The primary care crisis hits home

Concord, NH – about 30 miles from Nashua – is feeling the primary care crisis up close. Some straight talk from this local editorial:

A study of physician recruitment offers by a national health care search firm goes a long way to explaining the primary care shortage. Family practice doctors were offered an average of $145,000 per year, cardiologists $342,000, radiologists $351,000 and orthopedic surgeons $370,000. Doctors several hundred thousand dollars in debt for their education act rationally when they choose to specialize . . .
. . . The disparity in payment rates for general practitioners and specialists must be narrowed. Specialists will have to make less so generalists can make more. Since no doctors are about to reduce their own incomes, lawmakers at the state and federal level should restructure reimbursement rates under Medicare and Medicaid to recognize that preventing a disease and its complications is at least as important as treating it.
Years of work and hundreds of millions of dollars have made Concord a regional health care center, one that is of little value to people who can’t get through its gates.

Comments

jb
What absolute rubbish! This is the thinking that got us into this mess, and now more of the same is proposed. It was Medicare that decided how much our services are worth- they hired a PhD from Harvard no less who devised a system that purported to determine how much each service was worth. An input for practice expense, one for malpractice expense, and most important, an input for effort. The RBRVS! How scientific! How egalitarian! How socialistic! Some of you may remember that the original system also had 3 (count them!) conversion values. One for surgical procedures, one for E/M, and one for labs and stuff. The idea was that different flavors of docs could restrain the volume of services provided and thereby gain more money per unit of service if they did less. This was the only part that worked as desired. Surgeons did procedures as needed and their conversion factor increased much more rapidly than medical physicians (we can only remove a gallbladder or uterus once, but medical physicians can have their patients return every 3 months instead of every 4, thereby increasing their revenue as needed). This led to an imbalance as the surgical conversion factor became substantially higher than the medical. Medical docs protested mightily, and being superior in numbers, they won. Now we have a single conversion factor. End of that experiment.
Now the esteemed editors of this newspaper want more of the same, but this time even better. Maybe a guy from Harvard with 2 PhDs??? A Yalie??? How ‘bout an honest socialist from Havana? Someone who really really knows, really this time, that a 99214 is worth a certain fraction of 44140 (I cured a cancer with my 44140. What did you do for your 99214? Prevent a CVA? OK, you get more!).
Instead of more government intrusion, more central planning, more PhDs, how about less? Just once, let’s try to get back to a market system, like, you know, the one we had before Medicare? No one died in the streets. Docs made a good living, the revenue coming into practices allowed us to provide low cost care for those of limited means, and the PhDs could do useful work.
Anonymous
The medical profession is the only one in the nation in which wages are dictated by a central committee.
Even firefighters and policemen dont have their salaries dictated at a federal level. They can move from city to city, and cities compete for their services by offering higher wages.
Anonymous
“Lawmakers should expand -with proper oversight – the functions that nurse practitioners, physician assistants, dental technicians and other paraprofessionals are allowed to perform. In the short run, they will be the answer to alleviating the shortage.”
Uhhh sorry to break the news, but this has already been pushed to the max.
What other “powers” are you going to give NPs that they dont already have? They can already script every drug in the book, they can already open their own clinics with no doctor oversight, they can already order any lab or test they want.
NPs can already do anything and everything that a family doctor does.
So that pathway is a dead end. I suppose you could give them power to do surgery, but this article is about primary care, not surgery, and there is no shortage of surgeons.
Anonymous
“. I suppose you could give them power to do surgery, but this article is about primary care, not surgery, and there is no shortage of surgeons.”
You obviously have never worked in a community hospita in the Boonies. Or any hospital needing a hand surgeon or other highly sued profession.
Anonymous
“You dont need a hand surgeon in a small town community hospital.”
OK, I stand corrected. Their isn’t a shortage of surgical specialists in the Lawyer-Raped specialties. My hospital will be happy to hear that. They haven’t been able to find a new neurosurgeon or hand surgeon in 2 Years.
Anonymous
There has always been a shortage of specialists in the boonies. There’s a shortage of everything but quiet and money there generally. And even if they like the former, physicians are driven by the latter.
Why is this news or cause for comment?
Anonymous
Oops, I meant to say there is a shortage of money in the rural areas.
Anonymous
