How to Make Primary Care Financially Rewarding

     I have noticed with deepening regret the diminishing numbers of medical students who choose to go into internal medicine and become providers of primary care. The problem is that the insurers reward doctors for doing, and not for thinking and diagnosing. This may be in part because thinking cannot be measured, but a biopsy is proof that the doctor did something. Now that many students graduate with massive load debts, it is even less financially attractive to go into primary care. And for those who are concerned, as they should be, with their quality of life, the hours required to make a living from a primary care practice seem expecially onerous.

     There is something wrong with the financial reward system for physicians when the fee Medicare pays me for a rigid sigmoidoscopy, which takes 5 minutes to do   and is easy to learn, is 3 times the fee they pay me for 15 contact minutes with the patient during which I diagnose and examine and apply my skill and art that is the product of  7 years of study and practice.

     OTOH, dermatologists have a very nice and lucrative life, so much so that it is now the most competitive residency, with some programs looking back at the students' MCAT scores to help them pick future residents. This leads me to my plan to increase the income of primary care physicians. I was led to this in part by the many ads and faxes I get offering to train me in Botox injections and other dermatological procedures.

     All fourth year medical students should have a mandatory month of dermatology. In the morning they would go to dermatology clinic. In the afternoon, they would be taught how to do simple skin and lesion biopsies, to inject Botox and Restalen, and to do other uncapped dermatology/plastic surgery procedures. Then when they open their practice of internal medicine, they could set aside each Friday for dermatological procedures. They would probably make as much in that one day as they did the rest of the week. They even have the most powerful selling line in the world: "I don't think that bump is cancerous, but let's biopsy it to make sure". In this manner they could easily double their incomes and afford to practice internal medicine.