More primary doctors, less cost
By Dean Bina

Three recurring themes run throughout the current debate on health care reform - cost, access and quality.

Any reform effort aimed at improving access and controlling costs must focus on increasing the number of physicians, particularly those who practice primary care medicine. These front-line doctors are in the best position to manage the health of patients while utilizing appropriate resources (dollars) to keep the expense of health care down.

A big problem looms if Congress passes health care legislation that extends insurance coverage to a significant part of the more than 40 million Americans who lack insurance without increases in both primary care and sub-specialty physicians.

Across the U.S., the primary care doctor, family physician, general internist and general pediatrician has been identified as a key person in controlling costs and expanding access. However, there are not enough of them in practice now, and the current shortage of primary care doctors prevents too many Americans from getting the care they need, especially in rural areas, even when we use well-qualified physician assistants and nurse practitioners.

Mercer University School of Medicine, whose mission since its founding in 1982 has been to prepare primary care physicians for rural and medically underserved areas of Georgia, once again partnered with the citizens of Georgia and responded to the crisis in physician supply by opening a new four-year campus in Savannah last year.

When the campus reaches full enrollment of 240 M.D. students within five years, Mercer will be graduating twice as many medical doctors - 120 each year.

Even with this effort that is supported by the governor and the Georgia Legislature and with a mission focused on primary care, convincing students to seek primary care training remains a major challenge. Principal impediments include income and workload.

The average medical school student accumulates about $160,000 in debt for tuition and living expenses over four years. Primary care doctors are well paid, earning $120,000 to $170,000 per year. But physicians in sub-specialty practices often earn more than $500,000 per year.

U.S. medical school graduates reject primary care because sub-specialty training leads to higher compensation and is perceived as a more prestigious career. Some reject it because of its very difficult work - investigating and discovering the main problems, coordinating care and managing the follow-up and recovery phases.

The main rationale behind the increased access and cost control ideals expressed by Sen. Max Baucus, D-Montana, chair of the Senate Finance Committee, is that "patients with access to quality primary care are more likely to remain healthy and prevent costly and distressing chronic diseases."

To control cost, we must prevent and manage chronic disease. The nation's health and economic strength depends on improving the health care system. Seventy-five percent of every health care dollar spent in the U.S. is for treatment of patients with one or more chronic diseases.

I am a family physician. Family medicine is challenging, but rewarding. I think that every citizen of Georgia should be getting accessible, holistic, patient-centered care that is built on a primary care foundation. Payment reform will be critical to attracting more physicians into primary care practices.

In concert with our two major teaching hospitals, Memorial University Medical Center in Savannah and the Medical Center of Central Georgia in Macon, we are currently reviewing the clinical training curriculum to ensure that our graduates will be ready to take their place in the new health care workforce programs of the future. Together, we will be training more than 480 students and 200 physicians annually within the next five years. 

Our academic health center partners serve as high-quality, safe, and cost-effective care delivery and training sites that will, we hope, lead to more young physicians practicing in the medically underserved areas of Georgia.

William F. Bina, M.D., M.P.H., is dean of the Mercer University School of Medicine.