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Roy: PCP compensation will become fair


Medical Economics editorial board member Patricia J. Roy, DO, shares her opinion about the Supreme Court's Affordable Care Act ruling.

Editor's Note: We asked our editorial board members to share their opinions of the Supreme Court ruling on the Affordable Care Act. Here's what Patricia J. Roy, DO, said.

First off, unlike many of my colleagues, I think the ruling is a good thing.


First, I believe that universal health coverage is a good thing. The fact that we have so many patients in this country without health coverage is a national embarrassment, or should be. It is humiliating to me that we tout ourselves all over the globe as the good guys and allow this to continue in our own back yard. It is a travesty that really needs to end.

Second, I don't support the Obama plan as the "be all, end all" program, but at least somebody is doing something. Does it need to be tweaked and tuned? Of course it does. But at least we are "off the dime" so to speak, and are discussing something tangible in the courts.

Third, the court's decision will move universal coverage way forward. Instead of talking about it, as in the Clinton years, we are actually going do it....or at least are moving toward it.

Fourth, we have to separate health coverage from employers. It is ridiculous that the loss of a job means loss of health coverage...and this has got to stop. This decision will help move us on in that direction, at least as far as small employers are concerned.

Fifth, we have to stop calling anything health insurance. It is not insurance, period. It is health coverage. The difference is huge. Your auto insurance coverage does not pay for tune-ups; it pays for damages and accidents. Your home insurance coverage does not pay for maintenance like painting and re-decorating. It pays for accidents, theft, and other unforeseen events.

Health insurers figured out a few decades ago that if they paid for preventive items, the long-term costs would decrease as we detected disease earlier, in a more treatable, (read, less expensive) state. Many of us predicted that providing care at both ends, i.e., treating the generation that had largely ignored health risks, and paying for preventive items at the same time would bankrupt the insurers. Now, many are going back to very traditional care models, i.e., high-deductible catastrophic coverage, but with a yearly physical exam included. What a joke that has turned out to be: Let's find out everything that is wrong with a patient, but then deny the first $1,500 to $2,500 worth of care, as a deductible, essentially ensuring that the patient cannot afford to treat whatever it is we found.

What will be the effect on my practice?Well, since I chair the contracting and finance committee for our ~300 doctor physician-hospital organization, now we can move forward on some contract issues that have stagnated, waiting on the decision about the whole reform act. Especially with managed Medicaid and dual-eligible patients, there were just too many unanswered questions to proceed with negotiations.

My patient volume will not change. My practice has been closed to new patients for so long that the volume is flat. I like it that way. Births and transfers of family members from pediatricians are offset by the deaths and the loss of patients who move away. So demand might go up, but volume will not.

I actually had another physician, who is a patient, get very angry over the potential increase in access to care, asking this question: “Do you have room in your practice for all these newly covered patients? I don't. And they will push out patients like me who have had doctors all along. That's not fair."

Really? No care is better?

I predict that supply-and-demand economic theory will come into play, and as demand for care far exceeds supply, the value of primary care services will finally be compensated in a more fair way compared with other specialties, and that more medical school graduates will see primary care as a viable alternative to provide them with a comfortable lifestyle as well as the ability to pay back student loans. God, I hope so. In our community, patients with insurance can't find an open practice. We need PCPs, and badly.


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