My take: Mid-levels, health consultants, blogging

1) A reader writes: “I guess I’m just looking for an intellectually honest assessment of what is wrong with the practice model of one or two MDs supervising several mid-levels so the MDs are free to spend more of their time on the intellectually taxing cases.”

There is nothing wrong with that model. Mid-levels play a valuable role in primary care delivery, and moreso in the future, with the ranks of primary care MDs dwindling.

The problem lies with some mid-levels (unconsciously or not) attempting to replace a physician for primary care. The rigor of MD or DO training is not equaled by a physician assistant, nurse practitioner, or doctorate-level nurse.

I agree that most of primary care can be handled well by mid-level providers. Physicians are valuable in picking out those 5 to 10 percent of cases that do not present typically.

The question is, does the public value that?

2) “Private health consultants” charge $7,000 to $100,000 a year for round-the-clock email and telephone consults, and face-to-face meetings with a personal health adviser.

For that price, would a concierge physician make more sense? At least that way, you’ll cut out the middle-man.

3) A number of prominent medical blogs, including Graham Walker, Panda Bear, and Surgeonsblog, recently have signed off.

It seems that the lifespan of a medical blog is shorter than those of other fields. Over the past year, we’ve seen far too many health care voices go silent.

Blogging and practicing medicine often don’t go hand in hand. Most of the media coverage borders on negative, focusing on patient privacy issues. Hospital administrations have shut down physician blogs. Furthermore, practicing medicine is exhausting, leaving blogging at the bottom of the priority list.

We are fortunate that new voices have emerged as these blogs have closed down. That’s important. Physicians are often left out of the healthcare debate, despite the fact that we will play a pivotal role in any type of reform.

Mainstream media reads what we write, and has paid attention to issues that we have blogged about – like the primary care shortage and the physician payment system.

The blogging medium is an ideal way physicians can make our voices matter. It’s in our best interest to keep the medical blogging phenomenon strong.

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