The corporatization of medicine has destroyed primary care as a specialty. The primary care physician is supposed to be your go-to doctor, your advocate, the coordinator of your health care. Now that corporations buy out hospitals and private practices in an almost predatory fashion, the priority is turning a profit for the corporation at the expense of not only patient health but also the health and well-being of the primary care physician. Who do you think bears the brunt of patient frustration and public misconception? The PCP.
Patients actually accuse salaried primary care physicians of being greedy, “that’s why you don’t spend enough time” during those seven-minute visits. The reality is that in corporatized medicine, the physicians don’t make the rules. More often than not, hospital administrators with no clinical background or experience dictate how these practices are run. They decide how many patients you need to see in a day to turn a profit, to maintain the salaries of superfluous middle managers.
Primary care has become an unsustainable specialty. The average internal medicine patient, especially the older demographic, has numerous chronic medical issues. How does a primary care physician address their concerns in such a short visit, much less develop a relationship, which is just as important to patient health?
At the beginning of my career, I took great joy in learning about each patient, their family and home dynamic, having two minutes to chat about “how’s the family?” Now, it’s a challenge to make eye contact, as the pressure to document on the electronic medical record to maximize reimbursement and prevent litigation is the priority.
The nail in the coffin? There are several. In one of the wealthiest nations in the world, why are our patients so chronically ill? Rates of obesity, autoimmune disorders, cancer, cardiovascular disease are increasing. Assembly line medicine has led to “band-aid” medicine, relying heavily on pharmaceuticals to put out fires, because who has the time to focus on prevention and lifestyle counseling? Oh, and those greedy, millionaire PCPs, as the public perceives them? Their salaries actually go down every year, and they have to make up the difference by seeing more patients, in these poorly constructed RVU systems. Physician burnout is at a record high, understandably so. Primary care physicians are leaving medicine in droves. An already existing shortage will reach devastating levels in the very near future. Corporations like Walmart are opening clinics staffed mostly by nurse practitioners.
Who will care for the complicated patients, who may have rare illnesses in addition to the common fare like diabetes?
I fear for the future of health care in this country. Until the day physicians become as well organized and as strong a lobby as nurses, pharmaceutical companies, and health insurance companies, primary care is doomed as a specialty. Rest in peace, primary care.
By becoming employees of corporate medical systems over the past 40 years (beginning with HMOs) clinicians unfortunately lost the autonomy they had when owning their practices.
Optometrists face the same situation now even if they own their practices due to vision care plans and insurance companies setting fees that produce a price “race to the bottom.”
Today’s private optometric practices carry heavy incentives to see far more patients than ever before.
America remains the only advanced Nation in the world that allows direct-to-consumer media advertising of medications and procedures and the World Health Organization ranks American health care below many other countries. And ours is the most expensive.
In addition, while the percentage of our Gross Domestic Product spent for health care rose from about 7% to over 16% patient (and clinician) satisfaction declined.
All of which is why one sees references to the “health care industry” rather than the “health care profession” and to “health care providers” rather than “doctors.”
Kenneth J. Myers, Ph.D., O.D.