Comments on: ACP: How to fix the primary care problem in health care

By: Coalition for Patients' Rights

Coalition for Patients' Rights — Tue, 03 Nov 2009 20:43:19 +0000

Thank you for recognizing that healthcare professionals, who are not doctors of medicine (MDs) or osteopathy (DOs), play a large role in addressing our nation’s “primary care problem.” The Coalition for Patients’ Rights™ (CPR) represents more than three million licensed healthcare professionals committed to ensuring comprehensive healthcare choices for all patients.

Unfortunately, there is a concerted effort led by the AMA’s Scope of Practice Partnership (SOPP) to limit the care that healthcare professionals (who are not MDs or DOs) are properly educated, legally licensed and/or fully certified to provide.

We hope that divisive efforts among healthcare professionals will be eschewed in favor of efforts to meet the growing needs of our nation’s patient population for safe and reliable care. Dr. Weinberger gets it right when he recognizes the role of non-MDs or DOs in filling the gaps that exist.

If you would like to learn more about CPR’s providers, visit CPR’s Web site at http://www.patientsrightscoalition.org.
- The Coalition for Patients’ Rights™

By: Aestivate99

Aestivate99 — Mon, 02 Nov 2009 16:13:52 +0000

One more comment. I’m from Texas and we haven’t got any docs in a lot of rural areas, much less PCPs. I don’t think a big salary will change that.

By: Aestivate99

Aestivate99 — Mon, 02 Nov 2009 16:08:08 +0000

I’m sorta behind the person who said let the market work. Speaking of working conditions, I have also wondered why some PCPs are in their own practice with nice offices, spacious exam rooms, not lavish but welcoming waiting rooms, while others work under contract to someone else with no office just a tiny little stand up space in the hall with a computer, teeny tiny obviously cost cutting exam rooms, barren waiting room and often surly staff? As a patient I have experienced both and I got the hell out of the second situation as fast as I could. I know both are subject to Medicare and insurers but how did the first group achieve autonomy and why would anyone want to work in the second environment? Made me lose respect for them.

By: John Ryan

John Ryan — Mon, 02 Nov 2009 01:29:21 +0000

There is nothing fair about how primary care (or physician) salaries are determined. My payments for each encounter is regulated by Medicare & the insurers. I am forbidden to charge the patient more, no matter how much more service I give the patient, how complex their condition is, or how few doctors provide that service. Combine that with the tendency for insurers and our government to balance their wasteful management expenses by cutting payments further, and the smart incoming medical graduates avoid primary care. What is a fair income? — what the market will bear. Primary care in short supply? You’ve got to pay more until the shortage corrects itself. In most medium sized communities with a tight supply of IMs and FPs, patients would probably pay at least 50% above what Medicare and the PPO insurers have forced down the price down to.

By: anonymous

anonymous — Sun, 01 Nov 2009 18:16:15 +0000

respectfully, how can there not be a ballpark ‘right’ income if the argument is that income is not appropriate?

“1. Pay PCPs enough to incentivize them to take the time to see a patient as a person, not a problem.” i don’t know how you can say that, and then say there is no ballpark figure that would achieve this, at least as a policy level consideration.
jmo

By: Tom

Tom — Sat, 31 Oct 2009 14:17:46 +0000

Anonymous, hate to disappoint you, but there is no number, not even a ball park. My recommendation, for you, would be to stop trying to control the uncontrollable. Let the market work. It is the most efficient distributor of talent, if there are no distorting influences. What you are suggesting comes down to population control, and I don’t think you want to go there. Telling people where they can live and work has been tried before, and it didn’t go well. Centralized planning sucks for those under its control. The question for you is, do you see yourself as the party under control, or as the controlling party? No thanks, commisar.

By: anonymous

anonymous — Fri, 30 Oct 2009 23:16:42 +0000

ballpark the appropriate primary care salary for me. most areas are underserved with specialists, according to studies, despite the claims that their salaries are too high.

maybe we should control the distribution rather than the income. if we mandate jobs by government allocation to geographical regions, we might get the most effective ‘bang for the buck’ in health care cost controls.

By: jsmith

jsmith — Fri, 30 Oct 2009 18:22:31 +0000

Anon,The right salary level must be determined empirically. It is that level that will result in an adequate number of PCPs. That number will of course vary by community and job specification. Most areas of the US seem to be quite under that number at the moment.

By: anonymous

anonymous — Fri, 30 Oct 2009 11:43:24 +0000

to those who think fixing the salary discrepancy, how much do you think the salary would have to average to be ‘right’?

secondly, does it have to be right where you want to live? iow, people who stay in MA and earn 80k when they could be in Louisiana and make let’s say 170k. Is that something the system has to fix or is that a decision made by the MA residents to make less money and deal with the tradeoffs?

By: Tom

Tom — Thu, 29 Oct 2009 22:25:31 +0000

This is about what I would expect from the ACP, i.e., that if they are just allowed a free hand in academia, everything will be better. To fix primary care, there are two things that need to happen:
1. Pay PCPs enough to incentivize them to take the time to see a patient as a person, not a problem.
2. Let PCPs practice medicine, not social work. Patients bear the responsibility to take care of themselves. It is not an efficient use of resources to use a physician to fill out paperwork for no charge.