Recently, the NY Times published an article about the significant pay differences between primary care and specialist care. The American Medical Association has been at the forefront of these ingrained pay disparities. New proposed regulations under Medicare are designed to chip away at these pay differences, which is why many doctors specialize instead of practicing general medicine. The incentive is to do more testing as a specialist and be rewarded for doing this, instead of the older model of the doctor who knew you and would be financially rewarded for taking care of you while keeping you out of the system. Many doctors who have children considering medical school are advising them to consider becoming a PA or an NP because the system will hire them at good salaries, while the cost and years of schooling are far less, but the financial rewards are better. The system still requires PA and NP providers to work under a medical provider in 15 states; however, 35 states allow them to open their own practices if they wish. I am often appalled by some of the huge salaries some of physicians earn, even though their specialties are part of the cost problem, and the incentives are not necessarily for their patients’ health. It often seems that a patient with a complaint in an orthopedic office only has the painful part looked at, and they either receive an injection, a pill, or a procedure, which often misses the problem causing the painful problem. This is common in orthopedic offices where an older patient who has knee pain has the knee evaluated, an X-ray taken, and then an injection, or perhaps something injected into a joint space for a worn joint that still works, only to buy time until the joint is bad enough to be replaced. Many of these providers are paid $500K or more, even though this practice is why the knee goes bad, requiring a knee replacement. In many patients our chiropractic office has seen, mechanical dysfunction of the foot, ankle, hip, and lower back is the reason for the knee pain, and often, the opposite side may have been the actual cause of pain. These practices generate millions of revenue for hospital systems, which is why the orthopedics are paid so much, yet the patient may avoid all of this by visiting the chiropractor, who will evaluate the patient, how they walk and stand, and move. Chiropractic patient-centered care should be the gold standard, and unfortunately, the current standard is harmful to our health. The more we ignore the root cause of why patients hurt, the more we all expose ourselves to risks involved in the surgeries, which often result in other future surgeries that may have been avoided with healthier care. Most patients who visit a neurologist may learn more than just a test and an evaluation of nerves, as these are parts of other systems. I do not doubt that better incentives will improve medical practices. Currently, it is procedures over results. Reward results, and doctors will have an incentive to cure or refer to the best provider, vs. the current system’s idea of just referring to someone in the network. This would also solve some of the under-referring to chiropractors, who have the best reputation for treatment of back pain and many other musculoskeletal conditions. The medical funding system needs an adjustment. The proposed changes to Medicare are appropriate, but medical generalists should be getting larger raises, which would improve the incentives toward primary care practice. I also believe that primary care needs to be more patient-centered and the incentives towards holistic care, understanding cause, and one provider keeping you out of the system, is always more effective than primary care being a door to multiple specialists who all give you a medication when they do not know what to do next. Conveyor belt medical care is inefficient, often ineffective, can be life-threatening, and is costing all of us who are paying exorbitant insurance premiums for substandard care. Better funding will improve patient primary care and convince more providers to take a more primary care role with their patients, to keep them out of the system. There is more to primary care than one-size-fits-all urgent care. More importantly, the insurance system should stop enriching large systems and harming independent providers by starving them and causing consolidation. Insurers profit from charging higher premiums, which they gladly pass on to us. Healthcare needs more competition and patient choice, not less. In our chiropractic office, our primary care approach toward the musculoskeletal system is badly needed since the medical system addresses this so poorly. Patients are not protocols, so why treat them like one? Perhaps this is why we can treat on the first visit, and patients often improve without the use of drugs or injections or surgeries. Unfortunately, we do not get paid for most of the evaluation work to figure this out, but the right thing to do is to properly evaluate the patient and their progress for the best result. Would our system be better off rewarding results instead of procedures that often yield little information? Going the extra mile to get results should be rewarded for chiropractors and other primary care providers. Organized Medicine needs a wake-up call, and so do the institutions they work in. Proper rewards will likely solve the shortage of primary care while improving care. Insurance carriers need to get out of the way. Insurance carriers’ predatory practices resulted in massive consolidation of insurers as well as the hospital system. We are all paying more as a result. Tiering providers where those in large systems were having lower copayment costs, while those who were more cost-effective cost you more and pushed prices higher. This happened to Horizon Blue Cross Blue Shield Omnia plan when they launched it, making the large, expensive systems tier 1, costing consumers less, and they reduced the cost for them to purchase the insurance while making healthcare providers who were not part of these systems more expensive. Ironically, some of these hospitals and providers were more effective, and they eventually became tier 1 by paying to join the larger systems. This created monopolies, and healthcare costs continue to rise yearly. Years ago, insurers stopped paying primary care providers and other specialists to visit their patients they admitted into the hospital. Instead of seeing a face of someone they know and trust, hospitalists now do this, often charging high fees to say high, and maybe they will report back to the admitting doctor. This growing segmentation of care is bad for our health. Specialists cannot also be generalists, and generalists cannot get paid in specialties, which is why our system exists as it does. Doctors should be generalists with a specialty and be paid for both. Then, they must be rewarded for results. The insurers also have been abusive with their predatory precertification practices, which affect cash flow. This is not a replacement for primary care, but since they have undermined primary care practices for years, they use this to deny care when doctors themselves would keep patients out of the system. Maybe it is time for a universal healthcare system, and Medicare can be that system. Medicare is far better than Medicare Advantage, which is the same system you have been complaining about for years. One system, lower costs, and easier access to care would be lower in cost and far superior to our current disjointed mess. Unlike today, Medicare must fully pay for all chiropractic services, which is currently being lobbied for by the profession with the Chiropractic Medicare Modernization Act. You can ask your legislator to support this legislation using this link. See a chiropractor first for painful conditions for the best results. I am always amazed at how the general public has been conditioned to think that they need a specialist for their elbow, wrist, ankle, foot, hip, or back pain. The body is an interconnected system that should be evaluated and treated that way. What they are not taught is that most of these conditions will improve or resolve if you see a chiropractor first. Often, patients will see us after the medical system has failed them, which increases costs and can cause further damage to joints that are avoidable. Mechanical problems require mechanical solutions, which is why we need body mechanics. Chiropractors are body mechanics. Move better, feel and function better; it’s that simple. Think chiropractic first. Need help now? Book online or call today.