As we all know, the economy ain't doing so well. And there's good evidence to suggest that people are cutting back
on preventive doctor visits--when times get
tough, people reduce frivolous spending.
Doctor visits are frivolous?
American
medicine is absolutely horrible at preventing disease. Docs have done a phenomenal job prolonging the American life. Life
expectancy has risen from 49 to 77 years in the past 100 years. In
1900, the top four killers were pneumonia, tuberculosis, diarrhea, and
heart disease. But today, the number one killer in America is bad
behavior. Smoking, food addiction, alcohol addiction, and lack of
exercise create the top four killers -- heart disease, cancer, stroke,
and COPD. I have to give my physician colleagues in the past 100 years
a huge pat on the back. We solved the simple, acute problems with
antibiotics, vaccines, and rehydration. The dirty little secret is that
the life expectancy of a 65 year old in 1900 was only about six years
less than a 65 year old living today. In other words, the extra 28
years of life expectancy in America in the past 100 years is
overwhelmingly due to antibiotics, vaccines, and surviving childhood.
It's surely not due to our ability to change your behavior and prevent
your chronic disease.
The Great American Health-Care System was created in conjunction with
the technologies designed to solve simple, acute problems with pills,
shots, scalpels, and eight minute visits. And rightly so: Acute illnesses
killed us when our brick and mortar infrastructure was being built, and theory of modern health care was built to cure those ills. The problem is that pills, scalpels, and eight
minute visits are still all that today's docs know. They are the tools doctors use because
we've always used them. And they are horrible tools to use for changing your
behavior.
So how many doctors does it take to change your bad behavior?
That sounds like a lightbulb joke because, well, it is a bit of a joke. In med school, we got about one week of behavioral modification training during our
psychiatry rotation. The other 207 weeks of school were spent preparing us to be real doctors that simply prescribe and cut. Since doctors
have no idea how to change your behavior, we're treating the symptoms
of chronic behavioral-based diseases like we've always treated acute
illness--with pills and scalpels. We're using the wrong tools.
It's time face the fact that doctors in our current health-care system
practicing today's medicine aren't going to significantly improve our
nation's health. Only you, by leveraging the power of human will to
change your lifestyle for the better, will fix your own health. You are
the CEO of your body, and physicians are simply your consultants.
Because, on average, you spend one hour with your doctor per year, and
8,765 hours without. We don't need more doctors or more pills. We need
you to understand, and to care, that your behavior today affects when
and how you will live in the distant future. Unfortunately, doctors need you
to give up all your fun, and behave. No wonder you don't want to pay us
for that advice.
DISCLAIMER: I fully support this kind of prevention.
Jay Parkinson is a physician who lives in Brooklyn, and the Chief
Concept Officer at Myca. He saw that patients and doctors communicate
very differently from how the health-care industry does, using the
Internet and their iPhones. He soon had a functioning practice,
incorporating his Web site and house calls with email, IM, SMS, video
chat, and PayPal. This system was developed into an application
wrapping up all of those empowering technologies into one powerful
system--Hello Health. Parkinson and Hello Health were profiled in the Fast Company magazine article "The Doctor of the Future."
Imagine there is a committee of politicians made up of 24 republicans and 5 democrats. Their job is to decide a politician's salary--for democrats and republicans--and decisions are made by majority rule. Which party do you think would have the highest salary?
Much like American politics, doctors have a two-party system. It's the Primary Care Party versus the Specialist Party. For the past 20 years, the specialists have been pummeling the primary cares. In 1991, the AMA formed an expert committee called the RUC in response to a Congressional mandate to provide recommendations to the Center for Medicare & Medicaid Services (CMS) on the worth of every visit and procedure a doctor can perform. CMS then accepts, rejects, or modifies these recommendations and effectively places a dollar amount on the thousands of codes doctors use to get reimbursed. CMS sets the standard. Private insurers then use these standards to decide how much they reimburse physicians in their own networks.
At the tip of this convoluted payment pyramid lies the RUC, composed of 29 physicians, each representing the 29 specialties. Five of them are primary care doctors. Majority rules. It is the reason our nation's doctors practice quantity medicine, not quality medicine.
Our current health-care malaise is the result of the federal government making policy around recommendations from specialists who are looking out for their own, while ignoring the needs of a highly functioning system. The backbone of an efficient, cost-effective health-care system relies upon a strong primary care workforce to manage the common problems and refer for help in managing complex and rare problems. Other countries in the world that rank far better than the U.S. in medical services have about 75% generalists and 25% specialists. The U.S. is exactly opposite: 75% of our doctors are specialists. And about 94% of graduating physicians in America chose a specialty over primary care last year.
Med students, while inexperienced, aren't dumb. They follow the money and the lifestyle. There are two vastly different worlds available to them: Start at $80,000, work 60 hours a week on the eight-minute visit hamster wheel, drive a Toyota, and play on the public golf course; Or specialize, and start at $250,000, work 40 hours a week, spend 30 minutes with each patient, and enjoy the newest BMW and country club membership.
The primary care docs in America have been virtually eliminated by the Specialist majority. We, as a nation, are just starting to feel the hurt this is causing. The feds may soon mandate insurance coverage for us all, but there are so few primary care docs around that we won't be able to use our new insurance. Most of these new insurance plans will be micro-managed primary care gatekeeper-type policies. The ERs will be flooded because primary care won't be available. The cost of health care will skyrocket. And the waits to see a doctor will trump Massachusetts' 52-day wait.
The Obama administration has three proposals--increase the number of medical students, use more physician's assistants and nurse practitioners, and expand the National Health Service Corps. None of these will work. They are all band-aids that won't stick for more than 30 seconds. Increasing the number of med students will simply increase the number of specialists driving BMWs. The American public still wants to see doctors, not PAs and NPs. The National Health Service Corp will offer generalists another low-paying option to practice in areas where no docs want to practice.
Reversing the effects of the RUC will take 20 years, and a new generation of physicians. The first policy change needed to solve the primary care crisis is to remove the conflict of interest within the RUC. It should either be staffed with health policy experts, or with 75% generalists and 25% specialists. If that happened today, twenty years from now our actual physician workforce would reflect what's needed. Unfortunately, this would also be the beginning of the health-care war. We'll see lobbyists for specialists teamed up with the hospitals who profit massively from specialist care versus the lonely 25% of doctors who represent primary care fighting for equal pay, lifestyle, and a strong health-care system. I have a hunch which party is going to win this one. What are your thoughts, Hillary? Remember 1993?
Jay Parkinson is a physician who lives in Brooklyn, and the Chief Concept Officer at Myca. He saw that patients and doctors communicate very differently from how the health-care industry does, using the Internet and their iPhones. He soon had a functioning practice, incorporating his Web site and house calls with email, IM, SMS, video chat, and PayPal. This system was developed into an application wrapping up all of those empowering technologies into one powerful system--Hello Health. Parkinson and Hello Health were profiled in the Fast Company magazine article "The Doctor of the Future."
As we all know, the economy ain't doing so well. And there's good evidence to suggest that people are cutting back
on preventive doctor visits--when times get
tough, people reduce frivolous spending.
