Betsy McCaughey wrote an interesting article in The Wall Street Journal recently (October 29, 2009) in which she interviewed various physicians to get their their take on the health care reform debate. Dr. Seymour Cohen, an oncologist, said the following in the article regarding the issue of shifting resources from specialty to primary care.
Dr. Cohen: "Let's talk about specialization for a moment. . . . We don't go to our general attorney when we have a patent problem, but they're telling us to do this now in medicine. We have different types of engineers, even journalists. There's a financial writer, there's a sportswriter . . . . Now in health care we're telling everybody, 'you just go to the guy who's your general doc. He's going to know everything and maybe we'll find a specialist for you if the panel decides maybe you're sick enough to need a specialist.' It really doesn't make sense at all."
In a letter to the editor a few days later Rebecca M. Patton, MSN, RN, President of the American Nurses Association wrote in response:
"Currently, the system is built so that health-care providers can charge for each test and procedure performed, instead of being rewarded for the overall care of the patient. We need to re-form the health-care system away from the nation's current emphasis on (more costly) acute care come up to one that focuses more heavily on providing primary and preventive care, or more bluntly-to treat the patient rather than the illness. This does not eliminate specialist care when it is needed. However, better primary and preventive care would greatly reduce the demand for costly specialist care."
Specialists physicians are not used to being targets in the health care cost -reduction-debate.
However, the flaw in Dr. Cohen's argument is that he does not mention that he gets paid by a gatekeeper. It doesn't matter if the gatekeeper is an insurance company or the government (Medicare). He, or any other physician specialist, has to please the gatekeeper, or he doesn't get paid. In exchange, the physician specialist gets a guaranteed rate of pay for a set procedure code (and a steady stream of patients).
Not so with the comparative professions he uses by way of example, be they attorneys, engineers or journalists. I get paid directly by my clients, not from an insurance company. A sportswriter gets paid directly for the paper he works for. That allows for a certain amount of flexibility. I can choose the types of cases I want to work on, and the journalist can write on the subjects he wants to. To get paid I don't need to complete a health insurance claim form and wait for approval by the insurance company before they issue payment. On the other hand, I certainly am not guaranteed a steady stream of clients.
It's not that I don't sympathize with the plight of the specialist physicians. But I agree with Nurse Patton. To lower health care costs we must have a system in place that treats the whole patient first. Certainly primary care/general practice physicians, underpaid for the work they do under the present system, will be the financial beneficiaries of such a change. But that GP isn't going to be performing knee surgery on a patient, so, as I see it, the specialist is safe.