You spend too much time around Doctors. They're very smart, and very good at figuring out how the human body works as a system; but their cluelessness as to how the health system pays them is frankly astonishing to anyone who has to deal with them for more then 10 minutes. These are people who will, with a straight face, tell that one reason they deserve more respect then other PhDs (average salary: not $55k) is that they spent four years in pecuniary earning only $55k for their residencies
True, you are worth what people are willing to pay not what it cost to get the education to do the job. Quite frankly, the pay for activity model is broken.
In this case, no GPs are never going to be fired en masse. Arguments saying Nurse Practitioners are better, or a computer would be better are simply irrelevant in light of the fact that consumers want to go to see a Doctor.
Also true, which is why educating the consumer will be part of the shift to lower cost treatment venues. This is not something that happens overnight; but the growth of the minute clinics staffed by NP's is a step in that direction. Consumers may want to see an MD but will trade that off for seeing an NP today vs an MD next week.
Since the co-pay is the same either way NPs can only gain market-share in places where there are not enough GPs. Which means that no, no hospital is going to actually fire a GP and replace him. It would be stupid business, so an MD-run hospital might try it, and if you tried you'd lose market-share to the newly opened GP partnership of three guys you fired.
Moreover, Specialists willing to work in places far from the costs make princely salaries. $500k is not unrealistic. $200k is not unusual for people whose entire job is to read test results and not talk to patients.
Here's the problem. As insurers switch to pay for results and MDs can no longer make more money by running a test the ability to generate enough revenue to make a desired income will decrease. GP's will be competing with NPs and salaries will reflect that. This isn't about firing GPs but the impact computers and a changing way of reimbursing will impact the practice of medicine. A specialty will be even attractive because that is where the money will be.
Let me put it to you this way, which Hospital do you think is will do better:
A) Hospital A's business model is to fire three guys making $150k, replacing them with 3 NPs making $40k. This gives them $330k to buy a computer system that has to understand the entire human body.
B) Hospital B reduces is Surgical staff by two because it can out-source all data analysis in their specialties to a computer it will buy. It has saved $1 million. It can hire all 3 GPs A) just fired and it's computer budget is $550k. Which means not only does it have a better computer, that does less (remember: instead of understanding everything as a GP does it only has to understand a couple of specialties well enough that their specialists can cut analysis a few hours a week), it also poaches most of the patients those 3 GPs saw, and it's got a great marketing angle ("see a real Doctor").
First of all, the computer doesn't have to understand the whole body; rathe it needs to be able to treat symptoms not determine the underlying cause. When the symptom goes away you are cured, and the MD or NP's job is to determine what is the most likely course of treatment based on the symptoms, using the horses not zebras analogy. yes, they determine what you are most likely to have and act base don that, but it is very much a symptom -> action treatment based on pattern recognition; something computer can help with while relying on the MD or NP to recognize anomalies as well as validate the results.
The problem with your poaching model is your assuming insurers will continue to pay enough to cover a GP salary and make money. A more likely model is a number of NPs in practice with a GP so when they exceed their license they can turn to an MD or refer to a specialist. Small offices are already doing that because one MD often can't generate enough money to cover costs and make a living.
Look at it this way. An insurer is going to pay you X for a visit no matter who sees them or what tests they run. Unless the MD can see 2 or 3 times the patients that an NP sees they MD is a money losing proposition. The solution is either to replace them with an NP or cut their salary.
We can disagree but I think the independent practice NP will replace the GP as the entry point into the health care system so people will not first see an MD but an NP. This will reduce the costs while still providing the same quality of care. In addition, in hospitals specialist NPs, working with MDs, will provide more care thus freeing up the MD to work on the toughest cases and a wider variety of cases. Some of the MDs I've worked with have said their NPs are better at what they dothan they are, because the NP focuses on a specific area and does that a lot an thus has more experience than the MD who may only see a fraction of the cases the NP sees; so in the end the quality of care goes up and as the pay for performance model takes hold the hospital will make more money with that model than by sticking with the old one.