible primary care will quickly lose patients.
A collection of articles about direct primary care and membership-based practices is available on the Family Practice Management website. Clinicians and policymakers interested in learning more about direct primary care should also consider attending the second Direct Primary Care National Summit in June (registration code: MDUADPC).
**
A slightly different version of this post first appeared on the AFP Community Blog.
**
A slightly different version of this post first appeared on the AFP Community Blog.
- Primary Care Training: Follow The Money
Training any kind of doctor is time-consuming and expensive, but the way teaching hospitals are financed often means that it is more profitable to open a subspecialist residency program than one in primary care. In a previous post, I reviewed a Robert...
- Let's Get Creative In How We Provide Health Care To The Poor
When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later ruled...
- Guest Post: Why The Direct Primary Care Model Would Benefit Poor Patients (2 Of 2)
This is the second of two guest posts by Dr. Marguerite Duane. Part 1 is posted here. ** What about specialty care? In the Direct Primary Care model, physicians have more time to spend with their patients to diagnose and treat problems appropriately;...
- Guest Post: Why The Direct Primary Care Model Would Benefit Poor Patients (1 Of 2)
Dr. Marguerite Duane is the past medical director at Spanish Catholic Center of Catholic Charities of Washington, DC; a member of the Folsom Group; and co-founder of the Fertility Appreciation Collaborative to Teach the Systems (FACTS). She will attend...
- The "single Payer" Should Be You
When some people say that the U.S. should have a "single payer" health care system, they're generally talking about a system in which government is the exclusive payer of all health care bills. It's tempting to think that in such a system, the...