Dr. Jonathan Glauser’s recent adolescent tirade against primary care in Emergency Medicine News was apparently not his first. Here are some excerpts from a 2001 op-ed in the same publication, with some commentary by yours truly:
People vote with their feet. They come to emergency departments with non-emergency visits for myriad reasons, all related to the failure of the primary care system in this country. Few PCPs (certainly not enough) will provide charity care to the uninsured. We do. Of course, the law says we have to, but this is beside the point.
No charity care in primary care? Spend a day in any primary care office in this country and witness how much is done for patients without compensation. As for the law requiring emergency departments to see patients being “beside the point,” a little organization you may have heard of called the American College of Emergency Physicians had this to say:
More than one-third of emergency physicians lose an average of $138,300 each year from EMTALA-related bad debt, according to a May 2003 American Medical Association study. Emergency physicians and other specialists combined lost $4.2 billion in revenue in 2001 providing care mandated by EMTALA.
Color me cynical if I say that this would not be done but for the coercive power of the government.
EPs can still put their hand on the Bible, and recite the Hippocratic oath. Most PCPs keep inconvenient hours, convenient to the doctor but to no one else.
Yeah, those three 12-hour emergency department shifts a week are murder, aren’t they?
People who have back pain, a migraine, or viral illness may know that their disease is self-limited, yet they cannot get appointments within weeks. Often, by the time they are seen, they feel better.
Damn you evil primary care doctors! How dare you have the audacity to treat only patients requiring treatment! I guess it’s up to the emergency department docs to see that patient with a virus, get a chest radiograph on them, obtain a complete blood count with differential, and only then, $800 later, prescribe that unnecessary Z-pak. Better hurry, before the patient feels better without having cost the health care system anything!
Patients with multiple medical problems need health care providers to juggle all of their tests, to keep track of diagnostic work-ups, and to handle overall care, especially because specialists show no inclination to want to treat or to keep track of anything outside their field.
Uh…yeah, doc. That’s why they’re called specialists.
Since this op-ed was written in 2001, shouldn’t subsequent developments have caused the current state of health care to look much better than it does? According the New England Journal of Medicine, “Between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent.” Shouldn’t this be a good thing, if we accept Glauser’s assumptions? And why are stories about primary care docs planning on leaving the profession or the looming (or to be more accurate, worsening) shortage of primary care physicians being greeted with alarm? Why do we not hear the sound of applause and popping of champagne bottles? Where’s the celebration of the imminent extinction of primary care?
Equally curious are stories about minor ailments that primary care docs aren’t quickly addressing in their offices — you know, back pain, migraines, viral illnesses — not being the cause of emergency department overcrowding? This, again, from that obscure, hole-in-the-wall outfit called the American College of Emergency Physicians.
And this: Editorial Says Emergency Department Overcrowding Needs To Be Addressed By Increasing Funding, Resources; Covering Uninsured. Funds? What are these strange “funds” the article speaks of? I thought emergency departments provided charity care? I also thought it was “beside the point” that the law said they have to? Apparently the “law” in question was not the law of supply and demand since nations and empires from antiquity to the present have struggled to make it “beside the point,” all without success to date.
I don’t think Dr. Glauser’s viewpoints, which appear to have undergone no change whatsoever over nearly a decade of significant change in the American health care landscape, reflected then or reflect now those of the vast majority of emergency physicians.