~ by Linda M. Girgis, MD
Being a primary care doctor has never been more difficult. Not only do we have to be knowledgeable about new technologies and medical advances in every field of medicine, we are expected to be “gate-keepers”. In the US system, this model of care was set up by HMOs in an effort to lower healthcare costs. In the UK, physicians are expected to do the same under the National Health Services (NHS). All patients need to see their primary physician before going for specialized care. While this certainly has advantages, it comes with significant oversight and regulations. Primary care doctors on both sides of the Atlantic, in the US and UK, are being crushed under these systems.
In this model of care, medical decisions are increasingly made by third parties, whether a for- profit insurance company, the Medicare/Medicaid program, or the NHS. Doctors feel that giving the best care to patients is becoming an elusive concept. According to a GP in this article in The Guardian, “Everyone necessary for that care co-operated for the good of the patient – they didn’t compete for the benefit of shareholders. Sadly, patients are now right to be suspicious of motives concerning decisions made about them, which until recently, almost uniquely in the world, have been purely in their best clinical interest. Most politicians understand little about general practice, have no idea about the importance of continuity of care and blame GPs for a rise in hospital work, even though this is a direct result of their policies.”
Doctors in the US feel the same. We offer our best care to patients, however, our decisions often get tossed out in the prior authorization process by insurance companies. Many medications never get filled because of insurance company formularies whose guidelines are created, for the most part, by non-physicians. Instead, they are influenced by big pharmaceutical companies. Patients do not see all that goes into these decisions, so the blame falls at the doctors’ feet.
Doctors on both sides of the Atlantic feel that outside forces have too much influence in our medical decisions. This harms patient care and the doctor-patient relationship, which is one of the building blocks of primary care. Control of medicine has been snatched out of ours hands and we feel helpless watching while our systems fail to provide patients with the best care.
According to a recent report by London’s Assembly Health Committee, “a lot of London’s GPs are retiring or not far off it. About 16% of them are aged over 60 compared with 10% nationally. Many are taking early retirement and figures suggest growing numbers are considering emigrating. Meanwhile, GP practices are finding it harder to recruit partners.” The US is seeing a similar situation. Here, there is both a shortage of doctors in training opting to pursue a primary care career and more physicians retiring earlier.
As the population ages, the need for primary care doctors is flourishing. Yet, primary care doctors increasingly bear the brunt of flawed healthcare systems. Shortages already exist on both sides of the Atlantic and this can only grow. Overhauls are desperately required in the US and UK health systems to put quality patient healthcare back at the center of the healthcare equation.
Medicine and technology has never been so advanced as it is today. But, unless we give respect and decision- making powers back to the gate-keepers of healthcare (physicians), we will face a true crisis on both sides of the Atlantic. Healthcare systems need to keep pace with medical practices and join the 21st Century. Who wants to have the best medical tools in the world, and watch patients suffer for lack of access?
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University. She has appeared in US News and on NBC Nightly News.