OK, I'm going out on a limb. As I watched Bernanke on Bloomberg this evening, I heard him say something about being alert to areas in which excessive risk assumption is not being adequately compensated.
Hmm, sounds like primary care, I thought.
A few disclosures and acknowledgments; I am not an economist, taking a class in a public health school just doesn't cut it. I've played with the markets for years and have a passing familiarity with concepts related to valuation and one of the reasons I am more comfortable in the US than Canada. Markets work better at determining value than governments do.
So if a provider of a service can be somehow valued in terms of the assumption of risk, most primary care physicians work in a generally low-risk environment. Every service provided by a procedural specialist may represent a greater absolute reduction in risk. But risk is also additive, so the total amount of risk assumed by a primary care physician could be greater if considering the proportion of the population that requires the service.
One of the reasons that primary care physicians are generally paid so much less than procedural specialists is the shortness of supply for those skills. In a consumerist society, we seek rare and unusual skills and pay a premium. The perception of risk can be influenced by so many factors that cannot be scientifically objectified.
Maybe the market for various specialties is working as intended, but primary care is not using its leverage. Using leverage on referrals and denying approvals for emergencies that did not go through primary care may seem as repugnant to others as it does to me, but it is merely the most obvious level of leverage we have. It's what the insurance companies expect of us, because we are the primary risk reduction tool for them.
Maybe structural incentives need to be realigned so that we are expected to respond to the patient's perception of risk and not the perception of other stakeholders.
Maybe I just need to go back for a PhD.