In Search of Primary Care

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I am a longtime practicing primary-care physician.  I enjoy my work immensely. However, I see firsthand many of the problems pointed out in your article "Need a Doctor? Too Bad," [April 7-14].

As a teacher of medical students myself, I see that graduates coming out of medical school take into consideration financial reimbursement in relation to hours worked and can't help but come to the conclusion that primary care does not offer the financial rewards of other specialties. Compared with often huge debts coming out of school, this could direct students into other areas of medicine. I believe that this is an unrecognized aspect of the problems with medical care in the United States. One feature of other industrialized countries, which do much better statistically on many health parameters, is that they have an emphasis on the importance of primary care. Unfortunately, the United States is not the best place to obtain basic preventive healthcare. Our resources in this country would be better spent emphasizing primary care as opposed to treatment of end-stage diseases. One way to do this is to recognize the importance of primary care in our reimbursement structures. We would get much more bang for our buck, so to speak, preventing end-stage diseases rather than treating it at older ages.

Robert H. Potter Jr., M.D.

Genesis Medical Associates

Both the lack of primary-care doctors and the prevalence of C-sections ["A Risky Rise in C-Sections," April 7-14] can be traced to what society (or at least insurers) values and reimburses. An invasive cardiologist will be paid more for a half-hour cardiac catheterization than a primary-care physician will be paid for several years of visits to control the blood pressure, high cholesterol, and diabetes that ultimately lead to heart disease. An obstetrician who spends 20 hours with a patient in labor—canceling appointments or forgoing sleep to do so—will very likely be paid less than the colleague who schedules an unnecessary C-section and is in and out of the hospital in 90 minutes. There are many, many doctors who do what is best for their patients at the expense of their finances, their sleep, and time with their families. As these trends continue, there will be far fewer. Adjusted for cost of living, I make less now as a busy family doctor than I did 10 years ago. Even with the recent housing crash, I could not afford a house in my community at today's prices. Attracting young doctors to primary care—with longer hours and much less pay than their specialist colleagues—is becoming almost impossible.

Hope Erica Ring, M.D.

Charlton, Mass.  

I don't remember when seeing your family doctor or going to the hospital became an industry to be milked for stockholder profits or abused by those who influence our government for a piece of the taxpayers' pie. As the late Sen. Everett Dirksen is widely credited as saying, " A billion here, a billion there, and pretty soon you're talking real money." It is money that the taxpayer cannot afford. Yet some taxpayers have distorted, with help from lawyers, the usefulness of the right to sue for legitimate grievance against the supplier of a good or service. The reason that we cannot find a general practitioner is that they are being sued out of existence.

Robert C. Seward

Endicott, N.Y.