1) From a reader: “I don’t understand why, if there is a shortage of primary care physicians, can’t primary care physician dictate rates and policies to the insurers that may want them to see their patients? . . .
. . . Can the physician bill the insurer for the extra paperwork and copies (kind of like an attorney, billing every 6 minutes and 0.25 cents per copy)?”
My take: You are starting to see movement in that direction. An op-ed in the LA Times argued that rejecting insurers may be the future for primary care.
Insurance shields patients from the true cost of care. Patients generally are reluctant to pay more than the $20 co-pay. If a doctor went cash-only, they are gambling that patients are willing to pay for the true cost of the visit. Sometimes it works if you live in an affluent area. However if it doesn’t, you’re left with no patients and an empty, bankrupt practice.
If all generalists left en masse (as an increasing number are doing with Medicare), there will be more leverage to dictate to the insurers. However, there are still a sizable number of doctors who prefer the guaranteed, but decreasing, revenue of insured patients. Until this group is convinced to reject insurers, we will continue to be slaves to the current system.
Although you can’t bill strictly for paperwork – because insurers only pay for face to face visits – there is movement towards getting compensated for administrative tasks. Some are charging patients directly. Others bring in the patient for an office visit to fill out the necessary forms.
2) A cardiologist is sued for performing a cardiac catheterization that possibly led to a stroke.
My take: The case was settled, so we don’t know whether the stroke was a direct complication from the catheterization.
However, this should serve as a warning to patients that the more invasive the test, the bigger the risk of complications. More testing does not always equate to better medicine. In fact, the Dartmouth Atlas group does excellent research showing that more intensive care led to worse outcomes. and a greater degree of medical errors.
3) The NHS is proposing using ECGs to help with telephone triage of chest pain patients.
My take: Stunningly asinine. ECGs are not nearly sensitive enough to diagnose heart attacks. There will be a proportion of patients who will have MIs despite having a “normal” ECG and told not to go to the ED. This is going to open up the malpractice floodgates.
4) There is not a doctor shortage, but a primary care shortage.
My take: Building new medical schools won’t solve the problem. This will simply produce more doctors who will continue gravitating to specialties.
The answer lies in giving current students incentives to enter primary care. Two solutions I have proposed, forgiving debt for those who choose primary care and reconciling the disparity between generalist and specialist salaries, seem to be getting some mainstream media attention.
Related posts:
- How the primary care doctor shortage threatens Obama’s health reform plan
- Will the doctor shortage impede universal care?
- How the recession will help Canada’s doctor shortage
- Female physicians and the Canadian doctor shortage
- Canadian doctor shortage
- Once you hit Medicare age, good luck finding a primary care doctor
- Maybe we should throw money at the doctor shortage problem
{ 7 comments }
Why don’t the USA make your certification rules easier and import many English GPs who are fed up of the constrints of the NHS?
30% of our doctors are foreign medical graduates now and a lot of the ones who do get through the current certification process suck. We will be glad to have you but you’ll have to clear the bar that is in place–not ask for it to be lowered.
Kevin: If the fee and income differential is corrected, why would PCP’s need or warrant loan foriveness. Aim for the first and the second will not be needed. I know you don’t buy the idea that loan forgiveness will be result in enslavement but you’ll figure it out when it is too late if it is ever implemented. Better to get fair reimbursement and buy you own education with it than to be state property, bought and paid for.
shouldn’t there be some kind of differential. My residency was much more difficult and longer than that of a family practitioner. Shouldn’t some sort of disparity exist. I don’t expect to make as much money as a neurosurgeon or a ct surgeon.
I think the differential is a bit excessive at some times, but then I do know some fp’s that are making far in excess of the average, but they are working very hard and the specialists that I know that are making the average seem to be working with substantially more call.
Of course most of the fp’s around here don’t take any call, they send all of their patients to a hospitalist.
Kevin – I cannot find any reference to the exclusion of MI after a single ECG trace (in the article on the proposed triage system).
You may be aware that current health policies in the UK are geared toward increasing the management of chronic diseases outside of hospital (which increases the risk threshold for GPs, of course).
Many GPs have an ECG machine quietly gathering dust in a corner of their surgery – does this kit have ANY role to play in risk stratification ?
I can’t help noticing your concerns about litigation but in what way does an additional investigation increase the risk of a law suite, or is this more a reflection of the American health scene ?
As I say an ECG cannot be used to exclude MI but may be used in the prehospital setting to determine if a patient should be delivered directly to the cath lab rather than the ED (if elevated ST segments are evident on the 12-lead).
This investigation may also have it’s uses if it reveals Wenckbach rather than 3rd degree block, say ?
if equalizing the income disparity between general practitioners and specialists means decreasing the pay for the specialists rather than increasing the pay of the generalists, which, given the current political atmosphere, doesn’t seem all too unlikely, then i wonder who will go into medicine at all. all those loans and lost years for $75-90k a year?
@ Dr Blue, and Anon 6:23 PM – “Why don’t the USA make your certification rules easier and import many English GPs who are fed up of the constrints [sic] of the NHS?”
In fact, there IS reciprocity with the Royal Colleges and the American Board of Family Medicine.
http://tinyurl.com/4blv3q
[Links to the American Board of Family Medicine]
I don’t know about other specialty boards, they all have their own rules. But at least for family physicians (GP’s in the UK), the American Board of Family Medicine reciprocates with the College of Family Physicians of Canada, the Royal New Zealand College of General Practitioners, the Royal Australian College of General Practitioners, and the Royal College of General Practitioners of Great Britain.
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