Put primary care doctors at the center of reform

As a future physician in Georgia, I care deeply about the reshaping of our health care system. We need reforms that meaningfully enhance the ability of primary care doctors to care for their communities and attract the brightest students to their ranks.

An insufficient number of physicians want to enter primary care. In a 2008 JAMA report, investigators found that only 2 percent of medical students intend to pursue careers in general medicine. The results of this year’s national residency match program showed 9 percent of family practice seats remained unfilled, and less than half of those entering the branch graduated from a U.S. medical school.

The last time primary care received any attention was during the 1990s managed care “revolution.” Instead of rescuing health care, though, the movement burdened physicians with paperwork and moral dilemmas.

It also brought lower reimbursement rates and increased red tape, both of which still plague medical practices.

These have culminated in great dissatisfaction within the field. A recent survey by the Physicians Foundation showed that 49 percent of primary care doctors would seriously consider closing their practices if an alternative existed.

Historically, medical students have sought to enter more lucrative branches, such as dermatology and surgery. This trend continues today. UGA professor Mark Ebell revealed a strong correlation between salaries and popularity of specialties in a JAMA study published last year.

The relatively low salaries in primary care, at the very bottom in medicine, deter prospective candidates.

With careers characterized by relatively low pay, high stress and long hours, what incentive do we give students to enter primary care? To attract the best minds, we must properly reward effective primary care physicians in a way that improves the value of every health care dollar spent. We should:

» Forgive medical school loans for anyone entering primary care.

» Re-evaluate primary care payment systems. Stagnant fees, including the marginal 5 percent Medicare increases, will further exacerbate the crisis. The current model does not even keep pace with inflation.

» Make pay-for-performance real by valuing quality over volume. Incorporate the medical professional associations in the development and evaluation of these practices for public accountability, ensuring transparency and cooperation. The private industry will follow suit.

» Encourage primary care physicians to work after hours through moderate fee increases. Paying doctors to work nights and weekends will increase continuity of care. It also is one of the most effective strategies to reduce the congestion and costs incurred by unnecessary emergency room visits.

» Reward experience. Doctors with successful records should be paid more than those fresh out of residency. The current system reimburses uniformly across the spectrum of experience. A revamped approach will motivate physicians to sharpen their skills throughout their career.

Recent forecasts from the University of Missouri estimate a nationwide deficit of 44,000 family physicians and general internists by 2025. Georgia currently ranks 40th in aggregate physician supply. Our state has taken measures to boost its number of medical seats, such as developing the new Medical College of Georgia satellite campus in Athens.

If we want to draw the best and brightest to our state, though, we must be on the forefront of strategic efforts to value primary care. I hope our leaders have the vision and courage to take us there.

Deep Shah, a UGA graduate and Rhodes Scholar, begins medical studies at Harvard in August.