I have commented here before on this (in different context, but to reiterate) … take a gander around “The Tubes” of the Internet, when Sen. Stevens and the others challenged law providers peek out from their little domes, what do they see? They see people (like me) complaining about the lousy state of affairs, not only of insurance, and payment issues, but of care provided by far too many Primary Care Physicians that are not “doing it right” such as you and some of your colleagues here. Which leads to one nasty perception problem.

How many stories can you find about people complaining about being treated like a part on an assembly line? Of doctors that don’t even take the time to actually listen to the problem before writing a script for the medication of whatever drug representative happened to be in the office last? Ask a person about whether doctors are underpaid, and they think “He billed XYZ Insurance $100 for a six minute visit, where I got weighed, listened to my chest, wrote me a script” again, perception problem.

So, in short it looks to me that before this situation can get better that perception has to change, and the question becomes, is how to weed out the bad apples that are causing this perception issues.

By the way, if 40% of all primary care physicians are in solo practice, won’t the system die if solo practice dies? The fact is, there is plenty of money in the system – enough to fund the solo docs many times over – but it is just going to the wrong hands: insurance industry and overpaid specialists. Neurosurgeons deserve big salaries, but the ones in our area are earning over $1 Million. That could keep several solo docs in practice and still leave them quite comfortable.

Actually, I’m an employee. I’m not sure my ovaries are big enough for me to go into private practice. For me, being an employee works well. My paycheck is predictable, I can go on vacation without thinking about the opportunity cost, and the whole hiring/firing staff headache is someone else’s. Of course, I lose some autonomy, and some income. Working for an FQHC, the bottom line is important, but not the most important thing. I’m the rare bird who is an an employee but who isn’t harassed to see more see more see more patients.

I think your point that good primary care is the key to our nation’s health care woes is entirely accurate. But we have an image problem. Once John Q. Public, with a salary of $50K per year, hears what amounts to “But we only make $160,000 a year! The cardiologists make double that!” we look like a bunch of ninnies.

Personally, I think I make plenty for the work I do. But the damn urologist doesn’t deserve $375K a year. Geesh.

At the risk of raining on a historic, distinguished, and important solo doc parade, maybe the mom and pop grocery store just isn’t suited for the post-WalMart era.

This is a political issue, and needs a political solution. We need some good lobbyists, if anything is going to change.

Yes, I think it probably would be better if we were better organized and/or represented by organized medicine.

I think you have fairly well outlined the reasons that seems unlikely to happen.

Private practice PCP’s are simply too busy/financially strapped to get too involved with organized medicine, and even if they weren’t, most of them tend to have that solo independent streak that makes them not very inclined to be “joiners.”

I have to admit that I have that characteristic myself. I think it comes from my Southern/Scots-Irish cultural background.

I think most PCP’s, like myself, mostly just want to be left the hell alone and alowed to practice medicine without a lot of outside interference. It just naturally rubs us the wrong way and gets our “Ire” up when some bureaucrat from D.C. or the state capitol starts telling us how we have to do things, etc.

I think the AAFP, AMA, etc are very top-heavy with people who don’t share these tendencies and just don’t understand them. They think if they can just convince these idiots in private practice to embrace their guidelines, their rules, their maintenance of certification, their JHACO standards, their utopion goals for universal healthcare, etc., etc., well then everything would just be peachy.

They don’t get it. The folks in the trenches of private practice understand the concept of “Less is More” when in comes to bureacracy and rules and government and control.

To our “representatives” in organized medicine this is a totally foreign concept.

About the only organization that I’ve seen that sort of seems to get it is the Association of American Physicians and Surgeons.

I’m not a member of this organization (see my comments about the independent streak thing above), but I often contemplate sending them a check and joining their ranks.

Maybe I will.

For now though, I’m still preparing for my little tea party.

Check out the differences, by the way, of PCP salaries and specialists. The margin difference is enormous. Most of their work is done in the hospital, so they have no overhead there. We carry all of our overhead.

Sam – I can’t disagree. Wouldn’t it be better if we were at least somewhat organized?