Line Forms to the Rear

Need primary care?

Good luck.

Especially if you are in Massachusetts where you are required to have health insurance.

Since the law was passed, requiring residents to have health insurance, a little over half of the previously uninsured have gained coverage.

But at what price?

As the Cato institute reported, the state tax budget for health insurance subsidies overshot the mark by 33%.

But the cost of mandated care extends beyond dollars and "sense".

Want to see a doc?

Get in line.

Dr. Kate Atkinson is taking on new patients . . . who can wait until May 2009 before they are seen.

There are many reasons for this overcrowded access to primary care. One is there are fewer med school grads opting for the relatively low pay of primary care vs. a specialty.

Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.

The Medicare reimbursement rate.

As in, taxpayer funded plan.

And keep in mind that Medicare reimbursement rates are typically much lower, sometimes by as much as 30 - 40%, than reimbursement by private insurance carriers.

“It is a fundamental truth — which we are learning the hard way in Massachusetts — that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February.

Is this the same congress that wants to provide free health care for all as part of their election campaign promise?

Apparently they have selective listening skills.

The share who accept new patients has dropped, to barely half in the case of internists, and the average wait by a new patient for an appointment with an internist rose to 52 days in 2007 from 33 days in 2006.

52 days.

You could be well by then.

Or much sicker.

The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs.

Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice.


If your goal as a new doc is to pay off med school loans quicker, opt for the higher paying job.

You know, like rocket surgery.

But let's get back to those folks on taxpayer funded plans. How do the docs react when a Medicaid patient shows up?

Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.

“I calculated that every time I have a Medicaid patient, it’s like handing them a $20 bill when they leave,”

Gosh, she says that like it's a bad thing.