Kitty Felde
May 26, 2009
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Primary care physicians think of themselves as an endangered species. Three dozen California doctors lobbied Capitol Hill last week for a bill they say can help them survive and thrive. KPCC's Washington Correspondent Kitty Felde reports.
Kitty Felde: Chwen-Yuen Angie Chen is a primary care physician in Santa Cruz. She's been watching the debate over health care reform. Everyone wants better care, cheaper care, more care. But Dr. Chen has one question: where are you going to get the doctors?
Dr. Chwen-Yuen Angie Chen: I mean, if you have all of the access and you have everyone insured, that doesn't mean that you'll have the supply, which is the physician.
Felde: Family physicians – the doctors on the front lines of medicine – are in short supply. Ning Tang just graduated from Harvard Medical School. She's moving to California to begin private practice. She says she was one of only eight primary care physicians in her med school class.
Dr. Ning Tang: Most of us started really bright eyed and optimistic, thinking we were going to stay in primary care. There are very few of us (laughs) who are continuing into primary care. There's one going into cardiology, another one going into gastroenterology, another one going into hematology, oncology. This story is familiar across the country.
Felde: Dr. Tang says there's a reason the Marcus Welby-variety of family doctor is a dying breed:
Tang: We look at the current life of primary care physicians – our role models. And we see how tired they are. We see how frustrated they are dealing with insurance companies.
We see how they stay very late at night and still they go home and they're still not satisfied with the care that they deliver to their patients. And I don't think any one of us wants to go into medicine feeling like we did not help our patients in the way they really needed to be helped.
Felde: Long hours, fistfights with health insurance bean counters – and then, says Dr. Tang, there's the pay. She says primary care physicians earn half what cardiologists and oncologists do – and sometimes less than that. Dr. Tang says medical school can leave a new doctor with a quarter of a million dollars of student debt.
Tang: With that much student debt that we're looking at, why stay in primary care?
Felde: That's why Dr. Tang and three dozen other California doctors are lobbying Congress to support HR 2350, the "Preserving Patient Access to Primary Care Act."
Dr. Susan Sprau: It will help to improve the pipeline of primary care physicians by providing scholarship and loan repayment programs for primary care in critical shortage areas.
Felde: Dr. Susan Sprau of Santa Monica says the measure would also create pilot projects that pay doctors based on the quality of care they provide rather than number of patients they see. It all sounds great – but what will it cost? Dr. Sprau says she understands the cost worries.
Sprau: One of the things that I learned in my meeting with my, the congressional staff people, is that they're all concerned about not adding unnecessary costs to an already expensive system. And by increasing and supporting primary care, that is one good way to help control costs in the health care system.
Felde: HR 2350 has support from the 126,000 members of the American College of Physicians, the 93,000 members or the American Academy of Family Physicians, and many other medical groups. But many in Congress won't sign on until they know how much the measure's going to cost. They're waiting for an estimate from the Congressional Budget Office.
