Comments on: Op-ed: Why the doctor won’t see you now

By: R.alrajhi

R.alrajhi — Tue, 29 Sep 2009 22:36:38 +0000

I think the concentrating on the preventive care, and taking advantage of the media to promote for it would help in that matter and can decrease the patient load on the primary care clinic. The process for preventive care must be done under the umbrella of the universal coverage plan. An intensive commitment must be given to the preventive care so that the plan would work.

Rayyan

By: gromit

gromit — Sun, 13 Sep 2009 14:57:05 +0000

Kevin:

Like I said the first time this was posted – you claim to “observe the effect of the Massachusetts reforms” but the numbers you cite offer no before-after comparison.

Could national universal coverage create shortages? Sure, but looking at MA as an example doesn’t provide much guidance: shortages were bad before reform, they’re still bad after reform.

There’s a lot to be said about physician shortages, the effects on health care access, and different sorts of reforms that might alleviate the situation. But there’s no reason to hold of on universal coverage – after all, even MA didn’t get any worse.

-g

By: TexBryant

TexBryant — Sun, 13 Sep 2009 12:59:34 +0000

Is there a health care crisis? Some think so; some think not. I believe that having so many uninsured given the amount we do spend on health care services is unconscionable. Yes, if most have coverage, the present system of primary care physicians cannot handle the new demands. Health care reform certainly needs to address the shortage of primary care services and also about improving the rewards for primary care physicians–more money and more time with patients. Can it be done? We should try.

By: You get what you pay for and there ain't nothin free

You get what you pay for and there ain't nothin free — Sat, 12 Sep 2009 21:08:55 +0000

Actually, a more important issue is physician pay. I will not operate on a high-risk patient with multiple and severe health problems unless it is worthwhile (especially with the liability risk factored in). Physicians cannot run their practices with a deficit like the government.

By: Doc Stone

Doc Stone — Sat, 12 Sep 2009 21:03:40 +0000

Most missed preventive care doesn’t lead to more intensive care. Most of it leads to . . . nothing but missed preventive care. Most people don’t have a cancer in their colon waiting for a colonoscope. Most people who fit all the usual indications for a statin but don’t get one have no different outcome. Most people who don’t have a PSA don’t suffer from prostate cancer. Even those who have it usually don’t end up “suffering” from it even if undetected and untreated. In short, the hypothesis that getting all the recommended preventive care will on balance save money is not supported by evidence.

Most people forced to wait weeks for medical care don’t inevitably find their way to the ER either. Most get better as the natural course of their illness or at least do not substantially worsen while waiting.

For you or me to relieve suffering where we find it and can do so is a moral imperative. I fail to see where providing insurance as a moral imperative follows from that or any other basic principle.

It is pandering to the insurance-entitlement linkage that has put primary care physicians in such a bind. They have accepted en mass that patients are entitled to have their services paid by a third party. What followed was the result of trying to do it for whatever the third party wanted to pay, which in turn led to only providing the quantity and quality of care that the third party is willing to pay for. But it isn’t the insurance company that is sick, it isn’t the insurance company that misses the compassion, the careful listening, or the insurance company that has a doctor-patient relationship.

You will never escape the problems created by accepting the insurance-entitlement complex by further reinforcing the insurance-entitlement complex. If you think that this country is going to pay primary care doctors a salary commensurate with their investment to take their time and work at a Marcus Welby pace, you haven’t been paying any attention. The country will never pay you to do that.

But some of your patients might. And if they can, but prefer to spend the extra 50$ that that kind of office visit would cost on something unnecessary, then who are we to say that they “deserve” that kind of service funded by their neighbor?

By: Southernsurg

Southernsurg — Sat, 12 Sep 2009 18:25:11 +0000

If universal coverage (by any method) is established, the shortage won’t be limited to primary care, although that is where it will be most noticeable.

By: anonymous

anonymous — Sat, 12 Sep 2009 14:14:45 +0000

when they count academic docs in massachusetts, do they adjust for clinical time spent? for example if a primary care academic doc sees patients 2 days per week, are they counted as a .4 doc?

i’m just guessing, but massachusetts probably has as many or more academic docs as any state in the country?