Dr. Mark Jansen of the Arkadelphia Medical Clinic said last week that most of what America is doing in health care — at least 85 percent of it, maybe more — is fine. His primary concern is how to fix problems in the remaining 15 percent. Preventative health care was discussed last week. Today he talks about the alarming decline in the number of primary-care physicians and other issues.
Downs: How would primary care clinics like your own be impacted by universal health care?
Jansen: We don’t have an adequate medical work force of primary-care practitioners to provide care to the folks we are seeing. If more people are added to the system, I think the best approach will be to turn to nurse practitioners and physicians’ assistants. They can do the initial assessment, determine a diagnosis and begin a treatment plan. If someone has a more complex issue, or complications of basic issues such as diabetes or high blood pressure, these additional providers can move them on to the physician level of care. But at least the patients can get into the system promptly.
Downs: Doesn’t this call for what some would term a radically new approach to primary health care?
Jansen: Yes, and this is where our medical system is falling down — we’re “specialty” heavy — plastic surgeons, anesthesiologists, radiologists, etc. — who are better paid and work fewer hours than primary-care physicians. So the current system does well in providing more exotic care, but we continue to struggle with the provision of basic medical services. We have to do the basic things well so we don’t have the high-end expenses later on if disease is not discovered earlier and treated in a comprehensive and preventative manner.
Downs: How do we reverse the declining number of primary-care physicians?
Jansen: I think there are two answers. First, we must figure a way to incentivize physicians who are in practice to remain in practice if they are in primary care. Second, we must incentivize medical students to select “primary care” as their field of study rather than choosing to become specialists.
Downs: How can this be done?
Jansen: The most obvious way would be financial. I believe that the typical Arkansas student coming out of four years of medical school faces about $130,000 in educational debt. Considering that level of debt before these graduates even go into their residency, we can start talking about ways to help cover that debt. By helping them out with the cost of their education, we can incentivize these students to select primary care.
Downs: Why can’t medical clinics such as your own offer to cover these educational debts with financial assistance to these primary-care students after they graduate in return for a promise to stay, say, five years?
Jansen: The problem is that our reimbursements are going down. Medicare has a 21 percent cut coming up on Feb. 28. So with primary care clinics already having trouble getting by, I don’t think they have the resources to provide additional money to cover the debts. It’s the primary care clinic’s problem to find the physician but it’s even more the country’s problem to have those physicians in training and ready to be hired so they can later provide care for the citizens.
Downs: So these financial incentives would more likely be offered by larger medical facilities rather than by the smaller local clinics?
Jansen: So far as actually putting cash down to try to help that person, yes. Some larger corporations like the Baptist Medical System or the Mayo Clinic might have the deep pockets to help with medical education costs but not the mom-and-pop shops that are so common around the country, like ours, with three or four family doctors or pediatricians or internists just trying to get things done.
Downs: So if universal health care becomes a reality, how will this affect the Arkadelphia Medical Clinic?
Jansen: I don’t know how to answer that question because I don’t think we have the capacity to accept those additional patients. I think those in Congress who understand rural health care are aware of this problem — they may not want to acknowledge it — but they are aware of it.
Downs: Any other concerns?
Jansen: One would be to ease restrictions on physicians who are trying to justify medical tests that are needed. I understand that the insurance industry is obligated to have some plan of review to make sure the tests are being appropriately used. But the delay in making decisions means that patients have to suffer with their symptoms while we are negotiating with the insurer.
A second concern is that any time I or my staff are on the phone with an insurance company is time that we are not seeing patients and taking care of them.
A third thought would be to legislate away the “pre-existing condition” denials that are a part of all health-insurance plans. If no insurance company could deny care, then the playing field would be level, ill folks would have access and the companies could compete on cost of a policy. But at least those individuals would have a shot at some type of coverage versus none now.
Next week: Questions, concerns, solutions? Contact: downsw@sbcglobal.net
Arkadelphia, Ark. —
