Interesting Points Made While Selling Out Your Colleagues

An interesting commentary on CNN.com made the argument that contrary to President Obama's claim that our country is not producing enough primary care physicians, the reality is that the root of problem would probably be served poorly, or even exacerbated by a push for more physicians.

The rebuttal is penned by Clayton Christensen and Jason Hwang, M.D. M.B.A., authors of "The Innovator's Prescription: A Disruptive Solution for Health Care", and argues that the the gaps in primary care would most cost-effectively be addressed by nurse-run clinics, as opposed to primary care physicians. For those primary care physicians, their plan would be to leverage expert software so they could do some work that medical specialists would normally do. As for the specialists? The plan would be for them "to do even more complicated work that merits their additional training."

I actually like the idea in theory. It's essentially built upon a theory that less-expensive resources can effectively do work "further up the food chain", so primary care gets cheaper and so does specialist-type procedures. What's not completely clear to me, is how this the change in the balance of supply and demand will affect the individual providers of those services.

Put another way, if you view healthcare services as pillar, which might be a pyramid. The base of the rock represents primary care, and salary per practitioner will decrease as will costs per patient. Assuming that primary care physicians remain the same in number but will now be pushed up to lower frequency specialist procedures, will there be a corresponding drop in revenue per doctor? And how many specialists will you need to do that aforementioned "complicated work that that merits their additional training"? I never got the sense that specialists were desperate to do primary-care work to pay the rent. Is there going to be sufficient demand for all of these specialists who now have primary care physicians doing some of their former work?

With the proposed influx of nurses and nurse-practitioners who will now focus on the former domain of primary care physicians, we may see lower salaries for physicians, both primary and speciality care. And unless medical schools restrict supply appropriately, you may see doctors without a chair to sit in. So Dr. Hwang, your brilliant ideas might not be the greatest prescription for your fellow physicians.