Health reform threatens to cram already overwhelmed emergency rooms
“Everybody expected that one of the initial impacts of reform would be less pressure on emergency departments; it’s going to be exactly the opposite over the next four to eight years,” said Rich Dallam, a healthcare partner at the architectural firm NBBJ, which designs healthcare facilities.
“We don’t have the primary care infrastructure in place in America to cover the need. Our clients are looking at and preparing for more emergency department volume, not less,” he said.
I’m sure that some of the MD-bloggers will comment on this, particularly those in primary care. Reimbursement rates for primary care suck, the hours are long, demands are many, and primary care physicians have the same loan debt, insurance costs, and maybe even higher overhead than do doctors in some other specialties that pay more. The incentives to go into primary care are few, the disincentives many.
McDermott’s legislation would have required the government to pay for students’ medical education in return for students serving four years as a primary care physician. The measure did not make it on the final bill that eventually became law.
Not very realistic. When a medical student graduates, he or she pretty much has to participate in a residency in his or her specialty. More and more the year that used to be be called the “intern year” which exposed student doctors to a variety of specialties are being wrapped into the first year of residency in a specialty.
Outpatient training begins during internship, accelerates through junior and senior residency and is more extensive than in the categorical residency program.
So, a young man or woman completes a three year residency in primary care or internal medicine, then what? Does the four year period proposed by McDermott start then? What happens after that? Is the doctor, who is now likely to be in his or her mid thirties expected to go back and complete another residency or maybe a fellowship? Fortunately this proposal was left out of the final health care bill, which unfortunately passed and was signed into law. Despite it’s 2,200 pages, this bill was not well thought out. Or maybe it was if you believe that the primary purpose was not to improve health care but to grab control of a large portion of the American economy and the lives of citizens.
What a mess.