Hope must be part of the formula

January 10, 2011

Congress has delayed primary care's Medicare reimbursement cut for another year. Rather that this being cause for celebration, however, it simply represents the reality that had the cut gone through, there wouldn't be much incentive to stay in the practice of medicine-and Congress knows that.

Given that this fix is due to last for a year, and that the year after that there could be tax increases for many, compounded by the progressive weakening of the purchasing power of the dollar, feeling optimistic for enhancing the supply of primary care physicians isn't easy. When one considers that primary care physicians typically receive at least one-third of their income from government payers, the "purchasing power" of primary care within the residency graduates is only likely to continue to fall.

Political favors that will be being dangled in front of primary care in the next couple of years are relative trifles compared with the burdens of running a primary care office. Given the overall condition of the government budget and the mood of the incoming members of Congress, the administration may be offering up piecrust promises-easily made, easily broken.

The result is an ennui and resignation among many primary care physicians. Does it match or exceed the mood of the country? Judging by the patients I speak with, it is difficult to gauge which group feels it more intensely. The hope that I see is that, on the whole, physicians still care about their patients, and patients still care for their physicians. It is upon this hope that the hopes of the nation's healthcare delivery must rest.

The author practices internal medicine in Lexington, Kentucky, and is a member of the Medical Economics Editorial Board. Send your feedback to medec@advanstar.com
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