What we can do about state's primary care doctor shortage (Wayne Smith)

(Wayne Smith heads the Delaware Healthcare Association, which is the state’s hospital and healthcare trade group.)

The author begins by acknowledging that a national shortage of primary care doctors is developing. He attributes this trend to economics, e.g., starting pay for primary care doctors is relatively low whereas student loan balances to repay are quite high. This is bad; primary care doctors in the right places are essential to ensure patients receive quality care that will hopefully keep them from developing conditions requiring hospital care.

Fortunately, according to Mr. Smith, steps are underway to encourage more medical school graduates to sign up as primary care doctors.

FIRST, value-based contracting is needed in place of fee for services billing. Under such arrangements, healthcare providers have no incentive to provide as many medical services as possible in order to maximize their revenue. On the other hand, there are penalties for poor results for patients under care so the providers don’t have an incentive to skimp on necessary (versus potentially superfluous) services. Striking the right balance may not be easy, but the transition is underway. Thus, “our hospital members are participating in a federal Accountable Care Organization that is progressively instituting risk-taking with Medicare reimbursements. [And] Christiana Care . . . has announced the signing of two value-based contracts with insurers just this month.”

SECOND, Delaware needs expanded residency programs in primary care specialties (internal medicine, family medicine and pediatrics). Christiana Care, Nemours/Alfred I. duPont Hospital, and St. Francis are all making efforts in this direction. And efforts are getting underway at Bayhealth and Beebe Healthcare.

THIRD, a contemplated loan repayment initiative would offer up to $200,000 to pay for outstanding medical education loans for a primary care specialist who agreed to locate in an under-served area of the state for a minimum of four years. Happily, a bill to authorize these outlays – House Bill 257, sponsored by Rep. David Bentz and Sen. Nicole Poore – is pending in the General Assembly.

In sum, “while the short terms looks challenging, positive change is in the works that will lead to a better future for access to primary care in our state.”

COMMENT: These proposals hardly represent a free-market approach to the problem, and their implementation may contribute to a longer-term situation in which all the doctors will wind up working for hospitals or other healthcare organizations. Will patients truly be better served as a result?
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