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Reducing access to medical specialists will worsen American health care.

12:00 AM, Sep 9, 2009 • By STANLEY GOLDFARB
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Constraints on access to specialty care will be a key dilemma in any proposed reform of health care delivery. It is a myth, although quite widely accepted and advocated, that reducing expert but expensive specialist care will lead to better medical care. The myth is based on the idea that there is more uniformity than singularity among patients and that most care can be defined by guidelines. It may be true that for those with non-life threatening conditions that have only moderate intensity, that generalists could apply guidelines and deal with the problems in an efficient manner. But those with complex illnesses and advanced complications of highly prevalent diseases like Diabetes will not thrive in a generalist dominated world. The fear expressed by most Americans about the content of their medical care is not that their mild hypertension will be untreated but rather that if they develop a life threatening malignancy like that of Senator Kennedy, that they will receive every opportunity to avoid death and prolong meaningful life. This will not be achieved by a health care system that does not support an innovative and technologically adept specialist physician workforce. How to achieve wide access to specialists and contain costs is the conundrum that the current proposals do not begin to address. It just is not enough to simply cut the payments to physicians and hospitals. That will not generate more access to advanced care.

Stanley Goldfarb MD is associate dean of clinical education at the University of Pennsylvania School of Medicine and a nephrologist.