QUALITY: Let Them Eat Botox

We may not be able to tamp down diabetes in America but at least our skin will be flawless.

For a variety of reasons —including money —lots of young doctors choose fields like dermatology and plastic surgery instead of internal medicine, geriatrics and pediatrics. As we tackle national health reform, we need to make sure we put primary care back on center stage.

Two influential physicians, Joel S. Levine, chairman of the Board of Regents, American College of Physicians and Christine K. Cassel, president and CEO, American Board of Internal Medicine, chimed in about the "upside down" health care system and distorted incentives in a letter to the editor of the New York Times today. They were responding to the recent story, "For Top Medical Students, Appearance Offers an Attractive Field."

"The fact that so many medical students are choosing lucrative specialties like dermatology over internal medicine should be a clarion call that our health care system needs an overhaul," they wrote, noting that primary care docs can't hope for the $2,000-an-hour fees that a physician can reap on a cosmetic procedure.

Levine and Cassel called for a system that makes it attractive for young doctors to go into specialties that focus on caring for the whole patient. "More than ever, Americans need access to qualified primary care physicians to manage multiple chronic conditions as baby boomers gray and disease rates for obesity, diabetes and hypertension increase."

On a related point, Paul Levy, in his Running a Hospital blog fresh from a visit to Tuscany, described their per capita annual health care spending (1400 Euros) versus ours ($7000). Levy didn't convert Euros to dollars partly, he said, because "having a glass or two of Chianti while discussing the topic makes one care less about getting the numbers exactly right." Levy noted several difference between Tuscany and the U.S. including that they eat healthier and walk more -- and their health system covers people from cradle to grave. They also pay doctors less, but Italy has no shortage of doctors. One difference: U.S. doctors can end up with $300,000 in debts by the time they finish college, med school and residency. In Italy, medical education is free.