[Roberts:] Welcome back to the most news in the morning. During his make or break push on health care, President Obama has been stressing the importance of having a good family doctor. Here he is at a town hall earlier this month in New Hampshire talking about that.
[Barack Obama, President Of The United States:] Primary care physicians, ideally, family physicians, they should be the front lines of the medical profession in encouraging prevention and wellness.
[Roberts:] So as the president pointed out, medical schools are pushing more students toward lucrative specialties. So if reform gives health insurance to millions of Americans who currently don't have it, will there be enough family doctors to go around? That's something we want to talk about this morning. Joining us now is Dr. Lisa Sanders. She is the author of "Every Patient has a Story." She is also a technical advisor for the television show "House," and she's a clinical professor at Yale's medical school. She is a chronic underachiever and she joins us this morning. Dr. Sanders, good of you to be with us this morning. The American Association of Family Practitioners did a survey of fourth year medical students. They found that only 2 percent wanted to be general internists or primary care physicians. Why does nobody want to be a primary care physician these days?
[Dr. Lisa Sanders, Assistant Clinical Professor, Yale School Of Medicine:] Because it's not something that as a society we tend to value. And value has a specific meaning. It's an emotional value, yes. But there's also money. Why would anybody go in to what is clearly the lowest-paid, i.e. least valued of all of the specialties? There's a guy in San Francisco, Steve Schroeder. And he said if health care continues the way it is now, the only people who will go in to primary care are fools or angels.
[Roberts:] And you're one of those angels, correct? Or are you a fool? We're not sure. Which would you classify yourself to be?
[Sanders:] Depends on the day of the week, I think.
[Roberts:] And as we mentioned coming in to you as well, if public option or however they do it brings millions of people who are currently in the ranks of uninsured in to health care, they're going to have to go see a primary care physician, how great is the need going to be for the first line practitioners?
[Sanders:] It's going to be huge. If you survey people who are going to residencies, as you mentioned, less than 5 percent want to go to a primary care specialty. And that's crazy. If you look at all of the countries who do health care better than we do, and we've all seen that list, most of the physicians taking care of patients are primary care doctors. Here, only a tiny fraction of the health care is delivered by the people who are trying to deliver primary care medicine. That's crazy.
[Roberts:] Here's another statistic. Almost 21 percent of general internists who are board certified between 1990 and 1999 have left internal medicine, whereas only 5 percent of people in subspecialties depart. So what can be done to keep more people in that primary care role?
[Sanders:] Well, first, what we do has to be valued more highly. We are paid right now the way the system is now, we are paid to do, not to think. And it turns out primary care is all about thinking, either diagnosing or anticipating. We have to value that. Right now, that is care that is completely free. We have to pay for that, because it's important. And it's a way the costs are going to be contained in the long run. So I think that's the most important thing we have to do. Otherwise, we...
[Roberts:] Well, there's a contradiction here, or at least if not a contradiction there is a clash here. You say that primary care physicians need to be valued more, which might translate to you need to pay them more. But everyone is trying to get cost out of the system. So how do you marry those two things together?
[Sanders:] Oh, well, that's easy. I mean, even though seeing a doctor needs to be seeing a primary care doctor needs to be paid more, the cost savings down the line are huge. If you treat people for their chronic diseases, and most people in this country go to the doctor because they have or an emergency room because they have chronic medical conditions. If you treat those well, then it will reduce the number of times they have to go to the hospital, reduce the downstream consequences. That's why we do it in the first place. The reason we control diabetes and high blood pressure and cholesterol is because we want to prevent heart disease.
[Roberts:] And you make the argument that you could get more people in to primary care physicians if insurance companies were willing to do away with co-pays?
[Sanders:] Ah, well, you have to encourage people to to take care of their chronic diseases. If you if you charge them money every time they go to the doctor, they're going to go to the doctor less often. That's why people have co-pays is to discourage people from going to the doctor. But you don't want to discourage people who need to go to the doctor because they have chronic medical conditions. You want to reduce the number of people who make unnecessary trips to the doctor. And that is not the person who has diabetes or high blood pressure or cholesterol or asthma or any of the chronic diseases that require maintenance. If you don't go to the doctor to get the basic care, you are going to end up in the emergency room or in the hospital.
[Roberts:] You also make the argument that the average primary care physician works spends about four hours a week doing paperwork, filling out the various forms. And you can save some of time by standardizing insurance forms. And also, what about this argument that is made that electronic medical records and the portability of those could take a lot of money out of the system?
[Sanders:] Well, I think the electronic medical records could save money, but only if they're regulated so every electronic medical record can speak every other electronic medical record. It would be as if every television station could have its own kind of television. We all need to be able to read each other's notes and see each other's tests. Hat's not the way it's set up now. Now it's every man for himself, every company for themselves. My hospital and my practice, the two medical records, they don't speak to each other. That's crazy.
[Roberts:] Right. What about medical schools? Are they pushing students more towards these lucrative and prestigious specialties? And do they bear some responsibility in all of this as well?
[Sanders:] Well, I love medical schools. I went to one. But, yes, the fact that most people who go to medical school are trained by such specialists is not a deliberate effort to get people out of primary care. But just the people that you're exposed to, they're not exposed to people who are excited about primary care, who are excited about seeing patients and making diagnoses and managing chronic diseases. They're exposed to people who are doing cutting edge research. Also, extremely important, but you can't have a health care system with only people who are doing cutting edge medical research. We need people who actually take care of patients.
[Roberts:] Dr. Lisa Sanders, it's great to talk to you this morning. Thanks for sharing your thoughts with us. We really appreciate it.
[Sanders:] Nice to be here. Thank you very much.
[Chetry:] We're talking about the cash for clunkers deadline. We know the program is going to be winding down.
[Roberts:] Monday night, yes.
[Chetry:] Yes, running out of gas. But what about the dealerships? Are they happy that this is taking place? Do they think it's worked out for them? Is it lucrative? And what about the dealers who say they still haven't seen millions that they're owed from the government for passing on the rebates from their customers. We're going to talk about it. It's 18 minutes after the hour.