Keep these dollar amounts in mind the next time you hear, see or read about some physician pissing and moaning about being driven out of business or the cost of malpractice insurance. The only “crisis” in American allopathic medicine is that the providers are enriching themselves and bleeding the patients dry.
Anonymous
I wouldn’t work as an FP for less than $350K, or as an orthopod for less than $750k. Therefore I am neither. Where I live, the average new house is $2+ million. It takes a family income of $1 million to live comfortably. You will need about $10 million to retire. Sorry, but medical practice does not pay the bills here. There are no new doctors in the neighborhood, just lawyers and business executives. Get a clue—it is time to move on to better things. Why, one physician I know has retired from medical practice because her MLM cosmetic sales income and lifestyle has surpassed that of medicine. The costs of medical practice are high, and there is no such thing as part-time malpractice insurance. The return on investment is simply better in many other careers compared to medicine. Those not in medical careers who post here are either naive or sly as a fox.
Anonymous
A med school classmate of mine told me today she makes 600 K a year doing Hand Surgery. No ER call. The Hell with primary care.
Anonymous
1:54,
I understand where you are coming from but I feel sorry for you. I doubt you will ever be happy. You need to move. I work 8-10 ER shifts/month, live in average USA, live in an average house, drive a below average car. I don’t make very much but I have lots of free time and one super hot wife. We have cycled across this country and other countries, climbed mountains, competed in triathlons, helped out in New Orleans and other mission trips. I am so filthy rich with everything except money. But you are right, if making money is your goal, medicine is the wrong profession
Anonymous
Sounds like a plan. My wife and I are low maintanence too, however children are not. You need lots of money if you have kids.
Anonymous
You are right. Kids do cost money. I work more now that they are in school because what am I going to do all day. But I am not going to lay life out on a silver platter for them. They can do some work and go cheap State U. and study hard like I did.
The Locust
Anonymous 1:06 a.m. (clearly a member of the malpractice bar) wrote:
“Keep these dollar amounts in mind the next time you hear, see or read about some physician pissing and moaning about being driven out of business or the cost of malpractice insurance. The only “crisis” in American allopathic medicine is that the providers are enriching themselves and bleeding the patients dry.”
You idiot. The doctors you malign and sue so much spent almost 20 years in training taking on $400,000 in loans and 100-hour weeks for the privilege of making a much lower salary than just about any business professional with half the level of training and much less debt. The “pain and suffering” amounts you fools extract from doctors who frequently *have not made an error*– but in which an outcome is seen as adverse for whatever reason– far exceed even the amounts paid out to plaintiffs who are (deservedly) given monetary rewards for *deliberate damage*.
Think about that, for a moment– because of you idiot malpractice lawyers, plaintiffs get far more money from someone who is *trying to help them* and frequently does everything available to help them, than plaintiffs can get from the most vicious criminal who does them grievously bodily harm. There couldn’t possibly be a more cut-and-dry indicator of how warped and screwed up our “justice” system is.
You medical malpractice lawyers really are just about the most damaging people to the USA today. You contribute almost nothing to societal productivity and gains, yet you wreak enormous harm and extract wealth from others who do contribute. You all deserve to suffer and die slowly from the most horrid mutant forms of leprosy imaginable before being dispatched to become snack food in Hell where you belong. This would if anything be only a modest punishment for you considering the harm you do to this society.
MDmanager
This has been entertaining, although I don’t believe we have touched on a solution to the reimbursement fiasco.
I’ve been positioning our small family medical practice to “Just Say No”.
Surrounded by 2 giant hospital systems, in an expensive urban environment, I am tired of having to compete at a 70% disadvantage (tax exempt, huge buying power, and 40% better insurance reimbursements).
It’s been slow and painful, and required a significant investment, but my physician wife has developed a loyal clientele who value her services and we are closer to pulling the plug on Medicare, Medicaid,and three large, abusive insurance carriers.
Medicine has become an incredibly expensive and risky business. What we have given away – or had taken away is our professional status and pricing power.
Physicians have become indentured servants to the government and the insurance industry.
From my front row seat to the economic crisis experienced by all small primary care, independent physician offices … the only way out I can see … is not to play the game.
You only have your timeslots to sell. See where else you can grow your business, and over time, choose your most despised payers… and just say “NO”.

The primary care crisis hits home

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