Serving patients and preserving medicine requires better stewardship of resources than has been shown

Forty years ago, a seasoned doctor told me "as a doctor, you have knowledge, skill, and time, and that is what you get paid for."

We have long realized that our health care system was poorly constructed and must eventually change, but never in our wildest nightmares would we have envisioned health reform in the face of current economic challenges.

Reform focus must protect our profession for future generations. To attract the best and brightest to medicine, this new health system must have resources adequate to pay future physicians well for their knowledge, skill, and time.

This country will eventually provide a system of basic health care for every American. If the nation's $ 2.2 trillion annual health tab were better spent, we might already be providing that care.

The dollars available for health care are limited.

We might successfully argue that the physician professional portion of that dollar is appropriately spent, but we fail miserably in our stewardship of the remaining resources.

We use brand names when generics are fine. You want a scooter or lift chair -- no problem. And how can any system budget health expenses with the explosion in our use of technology?

We must plan for the needs of populations of patients, not for the wants of physicians and hospitals, if we hope to have money left over to pay physicians for our professional effort, our knowledge, skill, and time.

Every American should have a personal physician.

For most, that doctor should be a primary care specialist. The quality and cost-effectiveness of this type of health care is well documented.

Physician reimbursement must be adjusted to provide incentives required to build the primary care foundation needed to provide cost-effective health care for every American.

Larry Anderson, MD, DVM, Wellington, Kan.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2009/03/23/edlt0323.htm.