Primary care medicine - what'll save it?

Some people in medicine, like many of our professors, gripe about how we need more primary care doctors. Even the media cites how had it will be to see your local doctor when this impending shortage emerges, even though such predictions made by the AMA have been wrong in the past.

While I don't entirely believe in a primary care physician shortage because there's plenty of foreign medical graduates who fill the open residency slots every year, and despite conceding that there might be truth in the conclusion of a Dartmouth study that less doctors per capita may do the local populace some good, I assert that there is an ever-decreasing interest in primary care specialities (internal medicine, pediatrics, obstetrics/gynecology & family medicine) among students at my school.

Why? Because of pure and simple economics. Primary care doesn't pay as much as other specialties. So many, weighed down by the burden of student debt, are compelled to seek better paying options. And others just want to make plenty of money, which is hard to do in a primary care field because of the lack of insurance reimbursements, governmental & private, for the non-procedural kind of work these doctors do.

According to responses to a recent WSJ article, some feel that Medicare's bueracratically determined payments is to blame. "The physician shortage you describe in "Is There a Doctor in the House" (The Journal Report, Aug. 21) will worsen and spread as Americans age and as physicians increasingly opt out of Medicare to free themselves of Medicare's fee structure and tortuous regulations."

That same writer offers a plan for patients to get primary care in coming days when there'll be a shortage of such doctors, one different than the usual "tell Congress to stop the cuts in Medicare payments!":

Choose a physician who has opted out of Medicare. By opting out, a physician chooses to work directly for her patients and forgo Medicare reimbursement. Such physicians have fewer patients, more time and a strong financial incentive to deliver excellent care. Such an arrangement is better for doctors and patients and saves Medicare money.

Will this new (but really old actually) direct pay-for-service model take off?