The specialization of family medicine

Family physicians are sub-specializing to fight declining reimbursements:

Many family physicians embark on careers in sports medicine, academic medicine or geriatrics in which they take no overnight call and have no responsibility for caring for hospitalized patients. As “subspecialists,” they typically command higher rates of reimbursement for clinical work – particularly those with certificates of added qualification. In a time when family physicians feel increasing pressure to work longer hours in order to offset flat or declining reimbursements, these financial and lifestyle benefits of fellowship training provide a compelling incentive for today’s graduates to abandon traditional generalist medicine.

Comments

Anonymous
Another consequence of physicians allowing others to set their prices for essential services–price setting by those who want to save money who are not the actual consumer has priced primary care services below the level where people can provide quality care.
The right way to price professional services is to figure out what price it takes to provide qualty service that your patients want and you can be proud of, then charge that, refusing to do business with those who will not pay it.
It is really disgusting how people don’t even take histories and examine patients anymore. They only schedule procedures because that is what they get reimbursed for. The “right” answer is to uphold high standards of care and charge what it takes to afford it.
Anonymous
Good Luck to demanding pay for quality and what you “deserve”. There is only a limited pool of clients who will afford concierge services. Haven’t you noticed how your patients would rather have the pharmacy call you for their med refills, than visit you and have to pay another ‘co-pay’? To think that the real reason for a visit is a follow-up for quality monitoring of their treatment – all these are ignored because the public perceive doctors as rich money grabbing lot…how unfortunate!
Anonymous
Agree. Patients will complain as they come to pick up their records and prepare to go to a practice they do not otherwise “prefer” if it means they have to pay anything more than their basic co-pay. Going out of network basically means most of the patients seen in-network will go elsewhere. It does not even require charges typical of a concierge-type practice, and it is just as true with those who have money as with those who don’t. Most people who pay insurance companies resent having to pay anything more than the minimum and will go elsewhere before paying for service from someone they say they like.
Anonymous
Some do and those who know quality don’t. I just went to a physician that is not in my network yesterday paid entirely out of pocket for the visit 350 bucks and it was worth every penny and I would gladly do it again. You get what you pay for. It amazes me that people will pay thousands for a new TV or to have their car fixed, but complain if they owe anything outside a copay.
Anonymous
Heck, I just paid $575 to have a piece of rotten wood replaced in my 60 year-old garage today. The workers had to write the price on the side of my garage after taking to the jefe because they “no habla ingles” Thank God I had bought a bunch of Whole Foods stock a few days ago (which shot up today)and will be able to keep a roof over my head. My day job is pathetic in this day and age.
Anonymous
“Haven’t you noticed how your patients would rather have the pharmacy call you for their med refills, than visit you and have to pay another ‘co-pay’? To think that the real reason for a visit is a follow-up for quality monitoring of their treatment – all these are ignored because the public perceive doctors as rich money grabbing lot”
Please watch your overgeneralizations. Every time my prescriptions expire, I schedule another physical with my PCP (despite my health coverage paying less and less each year — in fact, most of the blood workup I pay for out of pocket, and it is very expensive…makes the physician’s charges seem like pocket change). Nobody from the doctor’s office ever tells me to schedule appts or sends reminders that it’s time for a follow-up. I do it because it seems like the intelligent thing to do, and suspect there are probably quite a few people who do the same.
Anonymous
“Please watch your overgeneralizations. ….I do it because it seems like the intelligent thing to do, and suspect there are probably quite a few people who do the same.”
I’d watch my “overgeneralizations” if you will avoid yours, and your oversimplification.
Have you actually been at the end where you get “requests” for refills on this and that prescription, because “I am just too busy to make an appointment…”
Providers and their offices don’t just get called by the patients for these refills…the pharmacies do the requesting too in behalf of the patient [i know having worked both ends-and customers blabber in the pharmacy about how they don't want to visit their provider because of the testing and almost always the co-pay; they do not want to co-pay anymore because they are medicare or insured lots]. Damn quality care, until they get unmonitored consequences, then they blame the providers again!
Believe me, you [and the few you are referring to] are the exceptions to my “overgeneralizations”
Michael Rack, MD
Family medicine/sports medicine is a great combination. It allows a family doc to market himself to young, generally healthy, athletic adults. When I went to med school, my fam doc was certified in sports medicine and he was able to take care of my rotator cuff problems without sending to me an orthopedist. I wouldn’t trust a general practitioner without added sports medicine qualifications to do any sort of musculoskeletal injections on my body. The sports med certification allows fam docs to add profitable minor procedures such as shoulder injections to their practice.
Anonymous
You attrack whatever kind of patients you design your practice to accomodate. I used to spend up to 2 hours a day fullfilling refill requests for people who had not returned in the recommmended time frame, and so were out of their meds. Also many of the requests were made by the pharmacy even though the original RX was still active because they didn’t look before calling.
I began charging 20 bucks a pop for refills. I hated to do it, but it was taking over my time.
Problem solved.
Didn’t really collect anything. I would always waive the charge the first time when people complained about it. Billing complained about the time to send out a bill for a small charge and then have me waive. But within a few months, I was getting 2 or 3 refill requests a week instead of 20 a day. People learned that when they got the last bottle on a Rx, they were due for a follow-up eval. I explained to people directly why I did it–not to make more money but to make everyone (me, patients, pharmacies) pay more attention and take care of business on time. Complaining stopped and I got home sooner. I learned that I had been part of the problem in letting it happen.

The specialization of family medicine

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