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Better pay would boost the ranks of primary care.

RESOLVING THE MALDISTRIBUTION of primary care physicians noted by Basu et al. will require a serious commitment to payment reform, according to Sondra Zabar, MD; Andrew Wallach, MD; and Adina Kaler, MD, of New York University.

Along with observing a steady decline in primary care interest overall, Dr. Zabar and her coauthors highlighted the lack of attraction to practicing in rural or urban areas. Among the reasons they cited are desired income, perceived workload, and level of debt. As compared to a well-run subspecialty practice, "most primary care physicians work with minimal support and can see only 2 to 3 patients per hour, and they are likely to receive lower payment than the subspecialty physician for each of those patients," they wrote.

What solutions are there?

"Our reimbursement system needs to incentivize a realignment in the ratio between primary care and nonprimary care that is associated with the best population health such that primary care physicians no longer shoulder a disproportionate share of administrative work such as medication refills and prior authorizations," they wrote. The problem has already been somewhat recognized by the Medicare Payment Advisory Commission and the Centers for Medicare & Medicaid Services, but more initiatives like debt forgiveness and innovative medical school curricula are needed to make a serious dent.

"To increase access to primary care, especially in underserved areas, we must align incentives to attract individuals into primary care practice, innovate primary care training, and greatly improve the primary care practice model," they wrote. "Physician payment reform is a key to making all of this happen."

These comments are adapted from an accompanying editorial (JAMA Intern Med. 2019 Feb 18. doi: 10.1001/jamainternmed.2018.7623). No conflicts of interest were reported.

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Title Annotation:VIEW ON THE NEWS
Publication:Family Practice News
Article Type:Brief article
Geographic Code:1USA
Date:Mar 1, 2019
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