1 in 2 family physicians is seeing fewer patients since the recession began in January 2008.

At the same time, 3 in 4 physicians have seen an increase in the number of uninsured patients.

Patients who are covered by employer-sponsored insurance and private health plans are in short supply.

Welcome to the new health economics for family physicians, where there are more patients without health insurance, more Medicaid patients, and more Medicare patients.

As a result, patients are:

– Telling family physicians about concerns over ability to pay for health care
– Cutting prescription dosages
– Cancelling appointments
– Forgoing needed preventive care.

These unhappy, unhealthy findings come out of a survey by the American Academy of Family Physicians, Patient Care During the 2008-2009 Recession, published in May 2009.

Health Populi’s Hot Points:
The financial bottom-line for family physicians in that more doctors are providing care that’s unpaid.

In this recession, 71% of doctors are providing more uncompensated health care.

As a result, 44% of these doctors are forced to cut, or consider cutting, services for patients as well as reducing staff.

In a time when primary care must be bolstered, encouraged, enhanced, and nurtured, this is the worst possible reality. The Primary Care Medical Home is seen by many of us as an important model for driving more effective, cost-efficient patient-centered care. But without aligning payment and performance, the primary care supply of physicians will erode.

The Preserving Patient Access to Primary Care Act, introduced by Rep. Allyson Schwartz in September 2008, would go a long way to addressed the primary care shortage. Passing this bill would help to balance one of the legs of this very shaky stool.

There’s an important essay in the May 20th 2009 issue of the New England Journal of Medicine, Achieving Health Care Reform — How Physicians Can Help, by Fisher, Berwick and Davis, that asks physicians to be front-and-center in practical health reform. One solution would be for providers to link up in accountable care organizations that integrates health care, aligns incentives and uses new payment models for patient care. Such population-based payment models put primary care at the center of patient care–exactly where it belongs.