Wednesday, July 01, 2015
Primary Care
I haven’t said it for a long time, so I’ll say it
again. If medicine was a science, there
would be no need for doctors. If one
could stick a finger a machine and learn the diagnosis and best treatment,
there would be little or nothing for anybody else to do. But no such machine exists yet so doctors
learn what science and technology can tell them and then resolve uncertainties
and choose among alternative courses of action.
It seems to me to follow that since science and technology
can tell much more than they could in the past, there is less for doctors to do
and we should need fewer of them.
The matter arises specifically in the case of primary
care. The June 23 issue of The Boston
Globe carried a rather lengthy article on the subject, titled Precarious future for primary care. The article discussed the difficulties of
recruiting physicians into primary care, given that the specialties pay better
and can be less demanding.
In my last two ER experiences (nothing serious, only bothersome
complaints at inconvenient hours) I learned during the visit that I was being
seen not by a doctor but in one case by a nurse practitioner and in the other
by a physician’s assistant. In both
cases my concern was properly addressed and I was completely satisfied by the
service.
Adding to that a reflection on what goes on during my unexciting,
periodically scheduled routine visits to my regular primary care physician
causes me to wonder whether we really need physicians for most primary care at
all.
Primary care physicians graduate from college, go to medical
school for four years and then undertake two or three years of residency. According to the article, the average salary
of a physician in family practice is $196,000 per year. There may well be a goodly number of people
who could be trained to carry out the function satisfactorily in a shorter
period of time and who would be happy to work for a lower salary.
