May 19, 2024

So, as a primary care doctor in private practice, will I soon embark on the road of dinosaurs? Is this just a business model change required by the times, or should it arouse people’s attention?  Will the system work better if there are fewer primary care doctors or a large hospital system?  Those who frequently read many blogs (and those who are smart enough to read the title of this article) already know my answer: Private primary care doctors areessential to a healthy healthcare system.

Why do we need primary care?

Although we cannot disagree with DrBiondo’s view on PCP medical examination skills, I’m afraid I disagree that this raises the issue of cost-effectiveness in primary care.  In your case (the practice of rheumatism), there are few expensive operations, the disease is uncommon (compared to cardiology and other high-cost specialities), and the patient will not spend many days in the hospital.  The overnight cardiac catheterization will pay a large part of the rheumatologist’s annual salary.

Like primary care, rheumatology is primarily an outpatient practice, and the measure of success is the doctor’s ability to keep patients away from the hospital and away from expensive operations.  Recently, rheumatologists have begun to have quite expensive biological agents (such as Enbrel), but the number of people taking the drug is still very small compared to the general public.

On the other hand, primary care is the source of all health care costs.

A good PCP can also be measured if the patient is discharged from the hospital and does not undergo expensive surgery.

 Generally speaking, the PCP is unlikely to:

  • Order X-rays compared to orthopaedic doctors
  • Get ECGs compared to cardiologists, or
  • Order endoscopy compared to gastroenterologists.

Some primary care physicians spend a lot of money, mainly due to the payment system that encourages expensive procedures and trial orders. For example, a PCP team in our area has its stress test kit and CT scanner.

I am 100% confident that the doctors in this group require much more CT scans and stress tests than the doctors in my clinic.  I also believe that the quality of care in my clinic will not be affected by our failure to order tests. Why?

Because doctors have financial incentives to request these tests, making correct business decisions conflicts with correct medical decisions.  As long as the order is harmless, the doctor can justify it. However, even these doctors will not do these tests as specialists who depend on chronic diseases to earn a living.  The only experts I have seen with very slow test requests and procedures have not benefited financially from their request: academic experts.