Physicians Healthcare

By: EconomyWatch Content   Date: 24 February 2010

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Physicians play an active role in the administration of healthcare policies, federal as well as private, in the US. Most healthcare insurers have an explicit network of physicians, who are responsible for the diagnosis and treatment of their insurance holders. These medical professionals are known as primary care physicians (PCPs). A PCP is generally a med-school graduate, with postgraduate training in a primary care program, such as general practice, internal medicine, family practice or pediatrics. The medical expenses under these physicians’ healthcare agreements are borne by the linked professionals. Therefore, the cost is reimbursed to them, not the insurance holder.

Physicians Healthcare: How it Works?

A physician’s healthcare network is usually restricted to a specific geography, to facilitate easier accessibility and administration. Healthcare insurers generally mandate its insurance holders to first contact a primary care physician part of its network. While some insurers allow treatment with medical professionals outside its network, these procedures generally accompany higher co-payments or contributions from the insured. This positions the PCPs as “gatekeepers” who are responsible for regulating the access to costly specialists and procedures.

In some instances, however, a primary care physician may refer a patient to a specialist, who may be within or outside the network. This is done when the PCP is not capable of treating the insured. This ensures that the insured’s treatment is not compromised on account of lowering cost. The co-payments in such situations may be higher, but are still affordable.

Physicians Healthcare Challenges

A shortage of qualified PCPs is the most important challenge faced in physicians healthcare programs. A 2008 survey by The Physicians' Foundation highlighted this wide-spread concern; wherein 78% of the respondents identified the existing shortage of PCPs.

A primary reason for this dismal scenario is the low compensation offered to PCPs in comparison to specialists. The Medical Group Management Association Physician Compensation Survey in 2004 indicates that the average income of primary care physicians was about half of that of specialists in the US. This steady decline of primary care physicians has had several detrimental outcomes.

The most important repercussion of this bleak scenario is that the quantity of physicians’ healthcare programs have taken supremacy over quality, as the availability of PCPs is limited.


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