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  •  Atul Gawande completely misses critical point. (1+ / 0-)
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    Brooke In Seattle

    He's absolutely correct about the corrosive, utterly corrupting influence of the profit motive on the practice of medicine.

    But as a surgical specialist himself, he has missed the biggest issue of all. Yes, the Mayo clinic system in Minnesota combines the lowest per-capita cost with the highest quality medicine in America. But this is not just due to its 'system' of practice and reimbursement. Perhaps the most critical feature of the Mayo system is the central role of primary care. Minnesota has twice as many family physicians and internists per capita as the national average, and half as many surgical subspecialists.

    This is critical: cost-effective, high quality medical care requires a large workforce of well-trained primary care physicians providing most of the routine care. As soon as you have highly trained, highly paid subspecialists providing everyday care for common conditions, costs explode even as outcomes deteriorate. They simply can't help themselves; they've been trained to practice aggressive medical maximalism on every case. And this paradoxically leads to medical care that is simultaneously more expensive yet less effective.

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