The unintended consequences of pro-active medical care

Name the disease or condition, and early diagnosis and treatment can reduce poor outcomes. Who knows what could happen in health care if patients heeded the advice on diet, exercise and smoking? Yes, who knows. Actually, we do know. Longer life resulting in higher Medicare and Medicaid costs further down the road. Another outcome we know about because it has already happened, is fewer primary care physicians. The expanding menu of interventions, screening tests, vaccines and devices has dramatically increased the work of patient care for all medical specialties, but particularly the guy who's going to make the decision when you complain of feeling poorly, according to JAMA Commentary, November 21, Vol. 298, no. 19.

"Providing all recommended preventive services to a panel of 2500 patients could require up to 7.5 hours a day of physician time; generalists report that roughly 4 separate problems are addressed at each office visit for those older than 65, and even more for those with chronic illnesses such as diabetes," writes John D. Goodson.

The workload is overwhelming and the reimbursement levels for primary care physicians favor the interventions and more expensive care which in turn passes the patient on to specialists. Now, if you were in med school (or paying for your child to go to med school), looking down the road at even more interference by the federal government, and higher insurance costs, would you choose family medicine or pediatrics, or would you head for the safer and richer green pastures of a specialty? Goodson reports that first-year internal medicine residents who express an interest in general internal medicine are less than 20%, but only about half of those will remain committed to this area.

Goodson goes on to recommend higher compensation by the CMS (Centers for Medicare & Medicare Services), the federal agency that determines how doctors will be paid. If this problem isn't corrected, a large portion of the population will lose access to personal care (or any care). Imagine. The government creates a problem with layers of bureaucracy and regulations (low reimubursement for general care) and is then expected to fix it (with more layers, studies, panels and commissions).

The perfect storm of immigrants flooding the country needing massive social services, to mix with a growing cloud of aging baby boomers who demand only the best. Katrina anyone?