As this Newsweek editorial points out, programs that are designed to reverse the worsening trend - such as tuition breaks for med students who focus on family medicine - have been shown to barely turn the wheel. The obvious solution - make it more profitable to be a family doctor - alas, seems out of reach. The problem is that health insurers look to Medicare to set their reimbursement rates, and the Medicare panel that makes those rates just happens to be stocked with specialists.
Newsweek doesn't see a politically feasible way out of this incentive spiral. To give more money to family doctors you'd either have to spend more money (not popular these days) or take away money from the specialists which, Newsweek claims, would mean fewer patients getting the special procedures they need (never popular). But hold on, would people really be losing out on the care they need if there were fewer specialists? Not according Maggie Mahar, of the Century Foundation, who argues that what drives all the procedures specialists do is not the need of patients as much as its the need of the specialists. In health care, as opposed to most markets, supply drives demand rather than the other way around. More money given to family doctors to sit around and talk through health issues with patients could also help nip health problems early on and avoid costly duplicative care. Any way you look at it, more money for primary care docs probably adds up to better care (or, at least, as good care) and less money.
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