Family Physician in the Forest

In the forests of the upper Midwest, the rural hospital ERs are in the crack of the rock and the hard places. The family doctors that care there are in the cleft of that crack and getting shoved farther down with eaching passing day. Not that the city family docs have it any better--in my estimation, it's gotten even worse for them in the past decade. Now the rural MDs have urban shoulders to stand on. What the urban MDs have to stand on is giving them the squeeze.

Every study of cost-effective health care over the past 30 years has shown that family physicians are the best--even better than internists, given that family doctors take on "all comers"--caring for and treating everyone in the family without costing the family its life's savings. They were and are trained to care for 90-95% of every disease, every ailment that we Americans are prone to get. Often, when they saw one, they saw all in the family at once--dispensing penicillin, for example, for everyone in the family with a sore throat when the first one in that family had a positive strep test. That's preemptive sickness care: true preventive health care.

Each member of that family weren't charged a separate office visit either. That's not good business but it is good medicine.

To think that the "fix" for the high cost of health care 25 years ago was aimed at those family physicians is understandable given the greed that this culture has supported.

It's better "business" to make a charge for everyone--especially when business administrators took over medicine. That way the administrators have many more "encounters" from which to extract their 30% administrative service charge. That way the administrators at the top of the business can make over $100 million a year while the family doctors are struggling to stay in practice.

I recently learned that my 2-3 hours of after-midnight emergency care for a person who subsequently became a nurse [I just worked with her last weekend] was charged to her @ $10,000. I received a little over $200 for that care which included sewing up over 8 inches of facial lacerations and the reattachment of her right ear and of a portion of her forehead [scalp] left on the windshield when the paramedics first brought her in. I knew enough to tell the deputy sheriff to go back to the scene and find that scalp so I could reattach it. I did not feed the plastic surgeon's children that night, but I'm sure the administrator's conscience slept well.

It now doesn't surprise me that just looking at a wound, without any treatment, costs $600.

If family physicians could charge half that amount, there'd be family practice clinics on every block of every city. Everybody could have their own personal physician again.

Right now, half of all the primary care physicians are contemplating retiring or just quitting. Those that have medical school and residency training debts yet to pay, don't have that option. Without outside monetary support, a new physician has medical education loans of between $100,000 to $200,000 to pay back on top of the cost of setting up a practice. That's not counting the 11-12 years of delay of life's gratifications that the training also extracted. It's no wonder that fewer and fewer new physicians are going into family practice. The hours are less and the pay is much higher to go into a medical sub-specialty.

The current system allows for an agency that employs nurse practitioners to charge $500 for a home visit for a new mother and her child. For a self-employed family physician to make that house call and charge for it wouldn't get a fraction of that amount.

Let's hope that President Obama will get advice from the caring health professionals that have kept on fighting to care and not just feed the present system by throwing money at it. If he has the wrong advisors, that's what we'll get.

And we'll all be in that crack, heading for the big squeeze.