How to boost supply of primary physicians

In 1977, a book titled "Doing Better and Feeling Worse: Health in the United States" was issued. It was based on the findings of the Commission on Critical Choices for Americans, made up of leading social and medical critics of that period.

It appears that our feelings about health care have not changed appreciably since. Even though Americans are living longer and many of us survive heart attacks, strokes and cancer, the fear of life-threatening diseases and dying continue to haunt us.

The need to produce more physicians to deal with these concerns has characteristically emerged. A recent article discussed this problem, pointing out the shortage of primary care physicians in our nation ("Regulations, disincentives have contrained supply of physicians," Insight, Star-Advertiser, May 16). This need for more primary care physicians is similarly discussed in the 1977 publication.

What are primary care physicians?

Primary care physicians are formally trained to assist and manage most medical problems. They include physicians who practice family, general internal and pediatric medicine.

They are readily accessible, capable of recognizing the potentially serious problems from the mass of patients seen in the office, care for their patients on a continuing basis with a concern for equity, and possess knowledge of the community, understanding its culture and resources.

Unfortunately, our media, hospitals and health insurance plans all tend to focus upon life-threatening diseases in their endeavors to promote "quality" concepts of medical care. Patients accordingly need to decide whom they should consult for their difficulties.

Suffering a pain in my chest, should I consult a cardiologist? With my headache, should I see a neurologist? What about a painful knee or feeling dizzy?

Our American medical care system has become reasonably proficient and effective in providing specialized medical services. However, we should understand that it is largely established and programmed to deliver services for urbanized larger communities such as Honolulu, where the major hospitals are.

Because the role of the primary care physicians often are undervalued, younger physicians are reluctant to join their ranks. Challenged by the often-complicated nature of the problems seen in primary care, and fearful of committing errors in making their clinical judgements, budding physicians usually face large debts from their lengthy medical education. Required to serve a larger volume of patients to generate sufficient income, they also must spend much of their time managing the business aspects of their practices. Is it any wonder they turn away from primary care practices?

Obamacare is proposing to increase the primary care fees by 10 percent next year, but this may not be adequate to turn the tide of the need to develop more primary care physicians.

I believe that our profit-driven health care system needs to be reformed. Our reimbursing method of paying a fee for each separate service provided has created a health care system in which profits and business management procedures have come to dominate medical care for everyone.

One way of controlling the excesses of our system is to alter our current way of reimbursing primary care physicians through what is called capitation.

Primary care physicians would be prepaid periodically for providing medical services for patients enrolled in their practices.

By providing continuing care for patients, better rapport and trust will develop. Some of the clerical, business paperwork could be curtailed.

Physicians could accordingly find more time to consult with patients and be able to discuss more fully the factors and issues relating to their medical issues.