Doctor shortage could derail reform

Everyone knows there is an enormous, and growing shortage of primary care physicians.

But health reform programs all mandate that everyone see one.

This is a contradiction that must be solved or health care reform is impossible.

What primary care doctors want most is to practice medicine without the burden of paperwork, as in this example from Seattle, describing a group practice whose rules let doctors spent a half hour on each patient visit.

The problem lies deep in the story, a quote from the company's medical director. "This is truly the way to save primary care."

Sorry, but no.

This system is great for the doctor, but if there aren't enough doctors already. If the numbers are due to decline, and if the need for them is about to grow exponentially, you are not offering a solution.

The answer is obvious, but it requires an enormous leap of faith from the medical profession.

Doctors can't be the only gatekeepers into the medical system.

Ways must be found to empower nurses, nurse practitioners, alternative medicine folks, and others to become primary points of contact on family health.

This means a lot of what primary care doctors do must be routinized, demystified, and turned into a checklist that anyone can follow.

Primary care physicians must become the top of a health pyramid, not the bottom of a care pyramid. They need to be backstops, not line workers.

It would take over a decade to train enough primary care physicians so that each American can see one, regularly. Reform does not have that kind of time available to it.

This will be an enormous leap for everyone, not just policymakers but interest groups, patients, and insurance companies as well.

Recognize and empower chiropractors? Give prescriptive power to nurses? Enable treatment by people who never saw the inside of a medical school?

Yes, we must. The numbers are inescapable. They don't lie. The sooner we recognize that fact and act accordingly the faster we move toward real health reform, in which everyone has someone to turn to for health.