Primary Care Doctors and Specialists Still Warring Over Healthcare Reform
Primary care physicians, who provide most care to most Americans, favor the healthcare reform in Congress and are pushing hard for it. But specialists, who are better paid and more numerous, don't share their colleagues' enthusiasm for change.
Two leading primary-care societies renewed their endorsement of reform this week, but no one should take this as an indication of where physicians as a whole stand on the subject. Between them, the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) represent 214,000 internists and family physicians. But the specialists who form the majority of U.S. physicians remain conspicuously silent but for a few notable exceptions such as cardiologist Clyde Yancy, president of the American Heart Association.
One reason for the divide: the ACP and AAFP are pushing for a 10 percent increase in Medicare reimbursement for their members, a bump intended to attract more young doctors into primary care and to reward physicians who better coordinate patient care. Uncoordinated care is a leading source of expensive and often fatal medical errors.
Both the House and Senate reform bills include a version of that increase, although the House offers a lower incentive. But here's the rub: More money for primary-care doctors is likely to come out of specialists' pockets. In fact, both the ACP and the AAFP call for CMS to be given greater authority "to identify mis-valued physician services and to make appropriate adjustments to the relative value of those services if appropriate and needed," as AAFP Board Chair Ted Epperly puts it. That's a clear attack on specialists' incomes.
At the AMA's last annual meeting, the delegates strongly opposed shifting Medicare funds from specialists to generalists. So while the primary care societies and the AMA agree on the need to rescind scheduled Medicare cuts to all physicians, they're at loggerheads over how to divide up the economic pie.
The ACP and AAFP statements also stress the need to bolster the primary-care system. The AAFP notes that reform will falter if primary-care doctors are flooded with newly insured patients. The ACP, meanwhile, notes that this will be a major problem even if reform dies in Congress. Without more generalists, the society forecasts, there will be a shortage of 35,000-40,000 primary care doctors by 2025.
The ACP argues that Congress needs to pass the "key elements" of the Democratic reform package rather than trying to adopt bits and pieces of it. "Without health reform, rising health care costs will soon put affordable care out of reach for tens of millions more Americans, including many middle class families," the ACP statement says. Without reform, the society adds, the number of uninsured will rise substantially; small businesses will be unable to find affordable coverage, and Medicare will go bankrupt.
The reality-based document of the ACP should be required reading for all lawmakers. Only when they get their minds around the fact that inaction on reform would be economically ruinous and a dereliction of duty to their constituents will their spines stiffen sufficiently to do what needs to be done.