Lessons from the VA – bad performance measures and insufficient primary care

This article delineates the problem beautifully. As a former VA physician (part time for 20 years and only inpatient the last 10 years) I can tell you that the patients who frequent the VA require intense primary care. They often have multiple medical problems and often psychiatric problems. Now the electronic medical record is the best I have seen, but it still takes time to type notes, and review the charts. The VA has great benefits, and often reasonable hours, but the salaries are not great from primary care. And the US has a shortage of primary care physicians, especially internists (who the VA seems to favor). Primary care internists have multiple options. Less internists do primary care than 15 years ago, and partly because many do hospital medicine (higher salary, more predictable hours, and more “days off”). The VA crisis in primary care will continue until the job improves. The crisis will not stop with the VA. We will soon see the same crisis for Medicare patients and Medicaid patients. We have to improve the job. We have to decrease the administrative hassles dumped on primary care physicians (actually all physicians). Primary care is the lynchpin of our health care system. Excellent primary care improves outcomes at a lower cost. And our politicians and our insurers have not addressed this issue. We do need to work very hard to fix this problem. The extra moneys put into primary care will save downstream medical costs.
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs