Obamacare, a bad deal for America

If you think it’s hard to get an appointment with a family doctor now, just wait until you’re a little older. By 2025, it’d really be best if you avoided getting sick altogether. That’s when America will have a shortage of about 40,000 primary care physicians, according to the U.S. Department of Health and Human Services. Money is at the root of the problem (specialists earn a lot more than primary care doctors), and there is no cure in sight. Many of us won’t be able to get an appointment at all.

So what’s a patient to do? You may not like the answer, but at least it’s simple: become your own doctor. I don’t mean you should go to medical school, of course. Nor do I mean you should panic-Google your itchy tongue (more on that later). But you do need to take on a new set of tasks.

Let’s look at the three things adult primary care doctors do best. The first is to offer “episodic care,” meaning the sort of medical attention you get when you come down with something and head over to the doctor’s office. The second is to offer preventive care, helping you to head things off before they become a big problem. And the third is to monitor and treat continuing problems like diabetes or high blood pressure.

These are all essential services, and we’ll miss them when they’re gone. But here’s the best way to keep them,sort of,going.

First, when you get sick, use a walk-in clinic. These are usually called “urgent care centers,” and they’re often open 24 hours a day, perhaps located in a mall or pharmacy. So if your stomach is hurting like crazy, go consult your yellow pages or Google “urgent care” services in your city. In fact, do it before you eat that suspicious-looking soufflé and get too compromised to make good decisions. Check out the walk-in clinics nearby, write down the info, and put it on your refrigerator or in your smart phone,  so you have it ready. Here’s what you should not do: go to an emergency room with anything other than a true emergency, like a life-threatening problem. Misusing the ER is an incredible waste of time and money and I mean incredible amount of money. It costs the hospitals lots of money to staff and operate an ER.

Second, start taking the lead in your own preventive care. The good news is that the resources are out there, and this wasn’t the case even as recently as five years ago. The best place to go is the website of the US Preventive Services Task Force. This is an entity that was created precisely to allow patients (and physicians) to have the most up-to-date and scientifically supported information on prevention. The recommendations come from non-governmental, non-biased experts, and there are strict rules in place intended to prevent personal biases—and especially monetary biases—from influencing the advice that’s offered.  Look for evidence based recommendations. Do not fall for the Naturopath’s or Chiropractors advice for “cure”.  Not to say that they do not play a role in medicine, but most of non-MD “healers” go beyond their knowledge of medicine.

Third, if you’ve got chronic problems that require regular attention, start going to specialists for them. Studies show that primary care doctors do neither better nor worse than specialists when it comes to management of long-term problems such as diabetes, so it’s reasonable for you to seek long-term care with specialists, who will still be plentiful, rather than primary care doctors, who may be as rare as giant pandas after the Obama Affordable Care act gets enacted. Why?  Because Obamacare wants us, the primary physicians to be held fiscally responsible if the patient is non-compliant and uses more than average resources. The physicians will not get paid under this plan if the patient is non-compliant and does not follow a treatment plan recommended by the physician.  Go figure!

Now, to be an active participant in your own health and prevention of disease you will need to rely heavily on Internet resources.  That’s perfectly fine. But what’s not fine is frantically Googling your symptoms and coming up with half-cocked diagnoses. Before you know it, you’ll be suffering from smallpox, typhoid, and rabies. Instead, recognize that the worst-case scenario (my sore throat could be cancer!) is not even remotely likely, and stick to sites that offer reputable information. The websites of the American Academy of Family Physicians and the American College of Physicians are excellent and open to the public. Use reliable sources.

Meanwhile, current primary care providers can do a lot to help adjust to the new shortage. Every primary care physician should have a website, even if it just has updates on epidemics, downloadable forms, and basic information about the practice. This would save a lot of time in the office. Also, primary care doctors should eliminate hospital care from their regular work. Traditionally, doctors pay bedside visits to any patients of theirs who are hospitalized, in order to provide continuity in the patient’s care. But the emergence of hospital generalists called “hospitalists”—along with more enhanced communication systems—has largely replaced this need.  While it’s nice for the patient in the hospital, it’s a huge and inefficient drain on a doctor’s time.

Primary care providers should also partner with urgent care centers and send all their same-day, sick patients there. This way, they stay on schedule and their sick patients are seen right away when it’s most convenient for the sick person. However, the urgent care centers need to realize that they are what they are (“urgent” care centers) and do not replace the continuity of care provided by their PCP.

Docs who follow this will have more patients, better informed patients, and restful nights. Certainly, the shortage of family doctors and Internists is going to be a problem, but it also creates opportunities for both patients and physicians to improve existing healthcare outcomes. The shortage of PCP’s is inevitable, and until Obamacare is repealed all primary care physicians will be driven out of business and you can expect care provided by nurse practitioners and physician assistants. Diagnosis of complex diseases will be delayed with higher costs of treatment.

Adios!

Harbir Makin, MD