Reforms May Favor General Physicians

Article excerpt

Journal Record Staff Reporter

While some doctors are wary of what health care reform could mean for them, the future looks favorable for primary care physicians, according to Dr. Roy L. DeHart, acting chair of the Department of Family Medicine at the University of Oklahoma Health Sciences Center.

"In many physicians' views, and certainly society's view, there's a greater need in the community for physicians who have an interest in general pediatrics, family medicine and general surgery," he said.

"There's a disproportionate share of sub-specialists, and a lot of our resources in medicine are concentrated in those areas. I, myself, feel a significantly greater portion of health care can be provided by primary care physicians than is the case."

Health care reform is ongoing, said DeHart, who also is professor and director of the Division of Occupational and Environmental Medicine. The future reforms, whatever shape they take, will require greater activity on the part of general physicians in providing initial care to the population, he predicted.

"In that context, the primary care physician becomes what some people refer to as the gate keeper; I prefer to call them gateways," he said. Under that system, the patient goes to the primary care doctor, who takes care of the problem if he or she is able. If not, the primary care doctor refers the patient to a specialist or consults a specialist.

"That has become the way medicine is beginning to be practiced under managed care, regardless of what happens with the federal government," DeHart said. "Generally, the primary care physician makes the determination, rather than the patient saying, `I have indigestion; I need to see a gastroenterologist.' "

Medical schools need to look at where their graduates are going, he said. "A disproportionate number have been going into the specialty and sub-specialty area. It doesn't matter what the needs of society are, physicians have been able to find a niche in whatever they want to go into.

"Part of the reason is, there's not a free-flowing marketplace in medicine," he said. "The patient has no concept of what health care is costing, because it's being paid by a third-party payor, the insurance company."

If clients were paying out of pocket for medical care, "we would be far more selective in who we go see. Rather than paying $50 to $75 an office visit for a specialist, we would see the primary care physician, at $25 a visit, to take care of the problem," DeHart said.

As a greater number of generalists are needed to meet the change in perspective, a greater number of graduates will be needed in the field. "Historically, there's been a disproportionate breakdown in income distribution. Primary care physicians make less income for each hour of service provided, compared to a procedural specialist," DeHart said.

"The insurance companies, for their own reasons, I suspect, have found it easier to pay a higher dividend to a proceduralist than to a physician seeing you in his office, spending considerable time trying to persuade you to quit smoking cigarettes."

DeHart said medical students "aren't dumb. …