Why (not) Family Medicine? TR Reid

Why (not) Family Medicine? is a series of posts from health care thought leaders, both inside and outside of Family Medicine. These will be posted every Friday. The participants were asked to focus on whatever they wanted in response to this question. We are glad that so many of these impressive leaders were willing to participate, and we hope that you enjoy their responses!

When I went around the world looking at successful health care systems, I asked doctors, economists, and health ministers to tell me the appropriate ratio between Family Medicine doctors and specialists. From East to West to Far East, the strong consensus view was that an effective health care system should have a ratio of about 2:1 — that is, two primary care docs for every specialist. And most developed countries have achieved this mix, making the Family Doctor the lynch pin of the health care system.
The United States, of course, is upside-down by this measure. Barely one-third of American doctors practice family medicine or other primary care specialties. This is a key reason why we spend far more for health care and have much less to show for it than the other industrialized democracies. All over the world, experience shows that there is an Iron Rule of health care: Greater emphasis on Family Medicine always leads to better health outcomes at lower cost.
Because other health systems value Family Medicine more than we do, they pay their primary care doctors more. I asked my family doctor in London once why it is that 62% of all the doctors in Britain are primary care physicians. “In the National Health Service, I’m paid twice as much as a cardiac surgeon,” Dr. Ahmed Badat told me. “If you do that, you’re telling family physicians that you value their contribution. And then more doctors will want to practice Family Medicine.”


TR Reid is the author of “The Healing of America”, and a correspondent for several PBS documentaries about health care. 

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