As I have stated in previous posts, I suspect that primary care pediatrics and, for that matter, primary care in general are in a decline from which they will never recover. This, combined with a lack of physicians’ willingness to go along with a centralized, mandated, top-down provision of healthcare may be the soft underbelly of national healthcare reform, where it is vulnerable to failure. There may be enough attrition from disillusioned primary care docs that there will be a need for less qualified providers to take up the slack. It has been noted, however, that this may be the goal of national healthcare reform in the first place, to decrease costs by jettisoning the more costly providers of that care to begin with.
DrRich, in a 2-part series on the demise of primary care posted here and here, posits that this may be a good thing for docs. Perhaps this is correct, that the folks out there may not tolerate their care being provided by nurse practitioners or those with even less training and experience. If they don’t, then there may be a safe haven for those “primary care docs” that could re-brand themselves as providers of an advanced sort of care. However, this model would still mean that there would be a lot less demand for these former primary care docs. The new wave of “providers” (nurse practitioners, physician’s assistants, pharmacists, emergency medical technicians, used car dealers, bowling alley operators, etc.) would suck up most of what passes for office visits these days. This could leave the few docs still in practice working as consultants when the more complicated issues come around (and they will). Where the rest of these former docs will go and what they will do is anyone’s guess at this point.