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
"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
DeHart said medical students "aren't dumb. …