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Are family physicians better suited to practice primary care?

Kevin | Physician | March 23, 2009

And if so, is this the best time to start a turf war?

The ACP’s Bob Doherty highlights a study from the research arm of the American Academy of Family Physicians suggesting that, “Medicare spending by general internists and subspecialists is significantly higher than for family physicians.”

I haven’t seen the study myself, but if this is correct, is it really the time to release a study that will divide primary care doctors?

Or, perhaps the AAFP sees the vulnerability in primary care internal medicine, and sees this as an ideal opportunity kill of the field and exert its influence.

How Machiavellian.

As Mr. Doherty says, “it will be regrettable if this article ends up creating a war of words on the value of family medicine versus internal medicine, when we should remain united on the essential contributions of both.”

Agreed. Primary care is on life support now, and with impending health reform, both family physicians and primary care internists need to be united in order for generalist medicine to stay alive.

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Tagged as: Health reform, Medicare, Primary care, Specialist

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  • Charlene Burgett, FP Administrator

    I think Internists see more complicated and older patients, therefore they would be billing more Medicare claims. Family Practice physicians have a larger spectrum of patients between pediatrics and geriatrics. My practice is only about 30% Medicare with the remaining commercial plans and self pay.

  • Anonymous

    I agree that now is the time for unity, not division. I have not read the article in question either, but my take on it was that the authors were suggesting that there may be some fundamental differences in the training paradigms for the respective fields. Such differences may be important if we intend to control costs down the road.

  • Sharon

    I don’t think anyone’s trying to start a turf war. I think the take-home point is that FM programs focus more on outpatient medicine than IM programs. Nobody would dispute that. The study shows that IM PMDs lead to more costly care than FM PMDs. The hypothesis to explain this finding is that more time spent on outpatient training produces physicians who utilize fewer health care dollars on providing outpatient care. It makes sense.

    What do we do with this? A key part of decreasing our health care spending may be to refocus IM residencies to be more geared toward outpatient care. I would think that many IM-trained physicians who practice primary care would agree with this. Am I wrong?

  • Anonymous

    This hurts me to say, because I’ve really come to respect Kevin’s insight over the past couple of years, but I’ve never really seen a compelling case for primary care IM outside the VA (where the vast majority of primary care goes to adult males without an overwhelmingly geriatric age distribution).

    One commentor (above) suggests the IM PCPs see more geri, but if that’s the distinction, shouldn’t the geri train wrecks be seeing geri and not IM (bias disclosure, I trained at BU which has a prominent geri department)?

    If you need to provide actual primary care in the community, most of the time FP can cover things. Of the things that FP might have trouble with, few could be addressed by IM anyway: rare pediatric conditions? IM won’t even see the kids; Ob/Gyn issues? same; the geri trainwreck? sure, IM MIGHT be better than FP at managing these patients on an outpatient basis, but then those cases should be seeing a geri specialist for their outpatient/primary care management.

    Where is the ‘competitive advantage’ (in terms of depth/breadth care, not profit margin) for primary care IM compared to FP?

  • Happyman

    Medicare should provide and pay for an accelerated geriatric certification status, say over 3 months, attainable over the internet without disruption of one’s current job, to boarded FPs and IMs.

    Then , if they could increase the reimbursement for 99213, 99214, 99215 by 50% and couple that with tort reform, that would go much further at reducing medicare costs than anything being discussed currently. And we’d actually have GOOD geriatric care, rather than a swamped pcp seeing grandma for 10 minutes and sending her to cardio for chf, gi for hemorrhoids, derm for eczema, ent for impacted earwax, etc.

    Friends of mine who’ve done geriatrics fellowships have ALL validated that 3 months is more than enough to learn the nuances of geriatrics, especially for IM’s that were trained in bigger hospital systems.

    It boggles the mind that medicare pays like $60 for a 99213 but doesn’t hesitate to spend $1000 annually on a nuclear stress test for a 90-yr-old.

  • Toni Brayer MD

    OMG, HAPPYMAN is right on. Especially about the savings. Every time I take care of a complicated patient in my office I save someone a ton of $$. One visit with me…$60. A referral to a specialist for the same thing would engender lots of wasteful tests and more referrals to his pals for other body parts. Crazy system and it doesn’t matter if it is FP or IM…primary care is dead.

  • Anonymous

    Could not agree more.
    In my family practice, I get 60-85medicare dollars for taking care of grandmas 10 problems. However, I get 60-70 dollars for taking care of some 45 year olds viral URI. Priorities have got to be shifted if our healthcare system is to survive.

    A family practitioner

  • Bad Medicine, Good Solutions

    Shift the priorities yourself. The government won’t do it for you. Opt out, and then enter a retainer practice.

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