A critique: Connecticut Magazine 2018 Best Doctors issue.

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Connecticut magazine recently published its April edition of 2018 Best Doctors: 779 doctors were named in 78 medical, pediatric, surgical and other specialties.

A total of 103 clinicians were named in the accepted Primary Care Specialties of Family Medicine, General Internal Medicine, General Pediatrics and Geriatric Medicine. The American Medical Association Health Workforce mapper provides the number of actively licensed clinicians practicing throughout the country specific to both state and county within state.

In Connecticut the number of actively practicing clinicians in the primary care fields total 5,061. Numerically the least represented specialty groups are emergency medicine physicians (often physicians of first contact) and family physicians with only 1/679 and 4/765 actively practicing, representing just 1/7th of 1 percent and half of 1 percent cited as “Best Doctors” respectively. All other medical and surgical subspecialties represented a total of 10,270 actively practicing clinicians.

A total of 676 clinicians in these additional sub-specialties are identified as best doctors representing nearly 6.6 percent a factor of 13 greater than those in family medicine and a factor of 44 greater than physicians in emergency medicine!

Mixed into the listing of best doctors were many advertisements for medical/surgical individuals and groups totaling 12 glossy photographs — none featuring clinicians practicing primary care. Overall, three times as many sub-specialists were named as “Best Doctors” as those practicing primary care. Sadly, in Connecticut there are twice as many sub-specialists practicing as primary care physicians.

Each year Best Doctors repolls their previously selected physicians for a new round. Obviously, if a group is grossly under-represented, then there is little chance for them to have meaningful input into the selection. The cycle repeats itself and the discrepancy increases.

No one would argue that we need excellent physicians, technology and facilities to deliver the best possible care for all disease states — but not at the expense of expanding access to quality primary healthcare.

The adage “An ounce of prevention is worth a pound of cure” has always held true. In this time of increasing healthcare costs, greater cost shifting to the patient and increasing patient deductibles this display of polling data delivers the wrong message.

Time and time again data has demonstrated that robust and quality primary health care improves quality and lowers overall cost. No one who understands our profit-driven wealth-draining healthcare system would argue this point. What is the take-home message here? “Primary Care as a field is not making the cut.” That is a dangerous presumption…

Connecticut magazine, you need to re-examine your intentions in publishing this type of material just as our healthcare system needs to redesign itself to deliver better healthcare, at lower cost with greater access for all.

H. Andrew Selinger MD is Chairman of the Department of Family Medicine at the Frank H. Netter MD School of Medicine at Quinnipiac University.


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