More Primary Care, Lower Physician Pay, and Cheaper Medical School


Rising healthcare costs have produced calls for reduced physician payments, caps on vendors' profits, and changes to how we pay for medical school.

Last week, in “Healthcare Reform Will Fail if We Don’t Reduce Costs,” I wrote that “Reform without cost-reduction and a realignment of incentives is a non-starter,” and that we are going to have to encourage greater integration of healthcare through the patient-centered medical home and other primary-care-focused models of care that will “bring access, preventive, routine, and chronic care maintenance into the system, reducing demands on high-cost, episodic, and isolated specialty care.”

I received an e-mail from a physician who wrote that “There is only one way to lower long-term growth in costs, and that is to cut payments to medical providers and profits of manufacturers of medical supplies and equipment. But, that is the solution that cannot be pronounced in public. The need for medical care will continue to increase as the population grows and ages, the uninsured become insured, and new high-tech treatments are discovered for previously untreatable diseases. Solutions aimed at decreasing the amount of care will only injure the health of the population and will not be tolerated by the voters. To lower costs, we need to revise the medical education system to produce doctors who do not need to make big bucks to pay off their school debt, and to change the culture of financial entitlement that pervades the current medical profession.”

What do readers think?

Will reducing payments to physicians and other providers make a difference?Are there other costs of medical care that are better targets for containment?How can we change the way medical school is financed so that more physicians can graduate without massive amounts of debt, freeing them to pursue the less-lucrative medical specialties (such as primary care)?Is this physician reader correct when he says that there is a culture of financial entitlement that pervades the medical profession?

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