Comments on: Are family physicians better suited to practice primary care?

By: Bad Medicine, Good Solutions

Bad Medicine, Good Solutions — Wed, 25 Mar 2009 21:44:00 +0000

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

By: Anonymous

Anonymous — Wed, 25 Mar 2009 13:21:00 +0000

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

By: Toni Brayer MD

Toni Brayer MD — Wed, 25 Mar 2009 05:14:00 +0000

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.

By: Happyman

Happyman — Wed, 25 Mar 2009 01:59:00 +0000

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.

By: Anonymous

Anonymous — Tue, 24 Mar 2009 07:10:00 +0000

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?

By: Sharon

Sharon — Tue, 24 Mar 2009 04:57:00 +0000

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?

By: Anonymous

Anonymous — Tue, 24 Mar 2009 02:31:00 +0000

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.

By: Charlene Burgett, FP Administrator

Charlene Burgett, FP Administrator — Tue, 24 Mar 2009 00:59:00 +0000

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.