I would urge THCB-ers to read Reframing Healthcare by Dr. Zeev Neuwirth. While much of the territory he covers will be familiar to those of us with an interest in healthcare reform (meaning just about everyone reading this blog), Chapter 5 breaks new ground in the field of primary care.

Primary care is perhaps the sorest spot in healthcare, the
sorest of industries. Primary care providers (PCPs) are underpaid,
dissatisfied, and in short supply. (The supply issue could be solved in part if
employers didn’t pay employees
bonuses to get useless annual checkups or fine them if they don’t, of

They are also expected to stay up to date on a myriad of
topics, but lack the time in which to do that and typically don’t get
compensated for it. Plus, there are a million other “asks” that have nothing to
do with seeing actual patients.

For instance, I’ve gone back and forth three times with my
PCP as she tries to get Optum to cover 60 5-milligram zolpidems (Ambien)
instead of 30 10-milligram pills. (I already cut the 5 mg. pills in half. Not
fair or good medicine to ask patients to try to slice those tiny 10 mg pills
into quarters. And not sure why Optum would incentivize patients to take more
of this habit-forming medicine instead of less.)

This can’t be fun for her. No wonder PCPs burn out and leave
the practice faster than other specialties. What some of my physician
colleagues call the “joy of practice” is simply not there.

To steal the thunder from Dr. Neuwirth’s book, he observes
that primary care is really five specialties rolled into one.  It was formerly six, I might add, but rounding
has been almost totally taken over by hospitalists. Doctors with an interest in
rounding can now become board-certified in doing that exclusively, while those
who used to have to drive to multiple hospitals to see one

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