This article demonstrates again the benefits of placing health care in hands of primary physicians -- benefits which have been demonstrated many times since the founding of the specialty of family practice thirty years ago.
Unfortunately, managed care and "health care reform" have pointed their cost-cutting measures disproportionately at family physicians. Many of us are still paying off debts generated during the most draconian years of capitation, and many of those who started practices at that time are no
longer able to afford to function as primary care doctors.
Although doctors who have started practice in the last five years are doing better than my cohort did, I fear that continued paring of reimbursement by insurance companies and by the government, increasing liability and cost of malpractice insurance, increasing populations of uninsured and underinsured patients, and the generally low esteem that
family physicians enjoy professionally will result in ever-diminishing access to this critical specialty.
The United States will continue to have a shortage of family physicians as long as the specialty is seen as the poor relative of the higher-profile subspecialties. The hard hours, emotional investment, and educational demands need to be recognized and rewarded appropriately.