This is an off the cuff, outside the box ramble.
I was talking to a buddy of mine in the OR locker room the other day about how it seems the body starts to break down once you hit that 35th birthday. (Except mine of course. I'm a machine who will never get sick.) He mentioned that he was diagnosed with Essential Hypertension about a year ago. A routine yearly physical exam noted a diastolic BP of over 100. His primary care doc put him on an ACE inhibitor and, with time, his pressures have drifted back to within normal limits. Since his diagnosis, he has been seeing his doc every three months for "check-ups". I thought that seemed rather intense. He agreed. He waits in the office for 45 minutes, gets his pressure taken by a nurse, the doctor comes in, listens to his heart, tells him everything is fine, see you in three months. He's paying over a hundred bucks a month for the anti-hypertensive. And then there's the fifteen dollar co-pay for every visit.
I understand that primary care physicians cannot afford to have too many empty office hours. Staying booked three months in advance is not only stress reducing, but it's unavoidable if one wants to remain a financially viable entity. But we're talking about a 36 year old male with controlled hypertension. Does he really need to be seen four times a year? And does he need to be on an expensive ACE inhibitor?
It's dogma that primary care physicians are both underpaid and overworked. This is pretty much undeniable. Advocates also aver that any universal health care reform is going to require more primary care docs, because they're already maxed out in terms of availability.
I ask: Is this part entirely true? Is there any evidence to suggest that a 36 year old male needs to see his PCP four times a year? Or that the 50 year old obese female with hyperlipidemia on Lipitor needs follow up appointments every two to three months? Or the 60 year old diabetic who also sees an endocrinologist for blood sugar management?
What I'm getting at is this: Is the jam-pack scheduling driven by medical need or is it more a financial necessity? Will primary care scheduling patterns change once reimbursement is increased? Let's say you get paid the same no matter if you see 30 low maintenance, known patients versus 10 complicated or new patients. Which is more preferable? I'm not certain everyone would choose the latter. Sometimes it's nice to cruise quickly through a day without expending a lot of mental anguish. As a general surgeon, my schedule is very flexible, even unpredictable at times; I have no idea what I'll be doing or who I'll be seeing three weeks from now. I'd be curious to hear from primary care docs in the trenches....