How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better hes reimbursed (返还费用). Moreover, the amount a physician receives leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patients disease. Combine this fact with annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.
Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.
Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduatedU.S.medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.
How do we fix this problem?
It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally (最佳地) managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.
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