I thank Dion Rudnicki of IBM for praising primary care ("A medical 'home' for every patient; Maryland is moving in the direction of more personalized, better-coordinated care," Commentary, July 13) It is the sine qua non of a solvent system.

I don't see how IBM will succeed at recruiting primary care providers to Maryland when Johns Hopkins is losing them. My sister-in-law left Hopkins a year ago for 50 per cent better pay in Pennsylvania. Doctors pay represents only 6 per cent of health care cost, and most of that goes to specialists.

With Baltimore area physicians' reimbursement amounting to 62 per cent of the national average (73 per cent of the national average and considering Maryland's 118 per cent average cost of living), no physician should come or stay. Internists, family practitioners and pediatricians need an immediate increase in reimbursement from all insurers of 38 per cent to attract even average providers.

My colleagues are sick of the threats of a 21 per cent pay cut and, in December, a 30 per cent pay cut. We already cannot afford to stay.

Smart, caring, essential providers are voting with their feet. Baltimore's medical Armageddon has already begun.

Hospitals are overrun by patients who could have been treated as outpatients. Physicians unable to maintain independent practice are now exhausted hospitalist employees. One medicine department head told me, "This is when mistakes are made."

Every Marylander must demand much better reimbursement for primary care physicians.

Ted Houk, M.D, Towson