In the emergency department, we often serve as the final safety net for our communities. Every day, I see patients who have navigated complex health journeys, often arriving at our doors because other health care options are stretched to their limits, leaving them with little room between stability and distress. 

A doctor in a lab coat poses in a medical setting.
Dr. Brad J. Uren chairs the board of the Michigan State Medical Society. (Brayan Gutierrez for Bridge Michigan)

While the emergency department is always ready to provide high-quality care, a truly healthy community depends on a robust and sustainable network of primary and specialty care practices that can manage a patient’s condition long before a crisis occurs.

Today, that network is under significant strain. For many of my colleagues in private practice in other specialties, the math of modern medicine is becoming increasingly difficult to balance. The root of this challenge lies in a Medicare reimbursement system that has not kept pace with the realities of 21st century health care delivery.

Medicare is a cornerstone of our health care infrastructure, providing coverage for 2.3 million Michiganders, or nearly 1 in 4 people in the state. However, the financial framework supporting this program has remained largely static. Over the last 25 years, the cost of running a medical practice — from hiring staff to implementing essential technology — has increased by more than 60%. Meanwhile, when adjusted for inflation, Medicare physician reimbursement has actually declined by 33% since 2001.

Physicians are unique in the health care landscape as the only group that does not receive an automatic annual inflationary update. This creates a precarious environment for the small and independent practices that are so vital to our neighborhoods. When these practices face financial instability, it becomes harder for them to accept new Medicare patients or invest in the preventative treatments that keep people healthy and out of the hospital.

This financial instability does not just affect today’s patients; it also shapes the future of Michigan’s physician workforce. As a physician who works closely with residents and medical students, I see their dedication to serving Michigan’s communities. Yet many of these young professionals are increasingly concerned about whether they can build sustainable careers in areas where patient populations are older and reliance on Medicare is high.

Currently, only 42% of students who train at Michigan’s medical schools ultimately stay to practice in our state. If we want to encourage the next generation to build their lives and practices here—particularly in underserved areas—we must ensure that the health care environment is one that is set up to help their practices thrive. 

In other words, this is not just about physician reimbursement; it is about protecting the patient’s ability to access care in the right place at the right time.

Fortunately, there is growing recognition in Washington that the current trajectory is unsustainable. I am encouraged by recent legislative efforts aimed at providing the stability physicians need to continue serving their patients. Specifically, critical legislation, such as the Provider Reimbursement Stability Act (H.R. 8163) would help bring stability to the system and force Medicare to take a closer look at what it takes to run a practice. 

By addressing the financial pressures, especially on smaller practices, bills like this help ensure that a senior in a rural Michigan county can find a local doctor for their chronic conditions, rather than having to wait weeks for an appointment or travel long distances for care. 

While recent temporary updates from Congress have provided a brief reprieve, the solution lies in long-term reform. By stabilizing Medicare reimbursement, we can preserve the essential relationship between patients and their physicians, ensuring that every Michigander has access to the primary and specialty care they deserve. When our outpatient clinics are strong, our entire healthcare system—including the emergency department—is better equipped to serve everyone.

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