Primary care seeks more pay, respect for undervalued services

The American College of Physicians is the latest organization to call for drastic changes to avert a primary care physician shortage.

By Myrle Croasdale, AMNews staff. Feb. 27, 2006.

Despite improved efficiencies, it's a challenge for New Hampshire internist Fred Kelsey, MD, and his eight partners to see enough patients to break even while still giving them the care they deserve.

The time and financial pressures lead to physician burnout, resulting in Mid-State Health Center in Plymouth, N.H., having the same difficulty that others around the nation have faced in recruiting young doctors. The pool of applicants has shrunk as fewer U.S. medical graduates choose careers in general internal medicine, opting instead for higher paying specialties or specialties with fewer hours.

"The No. 1 dissatisfaction of primary care physicians is the time pressure," Dr. Kelsey said. "We need time to take care of these people. We can't talk faster, and patients can't learn faster. We need time."

But that time isn't reimbursed by health insurers or Medicare. Now American College of Physicians leaders are proposing a way to change that. The ACPis among several physician associations that hope through change they will be able to re-ignite waning interest in specialties crucial to the health care system as it cares for a growing and aging population. They also hope new models will improve the care physicians can give to chronically ill patients.

On Jan. 30, ACP leaders called for a national Medicare demonstration project that would test a new model of care that links higher reimbursement to the time-intensive care that produces healthier patients. ACP calls the model the "advanced medical home" and wants the Centers for Medicare & Medicaid Services to launch a pilot project on it by 2007, a request CMS says it would consider.