Thanks for this article. It hits the nail on the head of specialty physician capture of the regulatory system, compounded by CMS underfunding to independently assess the basis for fees. The corruption is colossal and, because of political corruption, uninvestigated by Congress. Much of the harms of the current system is based in reimbursement which is opaque by design.

As a retired Family Physician, I have been exploring the structural reforms which would build primary care into communities with embedded ARNPs working with community based PCP’s, mental health & substance professionals, and midwives who work to optimize whole community health of all individuals where they life, learn, work and worship rather than referral ‘feeders’ in a multi specialty system. This would allow primary care professionals to coordinate and integrate care based on the demographics and health risks of a defined population (which could be financed by PMPM payments). They would be able to focus on primary prevention, sickness care, and coordinate chronic care groups based in the community.

Most commentators on the woes of US medical services industry, accept the current provider systems which are entirely structured to maximize wealth extraction from the insured public and not provide medically necessary, evidence based, cost effective care to defined populations.

Until we restructure primary care, reimbursement reform and increasing access will be important and necessary, but not sufficient. Thanks for your efforts. Ric Winstead, MD retired.

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Jul 1, 2022Liked by Merrill Goozner

Spot on. A similar under-representation is the AMA Board itself: 6 of 25 are PC but that includes 3 OB and a Geriatrician.

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