The primary care blogosphere is rightfully pissed at an op-ed by Dr. Jonathan Glauser, an emergency physician and MBA, that takes the form of an angry screed against the primary care profession. "If ever there was a group that has failed in providing care, it is our primary care system," he says. "To fund such a venture for groups that are singularly inept at performing anything of value to society is pure folly and a waste of precious health care dollars." Data is not the plural of anecdote, and anecdote is the only data Glauser offers. Dr. Rob, Bob Doherty, and even fellow emergency physician Shadowfax pull out the long knives and the longer studies. But the dispute is more than a simple rant. Primary care doctors are asking for massive subsidies right now. The ACP wants a 10 percent boost in Medicare payments. Kevin MD will see their 10 percent, and raises them to 20 percent. The problem they're responding to is real. We're about to face an epic shortage of primary care doctors -- we're talking 44,000 or 45,000 too few docs -- which will ensure massive disruption for patients. The problems for primary care are basic: Fewer graduates, more patients. As I understand the issue, there are two problems here. The first is lifestyle. Primary care doctors have too many patients, too little time, too much paperwork, too much administrative hassles, too little satisfaction. The other is money. Primary care doctors make far less than specialists, even though they go through a similarly expensive and rigorous training process. It's no surprise, then, that most doctors opt to become specialists, where they have better incomes and more control over their lifestyle. The famous stat here is that the highest MCAT scores are now to be found among dermatologists. Great money, nice lifestyle. The money fix being proposed comes on the payment side. How can we make it lucrative enough to be a primary care doctor? The answer is increase the pay of primary care doctors. And there's an argument for this: More primary doctors would probably make the system cheaper, even at higher reimbursement rates. Specialist medicine is expensive. But you could also examine the problem on the training side: How can we make it cheaper to become a primary care doctor?
