The latest SmartMoney list of insider secrets and unpleasant truths is just as bleak as every other news item about health care these days, starting with the fact that a primary care doctor—”someone to coordinate your health care, help choose your specialists and be the first to diagnose just about any problem”—is getting harder to find, and fewer med students are showing any interest in the (comparatively) low-paying profession: “the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade.”
They suggest that for basic illnesses, it might be both faster and more effective to try a walk in clinic—there are about 460 across the country now, but that number will jump to 4,000 over the next two years.
Walk-in clinics are… run by nurse practitioners, who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice or referrals if the problem is beyond their scope. These clinics have caught on in part because they’re fast and don’t require an appointment, says Steven Cooley, a physician and CEO of SmartCare Family Medical Centers in Denver. They’re also cheap — $40 to $60 a visit, versus $150 for a doctor or $300 for an ER visit — and many take insurance.
But perhaps the most disturbing fact is that the PCPs out there are probably least able to take on senior citizens as new patients because of how unprofitable they are. They often have complex medical conditions that take longer to diagnose and treat, and yet Medicare doesn’t pay much more than what the doctor would be able to earn on a 15-minute checkup of a healthy patient.
“It is fiscal suicide to go out there and say, ‘I am a geriatrician,’” Robinson says. “You get the patients that require the most time that pay the worst.”
“10 Things Your Primary-Care Physician Won’t Tell You” [SmartMoney]