Observations Yankee Doodling

Direct primary care: a new system for general practice

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4482 (Published 02 July 2012) Cite this as: BMJ 2012;345:e4482
  1. Douglas Kamerow, chief scientist, RTI International, and associate editor, BMJ
  1. dkamerow{at}rti.org

Can this scheme save primary care in the US?

US primary care medicine is a mess. In most of the developed world’s healthcare systems, primary care doctors comprise at least half of the medical workforce. In the US, it is less than one third.1 Primary care brings hard work, low status, and relatively low pay in the US, and graduating medical students, deep in debt, are voting with their feet. In the most recent class, less than half of the available family medicine residency entry positions were filled by US graduates.2

Doctors complain that insurance and health plan paperwork is burdensome, reimbursement is low, and thus a large number of patients must be seen daily to provide enough income to keep the practice afloat. The pressure of patient volume leaves doctors frustrated that they are unable to spend an adequate amount of time with each patient. Burn-out is common, further exacerbating the brain drain from primary care.

One widely publicised response to this situation has been for doctors to join so called boutique or concierge medical practices.3 …

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