A week of reflection on primary care

As you know, I think a lot about our health care system and how best to fix it. I try not to get overwhelmed by the day to day frustrations of the job and to see the bigger picture. Here's what I observed this week:

Day 1: The American Board of Internal Medicine has proposed a new designation for internists- Comprehensivists. People who receive this designation are supposed to be expert diagnosticians, communicators, facile with technology, team leaders and have an office that provides accessible and efficient care (the latter eliminates me). One must complete additional training and testing for this title, which, by the way, does not lead to better reimbursements or higher pay. What it does give you is a title other than Primary Care Provider or General Internist, which are no longer garner respect. Even internists don't want to be internists anymore.

Day 2: I read an essay from a geriatrician about the high rates of peptic ulcers in older folks associated with anti-inflammatory pain medicines. He notes that gastro-protective medications are not offered by Medicare plans, are prohibitively expensive, or require massive amounts of paperwork that primary providers don't have time to do. So the elderly suffer and have complications that are way more expensive to treat than giving the right medicine in the first place.

Day 3: Governor Deval Patrick announces a cut in Medicare reimbursements in the commonwealth of Massachusetts to make up for a budget deficit.

Day 4: The front page of our local newspaper carried a story about the shortage of primary care and mental health providers in western Massachusetts and Cape Cod. The state is trying to encourage state medical schools to promote primary care and is planning on giving loan reimbursements to those who choose to practice here. Massachusetts has one of the highest doctor to patient ratios in the country, but this is due to the large number of specialists in Boston. The Secretary of Health said that we have to show medical students that primary care is a rewarding career. See number 3 to see how the Commonwealth really views primary care.

Day 5: I read an article about incorporating meditation and mindfulness into primary care to avoid burnout. This is an eight week program designed to help PCPs survive the stresses of their job and deal with difficult patients. The article noted that most docs sleep less, eat worse, and exercise less than their peers. They also spend less time with family and have, on average, ONLY ONE FRIEND apart from a spouse.

Day 6: There was an article about lawyers and doctors in the NY Times a few weeks ago. The gist of the article was that these professions are no longer as respected or desirable as they once were. These jobs require more work and more training than many people can stomach today and the pressures to keep working longer hours are drives people away. One MD was quoted as saying that every so often he needs to call in sick on short notice and spend 24-48 hours in bed. He does this when he feels an uncontrollable urge to punch someone. You can spin this one two ways: either people are losing their work ethic or they are realizing that family/personal time is too important to sacrifice.

Day 7: "Safety Net Providers Being Stretched to the Breaking Point."The title says it all. This article comes from Internal Medicine News and notes today that safety net providers (aka community health centers) are taking on more of the burden of primary care. Since 2001, the number of patients increased by 60% and I would guess the staffing at the centers hardly increased at all. CHCs are often located in areas without specialty care or mental health services. The number of mental health visits to CHCs has doubled in the past 5 years.