The Baltimore Sun

The growth of "concierge" practices is a relatively minor symptom of a much more serious malady: the shortage of primary care doctors in our country ("Md. ponders regulation of 'concierge medicine,'" Dec. 20).

There is overwhelming evidence that enhancing access to primary care doctors improves health. And primary care is an especially rewarding area of medicine that puts years of medical training to maximal use and, at its best, allows for a close, long and productive relationship between a doctor and a patient.

If it's so much fun, why is there such a severe shortage of primary care doctors?

Medicare and commercial insurance reimbursement rates for services are skewed heavily toward specialists who perform procedures. Primary care physicians are compensated at much lower rates. Plus, the considerable amount of time primary care physicians spend coordinating care, listening to patients, thinking through complex medical problems and contacting specialists often goes uncompensated.

A recent article in The New England Journal of Medicine documented the debt that medical students accumulate. Early this year, 23 percent of all medical school graduates owed $200,000 or more; 87 percent were in debt with a median total debt of $145,000 for public school students and $180,000 for private school students.

Who can blame them for choosing careers in higher-paying specialties over the much lower-paying primary care career path?

And our present chaotic non-system of medical insurance increases overhead costs because doctors' offices need extra staff just to manage their patients' myriad different health care plans even as it often deprives them of the ability to afford to spend the necessary time with each patient.

Out of frustration, some retire and a small minority set up "concierge" practices.

There is very little governmental support for primary care training or much incentive for primary care practice, even though there is a crying need for more primary care physicians.

The beleaguered state of primary care doctors is a public policy failure that must be addressed by the Obama administration.

Let's keep our eyes on the prize, which is attracting medical students to careers in primary care and keeping practitioners in the field once they are there, and not be distracted by the minority of physicians who, perhaps understandably, feel they must bail out and create their own practice environments.

Dr. Robin Weiss, Baltimore

Having essentially strangled physicians out of business via a range of regulations and ever- lower reimbursement rates, government regulators and the insurance industry are now reviewing those physicians bold enough to reclaim the practice of medicine via "concierge medicine," a free-market model of medical practice if ever there was one.

Here's a pretty simple solution: Get off the backs of the primary care physicians, let them do their jobs and shift the dollars going to the for-profit insurance industry back to those doing the real work, the primary care physicians.

That way, you'll see a swift decline in "concierge" practice.

And when was the last time a bureaucrat ever diagnosed a malady?

Peter B. Bell, Monkton

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