The front line of medical care—primary-care doctors—is crumbling as med-school grads opt for better pay and a more predictable life.
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When I get sick or it’s time for my annual poke-and-peek, I head for a small, 60-year-old, two-story white clapboard building that is the antithesis of one of those gleaming high-tech shrines to modern medicine. I park myself in one of the half dozen wooden chairs that grace the small waiting room, and after what is usually a short wait, I step into the bright windowed office of my primary-care physician, Henry Maresh, something I’ve been doing for more than a decade now. It’s a relationship that has lasted longer—and is certainly more intimate in certain ways—than my previous two marriages.
He has treated me for the usual ailments—coughs, colds, aches and pains—and he’s referred me to any number of specialists along the way. I was lucky to find him—he was on a list my wife’s employer provided—after we moved to Connecticut back then. A year or so later and I probably wouldn’t have been his patient. Like about a quarter of the primary-care physicians in the state, he has not been taking new patients for some time. In so doing, he’s part of a trend that does not bode well for the thousands of newly insured patients expected to seek primary-care docs in the wake of the federal health-care reform act.
He still practices what might be called the Marcus Welby medical model. He listens, asks questions—usually cracks a joke or two—and draws on decades of experience to decide a course of treatment. His advice has always been sound, despite my efforts to thwart him from time to time.
There aren’t a lot of high-tech gizmos around. He just recently added a laptop to his medical bag and is working on his typing skills. Even so, he says that by the time he gets the computer to look up a prescription, he could have written 10 by hand. Like many older practitioners, he is not so sure about the current push for electronic medical records. The up-front investment probably won’t pay off by the time he’s ready to retire.
“It’s a low-volume practice,” he says. “I don’t have any physician assistants. My patients are aging, so that Medicare now constitutes about 60 percent of the practice”—which comprises about 1,500 patients.
It is also a comfortable practice, built on a model that, according to a recent Connecticut State Medical Society (CSMS) survey of primary-care physicians, most doctors find satisfying. Even so, an alarming one in five say they are thinking about shutting down their practices because they are unhappy with the practice environment in Connecticut that includes burdensome administrative requirements and malpractice issues.
Connecticut cannot afford to let this dissatisfaction continue to build and see its army of primary-care physicians disappear. In many ways, they are the gateway to the health-care system, or at least its hub, coordinating care through referrals to specialists and following up on patient care. However, they complain that an increasing percentage of what they do on the job, especially the time spent on paperwork, is not reimbursed, either through government programs or private insurance. Payment is usually limited to face-to-face patient visits and whatever tests and procedures they can perform.
“There are a lot of challenges,” says Sandi Carbonari, a pediatrician at Children’s Health Center in Waterbury. “The biggest one is time. The kinds of things that need to be done in terms of paperwork and that sort of thing are onerous. It takes an enormous amount of time. And then once you get all that done, you still have to do what you need to do for the patient.”