Your Specialist Is Your PCP

There are less and less family docs or internists specializing in primary care.   It is a fact and it will only get worse.  A new study shows that people are already adjusting.  At least 41% are getting their primary care from specialists.   Pretty soon they will be turning to auto mechanics and insurance salesman for their care.   That being said, the Reuters article had an interesting line:

The 2010 healthcare reform legislation, the Affordable Care Act, contains provisions directed at alleviating that shortage, including incentives for doctors to choose to specialize in primary care.

 Incentives?  Really?  Where?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Your Specialist Is Your PCP

  1. Marco Costa
    September 3, 2012 at 11:24 am

    In line with the mechanic parallel, sometimes I feel that PCPs act as “Valvoline” clinics in which patients are seen only in the office for “maintenance” but then referred to specialized care or emergency rooms without a minimal work up first or attemp to treat when something “real” arise. Not mentioning that when hospitalization is needed in many cases care is assumed by a “hospitalist”.

    Not surprise that patients with the access to information that technology provides nowdays try to by-pass what in many cases ends up being a waste of time by going to a specialist directly instead of their PCPs.

    I do agree with the perception that in the near future only midlevel providers will be in charge of PC clinics.

    I feel that PCPs in part have done this to themselves.

  2. Bridget Reidy
    September 1, 2012 at 5:28 pm

    Don’t think the specialists are doing primary care because of the shortage, rather the shortage and the specialists doing it both stem from a complete misunderstanding in our health system and of our culture as to what primary care is and it’s value. It was just beginning to be recognized as a specialty when the unpopular gatekeeper model of HMO’s combined with the increased discrepancy in per minute reimbursement for good primary care compared to one problem visits led to patients and providers devaluing the former.

    Call me an exaggerator but I am now working in a clinic where multiple physicians and PA’s routinely perform one problem visits on patients who for example were started on synthroid one year ago by us with no repeat TSH. And almost everywhere I see so called primary care providers thinking they can do comprehensive care without a chronic problem list or prevention flow sheet. We let EMR’s come in that not only got rid of these things, but make it almost impossible to review the chart to compensate for it’s lack, or even chart what actually happened at a visit instead of what the billing auditors want to see. As long as there’s so many of us happy to encourage even more simple one problem visits by handing out antibiotics for colds and small handfuls of Vicodin for every little pain, and so few of us willing to do the real work, then why not let the specialists and patients continue to think it requires no special expertise to do.

  3. Kurt
    August 29, 2012 at 10:31 am

    The NP and PA are going to be the new primary care docs. Students are not going to waste their time going to med school and residency to put up with a butt load of uncompensatable work like we are facing now. BTW the NP’s and PA’s will probably unionize and I won’t blame them.

  4. Pat Nagle
    August 29, 2012 at 9:19 am

    The HHS program to provide education subsidies for healthcare specialists, including family medicine docs, who spend time in underserved communities, has been expanded and made more flexible.

  5. August 27, 2012 at 11:56 am

    An auto mechanic can raise his prices to adjust for increased overhead and won’t be charged criminally if a tire wholesale company flies him to Vegas to promote a new line.

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