There is already a severe shortage of primary care doctors in the state
A third of the primary care doctors who are currently practicing in MA are approaching retirement in the next few years
Very few young doctors are entering the field to replace those retiring doctors
Hence, the shortage of doctors is going to get much, much, worse over the next few years.
The article discusses a proposal called “Primary Care For You” that would attempt to rectify the problem. Unfortunately, while it’s certainly a good thing that somebody is paying attention and at least trying to remedy the crisis, I’m not very optimistic from the reporting in the article that this plan will make much of a difference.
As best I can get from the article, the plan (which is difficult to understand fully as it sounds complex) would attempt to get various stakeholders (hospital systems, insurance companies, etc) to pay into a “stabilization fund”, which would then be used to give a pay raise to primary care practices that can demonstrate that they provide “quality care.”
While this sounds great in theory, the effort at reimbursing doctors based on “quality” has in fact been in full swing for over a decade now and is, I believe, one of the root causes of the epidemic of burnout and of doctors leaving the field. I’ve in fact previously written a piece about this very topic under a pseudonym (several years ago, before I left my corporate practice and hence didn’t feel free to critique certain things using my own name) which I will link to here.
To give the brief version: because it’s very difficult to define “quality” or to quantify it, quality metrics until now have largely been implemented by forcing primary care doctors to adhere to an ever longer and more ludicrous checklist of “quality measures” when they see patients. Some examples of these quality measures at my last practice included:
If you are over 50, have you had a colonoscopy?
If you smoke, have we counselled you to stop?
If you are a diabetic and have high blood pressure, are you on an ACE-inibitor (a type of blood pressuring lowering medication that has been shown to slightly reduce renal complications in diabetics)?
While each of these measures are in and of themselves reasonable and well-intentioned, by the time I left my last practice we had over one-hundred of these that we had to comply with in order to get paid. This led to very busy visits in which there was virtually no time to discuss with the patient what THEIR actual concerns were. It also created a very unhealthy dynamic in which a patient exercising their right to bodily autonomy by, for example, refusing to have a colonoscopy, represented a financial threat to the doctor. While I believe that colonoscopies are great and save lives, and I recommend them unreservedly for most patients, I don’t ever want to be in a position as a doctor where I am incentivized to resent you for not following my advice because it costs me money out of my paycheck.
Perhaps this new plan has better ideas about how to measure the quality of primary care that is delivered, but I’m of the opinion that any reform that doesn’t functionally reduce the amount of micromanagement that primary care physicians are under, and leave them free to practice to the dictates of their best judgement (flawed as that undoubtedly will sometimes be) and to the unique and specific needs of the patient in front of them will only continue to drive the profession into the ground. Generally speaking, people go to medical school because they find the science of medicine interesting and they envision themselves forging a human connection with and being of service to their patients. They don’t do it to become paper pushers, and any “reform” that doesn’t address this misalignment is doomed to failure, no matter how much it increases primary care salaries.
This is tragic for both patients and doctors. Primary care is really a very rewarding profession when done correctly. But as things stand now, the powers that be seem to be unintentionally hellbent on ensuring that no young doctor ever wants to enter the profession again.
