Crippling health care bills, long emergency-room waits and the inability to find a primary care physician just scratch the surface of the problems that patients face daily.
    Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The U.S. takes the opposite approach by emphasizing the specialist rather than the primary care physician.
    A recent study analyzed the providers who treat Medicare beneficiaries（老年医保受惠人）. The startling finding was that the average Medicare patient saw a total of seven doctors—two primary care physicians and five specialists—in a given year. Contrary to popular belief, the more physicians taking care of you don’t guarantee better care. Actually, increasing fragmentation of care results in a corresponding rise in cost and medical errors.
    How did we let primary care slip so far? The key is how doctors are paid. Most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he’s reimbursed (返还费用). Moreover, the amount a physician receives leans heavily toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient’s disease. Combine this fact with annual government threats to indiscriminately cut reimbursements, physicians are faced with no choice but to increase quantity to boost income.
    Primary care physicians who refuse to compromise quality are either driven out of business or to cash-only practices, further contributing to the decline of primary care.
    Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.
    How do we fix this problem?
    It starts with reforming the physician reimbursement system. Remove the pressure for primary care physicians to squeeze in more patients per hour, and reward them for optimally (最佳地) managing their diseases and practicing evidence-based medicine. Make primary care more attractive to medical students by forgiving student loans for those who choose primary care as a career and reconciling the marked difference between specialist and primary care physician salaries.
    We’re at a point where primary care is needed more than ever. Within a few years, the first wave of the 76 million Baby Boomers will become eligible for Medicare. Patients older than 85, who need chronic care most, will rise by 50% this decade.
    Who will be there to treat them?