Family medicine lost a great friend on June 10th when Barbara Starfield died. A pediatrician by training, she entered into services research and spent her career describing the American Health Care system. She became convinced around 2004 that the system that she was describing was not only dysfunctional but directly led to the bad outcomes that she had been describing, detailed here in this interview.  She then spent the last 6 years of her life as a voice in the wilderness, trying to let people know how important family medicine was to the health of our fellow Americans.

She died at 78, much too young and with much left to do. In his June 24 newsletter (worth signing up for), Fitzhugh Mullins of Medical Education Futures has given us a sample of 5 of her most important articles. The one that made the biggest impression on me was published in 2005 in Health affairs and as abstracted in Medical Education Futures:

The effects of specialists supply on populations’ health: Assessing the evidence
Starfield B, Shi L, Grover A, Macinko J.
March 2005 – Health Affairs
“Analyses at the county level show lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply. These findings confirm those of previous studies at the state and other levels. Increasing the supply of specialists will not improve the United States’ position in population health relative to other industrialized countries, and it is likely to lead to greater disparities in health status and outcomes. Adverse effects from inappropriate or unnecessary specialist use may be responsible for the absence of relationship between specialist supply and mortality.”

Wow. I was sitting next to a colleague at a meeting this weekend, and upon hearing this study cited, he said to me “That can’t be true. Congress would have done something if it were to protect the American people.” As I told him, I am willing to vouch for the consistency and thoroughness of Dr. Starfield’s analysis. I also continue to be amazed by the way the entrenched medical industrial complex, first described by Arnold Relman in the 1980s,  has managed to protect the self-interest of the non-primary care infrastructure.

Requiem aeternam dona eis, Domine, et lux perpetua luceat eis.

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