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Monday Mar 06, 2017

Primary Care Needs a Raise -- All of Us

We deserve a raise. The lifetime income gap between primary care doctors and subspecialists is a shocking $3.5 million.

But if you're a family doctor who feels underpaid, don't expect much sympathy from the public. It's hard to ignore the litany of mainstream news articles characterizing doctors' "bloated salaries" as being the scourge of health care. Although most of these stories fail to distinguish subspecialists from primary care physicians, it's still important to reframe the discussion of primary care compensation.

Whenever there is a discussion about compensation, there is the uncomfortable reality that everyone has a different opinion regarding what people "deserve." Do we compensate for training and subsequent expertise? Do we compensate for hard work? Do we compensate for taking on a job no one else wants? Do we compensate to recruit more talent? Or should health care workers simply get paid what the free market calls for?

Investing in primary care would do more than give primary care physicians a salary raise. Here are four major benefits of improving payments in primary care:

A Decrease in Health Care Costs
The ability of primary care physicians to lower overall health care costs has been demonstrated in several studies. One primary care physician per 10,000 people(health.usnews.com) can decrease hospitalizations by 5.5 percent, ER visits by 11 percent and surgeries by 7 percent. Through care coordination, we can save part of the $210 billion per year wasted on unnecessary or duplicative tests.(www.nytimes.com) And through providing evidence-based preventive health care, primary care physicians can save the U.S. health care system $3.7 billion(content.healthaffairs.org), researchers estimate.

We are able to do all this even in a broken system where the potential of primary care isn't realized yet. Only 5 percent of health care spending goes to direct payment for primary care(www.urban.org). That should be closer to 10 percent to 12 percent(content.healthaffairs.org) to realize primary care's full potential.

If primary care physicians were paid what we are worth, there would be more of us to continue driving down overall costs. But in this current system, the United States faces a projected shortage of 52,000 primary care physicians by 2025(www.annfammed.org).

A Raise for Everyone
Changing health care payments wouldn't just mean a raise for primary care physicians. It would translate to a raise for the entire hard-working -- and also undercompensated -- health care team it takes to support primary care, including nurses, medical assistants, phlebotomists, referral coordinators, care coordinators, health coaches, physician assistants, practice administrators, etc.

The economic impact of family physicians is often overlooked. One family physician creates roughly 23 jobs(ruralhealthworks.org) in a community and generates $889,156 in income.   

In this era of team-based care, every member of the team adds value in high-performing clinics, and this should be reflected in their compensation.

Modernization of Health Care Delivery
Value-based payment models are gaining popularity among hospitals, payers and doctors. With the shift away from fee-for-service, we now see an increased emphasis on keeping patients healthy. Various public and private payment systems are tackling care delivery differently, but we are seeing more points of access for patients, whether this is through telehealth, extended hours for primary care, or even the ability to email or call doctors. After all, health care shouldn't start and stop only within the walls of a doctor's office.

When primary care payments increase, family physicians no longer have to worry about uncompensated care in evolved payment models.

Improved Quality of Care
And, of course, the most important role we have as primary care physicians is caring for our patients and improving their quality of life. One primary care doctor for every 10,000 people can decrease mortality by 5.3 percent(www.ncbi.nlm.nih.gov). Compared to subspecialists, primary care physicians achieve similar health outcomes for conditions such as hypertension or diabetes, but we are able to accomplish this with fewer office visits, a lower percentage of tests per visit and lower hospitalization rates(www.nap.edu).   

As our health care systems looks for value -- to improve outcomes at reduced costs while keeping doctors and patients happy -- there is no more direct route for an immediate return on investment than primary care.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan(twitter.com).

Posted at 11:20AM Mar 06, 2017 by Natasha Bhuyan, M.D.

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