How to fix primary care – George Lundberg speaks out

When George speaks, I listen. He has picked up the “Quit the RUC, Replace the RUC” banner. And he goes a few steps farther outlining in his video – initially published in the At Large section of MedPageToday – how we can start on the pathway to fixing primary care. Take a look, Pat


Hello and Welcome. I’m Dr. George Lundberg and this is At Large at MedPage Today.

Primary care physicians, including pediatricians, are usually really nice people. But old baseball fans will remember that Leo Durocher famously said, “nice guys finish last.”

How true. And, as one result, the American healthcare system and the American people are the real losers.

A deliberate radical change in the behavior of American primary care physicians and their representative organizations could go a long way toward fixing our broken healthcare system.

Primary Care Physicians (PCPs) and the health policy kings should meld these three threads:

1. As Brian Klepper and David Kibbe have recently urged, ( PCPs should boycott the Relative Value Update Committee (RUC), that AMA-organized physician payment rate-setting cabal, where procedure-rich specialists have eaten primary care docs for lunch for years and the Feds have stood by in complicity.

2. Blend both the new U.K. Prime Minister David Cameron’s newest National Health Service proposal for General Practitioners ( to control how the medical money is spent for patient care in the U.K. with Dr. David Cundiff’s original concept of “physician managed care” (

Then, 3. Seize the vehicle provided by the Affordable Care Act called Accountable Care Organizations ( to implement these simple but profound ideas and RUN WITH IT.

No more Dr. Nice Guy PCPs until you do a better job of fixing our broken system.

These recent tools are all there … as famous baseball pitcher Dizzy Dean used to say, “the ducks is on the pond.” And, should you PCPs ever actually get real power, wend your power then as the kindly professionals you really are.

Fixing primary care would go a long way towards fixing the American healthcare system mess.

That’s my opinion. I’m Dr. George Lundberg At Large for MedPage Today.


George Lundberg, MD, helps shape the coverage of clinically relevant news at MedPage Today as Editor-at-Large. Dr. Lundberg also serves as president of the Lundberg Institute, and is a consulting professor of pathology and health research policy at Stanford University School of Medicine. He is a member of the Institute of Medicine (IOM) and serves on the Board of Directors of the Friends of the National Library of Medicine. Dr. Lundberg’s editorial work is marked by his distinguished 17-year stint as Editor-in-Chief of the Journal of the American Medical Association(JAMA) and its Archives publications. Most recently he served as Editor-in-Chief of The Medscape Journal of Medicine, the original open-access general medical journal, and Editor-in-Chief of eMedicine at WebMD.

Patricia Salber, MD, MBA is the founder and host of The Doctor Weighs In. She is also the CEO of Health Tech Hatch, the sister site of TDWI that helps innovators tell their stories to the world. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.