How One Small Group Sets Doctors’ Pay By PAULINE W. CHEN, M.D.

The crux of Dr. Chen’s article comes down to this problem: there aren’t enough primary care physicians in America, because it is more lucrative to go into specialty care. She attributes this gap in incomes between specialty and GP doctors to the biased governing body (RUC) that sets the prices of 10,000+ procedures in Medicare (and by extension to the prices of almost all medical care). I completely agree with her that the RUC voting members should no longer vote by secret ballot. The city council in the 5,000-person town I live in votes by open ballot, and they only oversee a few million dollars per year. RUC oversees the distribution of $44 billion per year, so they should be held to the highest standards of transparency and accountability.

One issue that Dr. Chen does not discuss is the importance of health care reform. Assuming it does not get repealed before it takes affect in 2014, health care reform will allow millions of currently uninsured and underinsured people to start getting regular care. If we think we’re in a primary care provider shortage now, how about in three years! The government should subsidize medical school tuition so that young doctors can concentrate on treating patients and improving American health, rather than on meeting their next loan payment. Kansas, which has a serious problem with attracting doctors to its rural regions, recently instituted a medical school tuition subsidy, and I’m eager to see how it progresses. Even if RUC keeps its current payment system in the future, where specialist make more than primary care physicians, medical school graduates who care about public health and preventative care for their patients will be able and willing to take a smaller paycheck and stay in primary care if they don’t have $300,000 in debt on their backs.