Would the Last Generalist Please Turn Out the Lights?
Came across a great article in Time about how doctors who are generalists are becoming increasingly rare. The reason cited was economic. It pays to specialize. Also, the workload is less demanding, as is the ability to know as much as possible about one particular area. When it comes to medicine, patients often prefer a specialist who can see their problem to the exclusion of everything else.
But the article makes a good case for worrying about the lack of generalists:
"So whom do you go to for what? Unless you have a close friend or relative in medicine, you still need a good generalist — someone who knows you and knows the ropes. This is going to take effort and maybe some money; there are fewer of them and HMO fees are so low that many won't take on new patients except as a favor. This is especially true for the good ones who really spend time and develop a relationship with their patients. Internists vary tremendously. Some treat everything, some just do check-ups and referrals. If competent, the former will save you a lot of anxiety, waiting-room time and money. They will treat the pneumonia or the backache themselves, instead of sending you to the pulmonary doc or orthopod."
My late doctor cousin is the reason I work in a medical office today. He was a generalist. The only doctor for miles in the rural town where he worked. We often laughed over how he accepted eggs from a chicken as payment, or perhaps some repairs to his barn, or work on his farm.
He lamented the maze and nightmare of modern medicine brought on by insurance company behemoths. To him, it was crucial to know how to set a broken ankle or treat an ear infection or whatever else came his way. That was his job--his place--in the community.
I remember him comparing himself to an auto mechanic that way, saying he expected the local garage to have the know-how and diagnostic tools to fix any make of car, so why shouldn't his mechanic expect the same of him?
I miss my cousin more and more these days.
What are your thoughts?
posted by Anne @ 8:15 PM
5 comments
5 Comments:
The days of the generalist, or more commonly referred to as the family practitioner are not gone. There is a double edged sword in the insurance industry to the family practitioner as one often has to have a "referral" from an FP to see a specialist and yet the RVU's set up for reimbursement are causing a decline in pay for the family practitioner. So, maybe it is not the morale of the doctor that wants to be the down home family doc, but can he survive financially today doing this. My immediate guess would be no.
I highly recommend that you read the book Redefining Healthcare: Creating Value Based Competition on Results. That is where medicine is heading and truly successful.
A good family practictioner is a valuable find. I hope the insurance companies realize what an important role they play in healthcare, and reimburse them accordingly.
It isn't just generalists that are a "dying breed". I work with Cardiologists, and there is developing a critical shortage of them. It takes 12 to 14 years of post-secondary schooling to become a Cardiologist. And, their reimbursement is dropping as much as 25% per year, so why would anyone want to invest that amount of time for the same pay as a FP? I'm concerned about the availablility of Cardiologists as the baby-boomers age. We had better take care of ourselves! And, OH, by the way, I have yet to find anyone who truely cares about quality - it's still all about dollars saved through rationing.
I will admit that I was born during the age of the "Family doctor", where house calls were common and office visits and hospitalizations were rare. A phone call to the doctor's office would alert him to the fact that I, at the age of 6, would be coming in. I would ride my bike to his office(no parent with me-they were working on the farm). Having said that, society today is different from my "growing up" years. Doctors today have little interaction with patients outside of the office, unlike the doctor back in the 50's who was an integral part of the community and knew everyone's family situation. Unfortunately, I do not see a return of the family practitioner of old in our present environment. Yes it is frustrating to see many doctors for a single ailment(at present I see 3 for the same problem but each has a different expertise in the field, however, seeing only one of them would not treat me effectively). I agree with Anonymous concerning the realities of financial survival for family practitioners. This is just the reality of today!!
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