Health care needs a maul, not a chisel

"If you have a doctor, be happy that you have a doctor."

So said Dr. Joe Corn, a Sequim physician speaking on a panel at Sequim Sunrise Rotary Club on Friday, Aug. 7.

Other panel members included, Dr. Tom Locke, health officer for Clallam and Jefferson counties, and Eric Lewis, CEO of Olympic Medical Center.

The shortage of primary care doctors is a nationwide phenomenon, but Sequim is feeling it acutely after the death of Dr. Paul Hoque in October 2008.

Efforts to find another primary care physician to replace Hoque at Sherwood Medical Clinic have failed, and the clinic is slated to close Sept. 30.

"We have no place else that we can send people," Corn said, referring to the 2,700 patients left without primary care by the closure.

Although primary care is the cornerstone of personal medical service, Corn said, few doctors are choosing to enter family practice because it is poorly paid compared to specialty medicine.

"Why would you become a primary care doctor?" Corn asked, when you can earn many times the income as a specialist.

Corn said when he was studying medicine, the University of Washington's family practice residency was considered the best in the country, but now they are having a hard time filling it.

Locke agreed, calling the primary care deficit a huge crisis.

"We don't have new primary care doctors in training," he said. The problem is more acute in rural areas, where 9 percent of the doctors serve 20 percent of the population.

Lewis identified three major problems in health care: cost, access and outcomes. The national health care bills deal best with the issue of access and would bring coverage to about 97 percent of the U.S. population, through a combination of mandates for businesses to provide employees insurance and individuals to maintain insurance coverage.

Lewis said the national proposal falls short in the areas of cost controls and outcomes. The government is addressing problems with a chisel, when a sledge hammer is needed, Lewis said, and they are not making major changes in the larger system of health care.

Lewis cited a proposal that all hospitals cut their costs by 1 percent, and that home health care would be cut 11 percent over four years.

"Some of these details have me concerned," Lewis said.

"We know it's much cheaper to prevent disease than to treat it," said Locke.

"Our system gives lip service to prevention but actually spends only about 1 percent of health care dollars on it.

"We have the world's most expensive health care system, with 50 percent of the world's health care spending going to 5 percent of the world's population."

When compared to the health care systems in Europe and Canada, Lewis said, those systems cost about half as much, have universal coverage and better outcomes. Half their costs go to primary care and half to specialists, but in the U.S. only 25 percent goes to primary care.

"I think primary care should be paid the same or more than specialists," he said.

Reach Sandra Frykholm at

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