The Year in Review: 2008

From the perspective of a primary care physician, 2008 was not an especially good year.

It was the year the Joint Commission on Accreditation of Healthcare Organizations decided it was time to start criminalizing the behavior of “disruptive” physicians in hospitals beginning the following year.

It was a year that physicians discovered that an error (or difference of opinion) in coding for an office visit could lead to a costly audit if it happened with a Medicare patient. 

It was also the year that physicians narrowly avoided a 10.6% pay cut from Medicare, no thanks to a veto of the pay cut reversing bill by President Bush and a number of “nay” votes by Republicans.  If the pay cut reversal bill incident damaged the reputation of Republicans with some physicians, capitalism itself suffered a PR problem as it became apparent that the Medicare Advantage plans that were supposed to introduce free market efficiency into Medicare cost more than traditional Medicare.  Worse still, the added cost of the Medicare Advantage plans appeared to be the result of simply denying patients coverage and denying physicians payment.

Poor reimbursement, chronic threats of pay cuts, and the risk of audits took its toll as physicians opted out of Medicare.  As the year wore on, stories like this one about Medicare patients being unable to find primary care physicians became more common.

Another reason Medicare patients had trouble finding primary care physicians was that there were fewer primary care physicians to find.  Two survey studies released in 2008 painted a grim picture of the future of American health care.  A mere 2% of medical students planned to go into internal medicine, according to one surveyAnother study showed that nearly 1 out of 2 primary care physicians would consider leaving medicine.  Within 17 years, a deficit of as many as 40,000 primary care physicians might exist.

Ironically, the very fact that primary care looked as grim as it did in 2008 may in retrospect turn out to be the moment that the American health care pendulum started to finally swing back toward primary care as the core of American medicine.  The reason for this is that many of the stories linked in this post were to be found in the mainstream media.  The problems related to primary care stopped being relegated to the professional practice management journal and the medical blog site.  In 2008, primary care’s problems became America’s problems.

In the New Year’s Day post on Dr. Bobbs, we’ll examine what 2009 may hold for primary care and why the prognosis is looking better than it has for a long time.

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