The New Jersey Academy of Family Physicians applauds Senator Joseph Vitale and Assemblyman Neil Cohen for their efforts, unveiled today, at developing a plan that will eventually lead to access to care for all of New Jersey's citizens. We must, however, caution all lawmakers to learn from the mistakes made in earlier efforts to provide similar access in other states. Clearly, providing insurance coverage is only one piece of the Universal Access puzzle. The greater challenge may prove to be providing enough physicians to care for us. No Universal Access plan can hope to be successful if New Jersey is not a place that fosters interest in Family Medicine and other primary care disciplines among medical students, provides the highest quality Family Medicine education and training possible, and finally maintains a practice environment that retains those Family Physicians in New Jersey.
In last month's post, I suggested that many believe the Universal Coverage plan in Massachussetts is failing because the state’s primary care infrastructure is unable to handle the influx of healthcare “consumers.” In short, the law has provided insurance, but no access. This conflict exists because there are not enough primary care physicians in the state.
The NJAFP believes that those same leaders in New Jersey government who have been courageous enough to take on the issue of Universal Access must also have the foresight and political will to make the difficult choices necessary to bring balance to a system that currently rewards high-cost specialties at the expense of the primary care disciplines that have been proven time and time again to deliver significantly better outcomes at lower cost.
Monday, March 17, 2008
Sunday, February 17, 2008
Where Will We Get Our Primary Care?
In 2006, the Massachusetts Legislature passed what many consider to be the first universal health coverage legislation in the United States. In 2008, it is clear that while the legislation may have been successful in bringing health insurance to the uninsured population, the program may have missed its intended mark. Many observers believe that this ambitious program is well on the road to failure because the state’s primary care infrastructure is unable to handle the influx of healthcare “consumers.” In short, the law has provided insurance, but no access. This conflict exists because there are not enough primary care physicians in the state.
In New Jersey, the problem is magnified. A recent article in NJBIZ noted that New Jersey ranked 27th out of the 50 states in the quality of medical care in a report released last year by the Public Citizen Health Research Group, a nonprofit organization in Washington, D.C. Not coincidentally, a 2004 Dartmouth University study found New Jersey to be the sixth most expensive state in terms of annual Medicare spending per beneficiary, but only 42nd in terms of “overall quality” of medical care for such beneficiaries. When it comes to NJ healthcare, we spend more to get less. There is no other area in our national dialogue where this would be acceptable. Perhaps the most frustrating aspect of this issue is that the solution is clear. We need to make the practice of primary care medicine, and particularly Family Medicine, more attractive to a new generation of medical students who increasingly – and not surprisingly – follow the rewards. According to NJAFP Board Member, and Chairman of the Department of Family Medicine at Robert Wood Johnson University Hospital, Al Tallia, MD, most physicians prefer more lucrative specialty practices such as cardiology, urology and oncology. Fewer than 42% of New Jersey’s 20,710 physicians were in primary-care practice in 2006, according to a report last year by the Rutgers Center for State Health Policy in New Brunswick. Nationally, the average was 43 percent. The future may be even bleaker, as Tallia notes that he expects only 25 to 30 students out of the current class of 150 at the Robert Wood Johnson Medical School to enter a primary care practice.
Primary Care Physicians are not alone in their criticism of our current healthcare system, or in their belief that a stronger primary care infrastructure is critical if we are to find a solution. Even the leadership at Horizon Blue Cross and Blue Shield, the state’s dominant health insurance carrier and an organization that many physicians see as adversarial in many areas, seems to agree. In the same NJBIZ article noted above, Christy Bell, senior vice president of health care management at Horizon, highlighted the issue using the lack of primary care at the end-of-life as a prime example. Bell said; “In New Jersey, patients receiving end-of-life treatment more often die in ICUs [intensive care units], have more specialist visits and spend more time in hospitals than in any other part of the country, and it doesn’t change the outcome.”
The NJAFP believes that the leaders in both New Jersey government and healthcare must begin to invest in primary care immediately. While loan forgiveness programs and other enticements will help, the necessary change will not occur until we make what will surely be difficult choices to bring balance to a system that currently rewards high-cost specialties at the expense of the primary care disciplines that have been proven time and time again to deliver significantly better outcomes at lower cost.
In New Jersey, the problem is magnified. A recent article in NJBIZ noted that New Jersey ranked 27th out of the 50 states in the quality of medical care in a report released last year by the Public Citizen Health Research Group, a nonprofit organization in Washington, D.C. Not coincidentally, a 2004 Dartmouth University study found New Jersey to be the sixth most expensive state in terms of annual Medicare spending per beneficiary, but only 42nd in terms of “overall quality” of medical care for such beneficiaries. When it comes to NJ healthcare, we spend more to get less. There is no other area in our national dialogue where this would be acceptable. Perhaps the most frustrating aspect of this issue is that the solution is clear. We need to make the practice of primary care medicine, and particularly Family Medicine, more attractive to a new generation of medical students who increasingly – and not surprisingly – follow the rewards. According to NJAFP Board Member, and Chairman of the Department of Family Medicine at Robert Wood Johnson University Hospital, Al Tallia, MD, most physicians prefer more lucrative specialty practices such as cardiology, urology and oncology. Fewer than 42% of New Jersey’s 20,710 physicians were in primary-care practice in 2006, according to a report last year by the Rutgers Center for State Health Policy in New Brunswick. Nationally, the average was 43 percent. The future may be even bleaker, as Tallia notes that he expects only 25 to 30 students out of the current class of 150 at the Robert Wood Johnson Medical School to enter a primary care practice.
Primary Care Physicians are not alone in their criticism of our current healthcare system, or in their belief that a stronger primary care infrastructure is critical if we are to find a solution. Even the leadership at Horizon Blue Cross and Blue Shield, the state’s dominant health insurance carrier and an organization that many physicians see as adversarial in many areas, seems to agree. In the same NJBIZ article noted above, Christy Bell, senior vice president of health care management at Horizon, highlighted the issue using the lack of primary care at the end-of-life as a prime example. Bell said; “In New Jersey, patients receiving end-of-life treatment more often die in ICUs [intensive care units], have more specialist visits and spend more time in hospitals than in any other part of the country, and it doesn’t change the outcome.”
The NJAFP believes that the leaders in both New Jersey government and healthcare must begin to invest in primary care immediately. While loan forgiveness programs and other enticements will help, the necessary change will not occur until we make what will surely be difficult choices to bring balance to a system that currently rewards high-cost specialties at the expense of the primary care disciplines that have been proven time and time again to deliver significantly better outcomes at lower cost.
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