Primary Care

The shortage of primary care doctors is a big problem across the nation, but it's an especially big problem in underserved areas, where people are more likely to struggle with poverty and less likely to have health insurance.

Where have all the medical students gone?

No, Pete Seeger has not written the anthem for health reform circa 2009. (Although it's not a bad idea).

We write all the time about the economic and moral imperative for covering all Americans. Today, we'd like to address the public-health we're-all-in-it-together pandemic flu imperative for covering all Americans.

We don't yet know how bad the outbreak will become, and it goes without saying that along with everyone else on the planet, we hope it is mild. But the fact that we have 46 million (probably more given the recession) people who are uninsured and don't have easy access to care, outside the emergency room, is making us nervous. The border States have particularly high rates of insurance. One-in-four Texans lack insurance, nearly as many New Mexicans, one-in-five Arizonans and Californians, (and that's 2007 data, it may well be higher now). And think about all the people who do have some insurance but may still postpone going to the doctor because they have a bare bones or high-deductible insurance policy. Times are tough, and they'll try to ride it out because they can't afford the co-pay or deductible. Delayed care can mean more serious illness—and more spread of disease.

Having visited New Orleans and the Gulf Coast 18 months after Katrina, and having seen first-hand the stresses on the hospitals, ERs, clinics, mobile health vans and other health centers, it's heartening to hear even a little bit of good news emanating from that struggling city.

We've written a lot about the shortage of primary care physicians, but recently we've also seen several articles about the shortage of general surgeons, particularly in rural areas and smaller communities. Today's Wall Street Journal takes a look at the problem, and the imperfect solution—the surgical equivalent of circuit riding judges.

Sitting in traffic Sunday with the rest of those migrating Turkey Day pilgrims, we caught a story by Karen Brown on NPR's All Things Considered.

Stop the world. Primary care doctors want to get off.

A survey by the Physicians' Foundation, which promotes better doctor-patient relationships, found that nearly half the primary care physicians would do something else if they could. Patients aren't the headaches, as much as red tape from both private insurers and government programs.

More evidence that it's not just the uninsured clogging up our ERs. It's the whole flawed health care system clogging up the ERs.

Even author-recluse Don DeLillo knows the value of a good internist. In White Noise, he observed that:

An article by Brian Rank, M.D., in the New England Journal of Medicine on executive physicals-the Bentley of Cadillac care-is generating a lot of buzz in the blogs (here, here, here). The main message: more care is costlier care, but it's not necessarily better care.