(HOST) There’s a shortage of primary care physicians in Vermont. Commentator Tim McQuiston has been thinking about this problem and what we might do about it.
(MCQUISTON) In one of Norman Rockwell’s most popular paintings, a grandfatherly doctor patiently checks the heart of a little girl’s doll. Whenever I see it, I remember the times that our family doctor came to our house when I was a kid, to check up on sore throats. But private family medical practices of the Norman Rockwell type are disappearing. By the time I’m old enough for Medicare, there may not be any family doctors left.
And the primary cause for this appears to be that as chronic illness is increasing, Medicaid and Medicare reimbursements are decreasing.
According to various independent and government reports, chronic illness consumes seventy to eighty percent of all health care spending in the United States. And in Vermont health care costs about three and a half billion dollars a year. That’s billions with a “B”.
Reimbursement rates for Medicaid and Medicare versus total costs of service keep slipping.
That’s led to cost-shifting – or charging one person more to help pay for someone else. And in the context of a non-profit hospital, those costs are shared by many patients.
Of course, cost-shifting only increases private health insurance premiums for most of us, while the government pays less and less on the other side. Meanwhile, more chronic illness drives up costs.
Personal paychecks and business profits suffer from increasing health insurance premiums, and as a population we’re not any healthier.
But there’s another problem, which will only exacerbate all the others: a shortage of primary care doctors. It’s a situation that will only get worse, and the people who will suffer first from this shortage are Medicaid and Medicare patients.
The ability of family docs to cost-shift is very limited. A lot of their patients are on Medicaid or Medicare. Paperwork is increasing. Malpractice insurance is going up. So, many family practitioners are moving out of state or retiring. And thirty percent of primary care physicians in Vermont are simply not taking new Medicaid patients. That’s double the rate of just ten years ago; so it’s easy to imagine that in a very short time, private family docs won’t have any such patients. It’ll be just too expensive.
Here are some changes that might help general practitioners: increase reimbursements; get rid of co-pays; and help med students with loans, if they work in Vermont. Also, the doctors say that any plan that ultimately increases the number of patients using primary care will fairly quickly reduce total health care costs. General health will improve. Chronic illness and costs will decline.
Clearly, asthma, diabetes, allergies, obesity and smoking are better confronted in a doctor’s office than in an emergency room.
But if nothing is done, it’s a pretty good bet that family medicine will live on only in the nostalgic world of Norman Rockwell and house call memories.
Timothy McQuiston is editor of Vermont Business Magazine.