Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why patients don’t value primary care doctors

Chris Rangel, MD
Physician
June 30, 2010
Share
Tweet
Share

“Hey doc, all I need is this referral.”

I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant with their return appointments.

Or they do show up years after their last visit for no purpose other then that the specialist they recently saw after developing a serious illness and being hospitalized, told them that they needed to “go see their PCP to get a referral.”

Seriously? This entire concept of the “referral” system required by insurance companies was designed to contain health care costs by making the primary care provider a so-called “gatekeeper” who controls utilization by deciding who needs a referral and who does not.

In very few circumstances were the “gatekeepers” given incentives to avoid “unnecessary” referrals and more commonly, they were penalized financially for what the insurance company considered to be excessive utilization. Even worse, at least one study found no differences in utilization of referrals whether they were required or not. Hence, there remains no good evidence that this system works to reduce utilization or enhance primary care.

Currently, our health care is a system that emphasizes specialty and complex care over primary care and requires patients to get referrals from their PCPs but does not absolutely require them to be compliant with routine primary care visits and preventative care. As such, the importance and utilization of primary care has been marginalized even by patients who increasingly see it as a bureaucratic burden. Even for patients, primary care is little more than a paperwork hassle.

The irony is that primary care works!

In 2008, a Congressional Budget Office report found huge geographic variations in Medicare resource utilization (health care spending) and that areas with high spending also tended to have high relative populations of medical and surgical specialists (and hospital beds) and actually had worse quality outcomes than areas with lower spending rates and lower relative numbers of specialists.

But it’s not just the relative numbers of expensive specialty care that affects care quality. A 2005 review of the literature by Johns Hopkins University researchers found that primary care does indeed work to prevent and treat disease and health care quality and access is improved in areas that have higher relative numbers of primary care physicians.

But all of this favorable data was virtually ignored by Democrats and the Obama administration in the last – certain to be disastrous – “reform” of health care which didn’t even fix the always impending 21% Medicare physician pay cut.

Patients take their cues from the current system and insurance company and Medicare policy. Primary care providers are seen as little more than purposeless “gatekeepers”, especially when it comes to anything more serious than a cold or vaccines.

But maybe if these patients in question – all of whom had insurance with low co-pays – had been seen regularly then maybe this would have changed. Maybe if the patient noted above would have been seen much earlier when her symptoms first appeared, a simple blood test could have detected her condition at a stage where she could have been evaluated and treated as an out-patient before it became severe and life-threatening.

Avoiding expensive hospitalizations is something that primary care can improve and yet primary care is even marginalized by the insurance companies who end up paying for the hospitalizations and ER visits. Go figure.

ADVERTISEMENT

Chris Rangel is an internal medicine physician who blogs at RangelMD.com.

Submit a guest post and be heard.

Prev

Surgeons need to reconnect with patients after an operation

June 30, 2010 Kevin 2
…
Next

What doctors can learn from Dave Weigel and Journolist

July 1, 2010 Kevin 6
…

Tagged as: Patients, Primary Care

Post navigation

< Previous Post
Surgeons need to reconnect with patients after an operation
Next Post >
What doctors can learn from Dave Weigel and Journolist

ADVERTISEMENT

More by Chris Rangel, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Are Cadillac plans responsible for rising health costs?

    Chris Rangel, MD
  • Should drug testing be considered screening tests?

    Chris Rangel, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Are hospitals really soaking the poor with high prices?

    Chris Rangel, MD

More in Physician

  • The shocking risk every smart student faces when applying to medical school

    Curtis G. Graham, MD
  • The physician who turned burnout into a mission for change

    Jessie Mahoney, MD
  • Time theft: the unseen harm of abusive oversight

    Kayvan Haddadan, MD
  • Why more doctors are leaving clinical practice and how it helps health care

    Arlen Meyers, MD, MBA
  • Harassment and overreach are driving physicians to quit

    Olumuyiwa Bamgbade, MD
  • Why starting with why can transform your medical practice

    Neil Baum, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 66 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why patients don’t value primary care doctors
66 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...