Does ObamaCare place too much emphasis on primary care?

December 1, 2009

How will urologists be affected by reform measures aimed at bolstering the role of primary care physicians?

Suggestions for increasing the number of primary care physicians include tuition reimbursement for doctors who agree to practice in underserved areas and increased reimbursements designed to keep primary care physicians' income on par with that of specialists.

Urology Times asked urologists what they thought of these measures and whether a boost in the primary care work force would alleviate some of the pressures created by the current urologist shortage. Most of the urologists who were interviewed say that while no one knows how the reform proposals will shake out, they do foresee changing roles for specialists, including urologists.

"It's incumbent upon us to educate our fellow primary care physicians as to what's appropriate in managing urologic disease. For example, it's very appropriate for a primary care physician to prescribe an ED drug such as Viagra. The primary contraindication for Viagra is cardiac disease, and primary care physicians are well aware of that.

"I'm less enthusiastic about them treating prostate disease, but they will be doing that, so it's our responsibility to set out guidelines for what is safe for them to do in the office and what would be wise to refer to the urologist. Blood in the urine is an example of a condition that should be immediately referred to a urologist. Far too often, well-meaning primary care physicians treat patients for 'infections' when there's no evidence of infection. The single most common cause of blood in the urine is bladder cancer, and that's a condition for a urologist."

More primary care docs needed

"There definitely seems to be a lack of primary care physicians, at least in the areas I've practiced: Tennessee and now New York," Dr. DiBlasio observed. "A lot of that seems to do with reimbursements. It's difficult for internal medicine doctors and family practitioners make a decent living, particularly where I practice, which is an expensive part of the country to live. It's difficult for them to recruit young primary care doctors in areas like this because they can't support their families.

"In that respect, I definitely think health care reform should focus on general practitioners because otherwise there will be nobody to take care of patients."

Dr. DiBlasio agrees with Dr. Brendler that it will fall to specialists to make sure primary care doctors are aware of specialty practice guidelines.

"If there were more primary care physicians, they might be able to take care of more patients rather than passing as many on to specialists-if we are able to keep primary care aware of changes in [cancer] screening patterns and other urologic conditions. Sometimes guidelines are changed without being publicized enough that they would be aware of them. It's the urologist's job to keep other physicians aware of trends and changes in our guidelines."