For , writing for the Health Care blog, the future of primary care is a barren landscape:
I fear that the independent family doctor is going to go the way the corner bookstore went, and be replaced by the cold, impersonal, shiny mega-clinic chain in the city. It won’t be long after that before Wal-Mart sets up the Wal-Health clinics in rural America. Any young kids out there planning on going to medical school and hoping for an illustrious career with Wal-Mart?
The Institute of Medicine defines continuity of care, the core attribute of primary care, to have 3 dimensions: continuity in information, continuity in management, and continuity in the patient-physician relationship.
at best lack one essential element of continuity: the patient-physician relationship. But does this really matter? The person who commented on her story certainly thinks so:
I’m going to look for an internist who will agree to be my ombudsman if my health indicates a need for any kind of specialist (heart, circulatory, ortho, etc.). I understand being referred to a specialist, but I don’t want to be sent off on my own. I really want a medical pro to guide me among several options… and if possible, I want his second opinion about anything a specialist would do if it is anything other than trivial or an emergency.
I don’t know if I will succeed in finding the PCP of my dreams, but I know I can’t put it off forever. … In my case expertise is less important than a personal willingness on the part of a professional to advise me on matters I can’t learn on my own.
It appears that the great demand for health care will create the drive through medical care which will be bad for the our society.
The primary care doctor will be placed in the position of overlooking NPs and PAs and/or return to a fee for service at a direct expense to those whom may be able to pay a higher price to see a physician and avoid the insurances. There are seems to be lower number of primary care doctors but there are several individuals whom are willing to pay extra in order to avoid the insulting attitude toward healthcare that some multi-physician clinics deliver.
I think there is a nitch for everyone. I am at a constant look out for good hole in the wall restaurants Italian, mexican and just about any hole in the wall restaurant is better vs the chain feeding dumps.