Comments on: Health reform ignores primary care doctors at its own peril

By: jsmith

jsmith — Sun, 01 Nov 2009 15:47:51 +0000

I also think PC is in a death spiral. A lot of people don’t realize how much tougher it has gotten in terms of the paperwork. Twenty years ago, when I got our of residency, my clinic’s pt population was much younger and healthier. Not much paperwork. The old and sick increase our administrative burden exponentially and the population is aging. Also, with medical progress there is more to be done on each pt.
I read a comment on the internet a couple months ago by an Oregon ER doc, something like ” if you’re smart enough to get into med school,how could you be stupid enough to go into primary care.” Harsh, but some truth to it.

By: TrenchDoc

TrenchDoc — Sun, 01 Nov 2009 00:35:28 +0000

PP
You nailed it. Primary care practice is on it’s death bed. It takes me 8 hours for uncompensated administration work for every 40 hours of patient care. Requests for disability and power wheelchairs that require multiple forms and letters. We need to move to charging for our time involved in nonclinical tasks and stop giving out tine away.

By: pp

pp — Sat, 31 Oct 2009 17:13:56 +0000

I don’t know how much longer you can expect primary care physicians to stay in practice.

Two trends are:

Insurance companies constantly reducing compensation (they all do it, but GHI, United Healthcare and Blue Cross are the worst). This leads to physicians having to take on greater patient loads and having less time to evaluate and treat patients. Patients can help by either switching to private fees, a better insurance plan or having a written list of issues ready for the doctor. This trend also makes the physician the chaser of payment, a very bad use of precious resources. Insurance companies have been saying recently that their profit margins come out to only 2-6%, this is an attempt to mislead. The companies pay out 100s of millions to billions in compensatio to their executives and then give their shareholders paltry returns of 2-6%. Their profits are in the 30% area and don’t let them mislead you. Also the executives taking huge amounts of compensation is a problem throughout all public companies, not just healthcare, and so you should be very careful investing your money/

Government constantly adding requirements that all sound nice on paper but the government never provides funding for those requirements. This means that physicians have to expend more time and money to comply.

There is the constant fear among physicians that one mistake/bad outcome can ruin the physician’s career forever. This is a real and palpable fear and a problem for a physician which almost no one who is not a physician is aware of or relates. The trial lawyers will throw out figures which say that judgements in malpractice are small compared to total healthcare expenditures. What they fail to mention are all the settlments that are done so that physicians or insurance companies avoid going to court. Also they fail to point out how much weight and damage the fear instilled by malpractice lawyers and malpractice insurance does to the psyche of the physician.

There is an upper limit to how many patients a day we can see and provide quality treatment. Once you cross that 8 minute per patient line there is a severe reduction in quality. Primary care physicians have not choice, they must see a patient every 8 minutes to pay for all overhead.

The rest of the day is uncompensated work like dealing with 20 refill requests + 5-10 prescription adjustments due to patient wants cheaper med since insurance won’t pay for the one prescribed, 4-5 clearances (usually on an immediate need basis since the patient makes the appointment with the specialist and then informs that they need clearance tomorrow), 25 diagnostic reports (labs, radiology and specialist consults), 4-5 discussing abnormal results and the usual 10 “I would like to talk to the doctor requests”.

By: Anonymous

Anonymous — Sat, 31 Oct 2009 02:01:30 +0000

We should outsource diagnostic radiology and use that money to support primary care doctors. Diagnostic radiologists are over paid anyway.

By: Medical Student

Medical Student — Fri, 30 Oct 2009 21:53:25 +0000

The cure will not be worse than the disease, but we may need a second cure soon after the first.

By: Rezmed09

Rezmed09 — Fri, 30 Oct 2009 21:35:19 +0000

The only voice for primary care physicians that will be heard and acted upon will be footsteps of those leaving practice.

Expect more federal expenditures with no real cost control or improvement in the practice hassles for PCP’s. The solution will be more corporatization of medicine. Walmart, or its equivalent will come to the rescue and offer “health care for less” – outsourcing and all.

By: R Watkins

R Watkins — Fri, 30 Oct 2009 21:00:22 +0000

Is it possible to post a link to the original article?

Thanks

Also, 78 million baby boomers will not turn 65 in 2011.

By: Tex Bryant

Tex Bryant — Fri, 30 Oct 2009 20:56:19 +0000

Dr. Reece certainly points out clearly one of the many significant problems in the provision of health care. It seems that the demands of primary care providers steadily grows as the rewards steadily diminish. I believe many of the problems of health care could be greatly lessened with significantly better pay for the primary care provider, whether it be more for the services performed now or whether pay for presently unpaid services, such as use of email or telephone consultations. Personally, I believe that phone and email provision of services should be reimbursed. There are a few companies that do so now.

By: Michael Kirsch, M.D.

Michael Kirsch, M.D. — Fri, 30 Oct 2009 19:13:27 +0000

Obamacare, the cure, may be worse than the disease.