Unhealthy Health Care

We can exercise, watch what we eat, take cold showers, practice yoga and Tai chi, meditate for peace of mind. But even if we are doing everything we can to “own our health,” we’re still going to need a doctor someday. Good luck finding one.

The Massachusetts Medical Society’s 2007 Physician Workforce Study found physician shortages in primary care (family practice and internal medicine), psychiatry, and vascular surgery for the second consecutive year. Anesthesiology, cardiology, gastroenterology, and neurosurgery remain in short supply, while urology appears on the list for the first time. In public opinion surveys conducted as part of the study, the Society also found that access to primary care physicians, as well as some specialists, remains strained, and waiting times for appointments are increasing.

The American College of Physicians recently warned that “primary care, the backbone of the nation’s health care system, is at grave risk of collapse.” Fewer internal medicine residency graduates are choosing to become primary care physicians (PCPs)—18 percent in 2006, down from 50 percent in 2000—and existing PCPs are unhappy in their jobs, with many choosing to leave the field.

What this means is that it is harder and harder to find a primary care physician, and, when you do find one, it is likely that he or she is overburdened with a large patient panel and hours of bureaucratic paperwork.

How then, to create the kind of meaningful healing partnership with a physician that we all need and want? These kinds of relationships take time, something that is in short supply in this era of the 15-minute medical visit. One doctor told me, “if we just saw patients in the office the way we used to, we’d go out of business. No one can break even practicing medicine alone, because the health care finance system pays you to do things to patients—colonoscopy, MRI, CT-scan, endoscopy—not merely talk to them.”

But “merely” talking is the only way to get to know us patients; the only way to understand and help us manage the stress in our lives that may be causing physical or mental illness; the only way to educate and encourage us to make healthy lifestyle choices, to take responsibility for our health. And “owning our health” may help to make those expensive tests unnecessary or avoid even more expensive hospitalization and surgery.