Despite the sweeping changes coming to health care, the amount of time primary care physicians spend with patients during routine office visits is unlikely to improve until the issue of payment reform is addressed, argues Abraham Verghese, MD.
In a San Francisco Chronicle op-ed, Verghese explains why time is the scarcest commodity of all for primary care physicians:
The problem though is less with the physician than it is with a payment system that penalizes the doctor for spending much time with the patient. There is so little reimbursement for a regular office visit that a primary care physician has to churn through large numbers of patients per day in order to cover the overhead. (It is the reason many physicians are going into concierge practice, where they can spend as much time as they want with a limited panel of patients).
By contrast, a procedure of any sort - biopsy, stress test, endoscopy, cardiac catheterization, minor surgery, major surgery - generates a payment that dwarfs the regular office visit. Is it any surprise that fewer medical students each year opt for primary care as a career? Is it any surprise that there are so many posh freestanding surgical centers and birthing centers and cancer centers and cardiac centers and pain centers? They emerge in Darwinian fashion when we pay well for physicians to do to patients, and pay poorly for physicians to be with and do for patients.
Verghese is also speaking at the Commonwealth Club in San Francisco tomorrow evening. More information about the event can be found here.
