Today, Feathered Quill reviewer Barbara Bamberger Scott is talking with Gregg Coodley, author of Patients in Peril: The Demise of Primary Care in America.
FQ: How did you organize your time and energy to write this lengthy treatise, given what must be a very busy life of medical work?
COODLEY: I have more time to write since my children are grown and off to college. In addition, my work experience provided lots of material for the work. I am worried about the future of primary care and how this problem doesn’t seem to be in the consciousness of those who could make changes.
FQ: Is your book offered as a manual for workshops or gatherings within local communities?
COODLEY: No, but people are welcome to use it in any way that they find useful.
FQ: Are you allied with any other medical professionals/organizations who share your compelling views on PCP care and the need for readjustments in the overall American medical system?
COODLEY: I haven’t had the time to be involved with lots of organizations. I think a number of different groups see different aspects of the problem.
FQ: Do you see in the PCP role something akin to a preacher/counselor?
COODLEY: I try to discuss the problem and possible choices with patients rather than strongly pushing one solution since I think it is ultimately the individuals’ choice. I certainly provide my opinion and suggestions when they are open to it.
FQ: Does examining and writing about the complex problems within the medical world and the ways it might be reformed give you a sense of hope?
COODLEY: I don’t see those with power and influence being concerned with the problem of disappearing PCPs. I did find that there were some simple solutions that would have a major impact without costing anything to the health care system overall. I have tried to share these and make the case for them.
FQ: Did the complications of “Covid times” spur you to write more and/or share more about these looming issues?
COODLEY: I think Covid has just accelerated many problems with health care, including the closure of multiple small primary care practices.
FQ: With the lack of PCPs, many communities have seen a big rise in “Walk In” quick care for minor issues (pink eye, colds, etc.). Do you see this as a good thing or another road block in efforts to encourage more PCPs?
COODLEY: I think the urgent cares are a consequence, but not a cause of fewer PCPs. Unfortunately, the data suggests that they add to overall health care costs, result in a huge proportion of unnecessary antibiotic prescriptions and don’t provide the comprehensive care patients would get from their PCPs.
FQ: Our area, like most, is suffering from a lack of PCPs, with many leaving the area for bigger cities. The typical wait for a new PCP here is now one year (I know, I just went through this). Do you think the frustration with this will keep people from seeking health care?
COODLEY: The evidence is that lack of PCPs results in poorer and costlier care for individuals, as well as reduced preventive care. I think many people will defer issues until they become emergencies.
FQ: I worked in a college physics department for years where we had all the pre-med students come through for required physics courses. In all those years, I only met a small handful of future doctors who had any interest in becoming a PCP. They all had their sights set on the much higher paying specialist positions. So - do you think colleges could be part of the problem and what would you say to the Chairs of those departments to help fix this issue?
COODLEY: I think the problem lies with medical schools which could reduce their requirements and shorten their time frame to reduce the high cost of training. Medical schools and residency training programs could also choose to reduce the costs specifically for those going into primary care. The differential in pay lies under the control of the Federal government, specifically Medicare, whose policies are aped by the insurers. Colleges are innocent bystanders in the process.
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