Next in a series. We have a real paradox in American health care. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical and biotechnology industries continuously bring forth ...

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Next in a series. There is and will be a need for many more primary care physicians (PCPs). Why? There is a shortage now and it will be exacerbated in the coming years for at least three reasons. The population is growing, the population is aging and there will be more individuals with health care coverage as a result of the Affordable Care Act (“Obamacare”). I believe that the need will be much ...

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Next in a series. Primary care physicians (PCPs) are becoming extinct.  It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to ...

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Next in a series. Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike. Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced ...

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First in a series. The primary care physician (PCP) should be the backbone of the American healthcare system. But primary care is in crisis -- a very serious crisis. The first statement is my considered opinion and I will attempt to convince you of its truth. The second sentence is a simple fact. Accounting for only 5% of all health care expenses, the PCP can largely control the “if and ...

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The Affordable Care Act is not so affordable if you own or if you are an employee of a small business. Here is why. Consider the owner of a small service business with one or multiple outlets (e.g., a large restaurant or a small chain of sit down restaurants, a chain of barber shops, a taxi company.) The owner has more than 50 employees but the business is still “small” with ...

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There are just a few key reasons why Medicare has become inordinately expensive. There is no end in sight for cost escalation. But there are some obvious solutions and they all begin with chronic illnesses. Chronic illnesses -- diabetes, heart failure, cancer, chronic lung disease, etc. -- are increasing at exponential rates; are caused largely by lifestyle behaviors; and consume 70-85% of all claims paid. Medicare enrollees tend to have chronic ...

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“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) ...

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Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000. Is there a good solution to the Medicare cost and quality issues? Setting aside either the Democrats’ approach to basically enact price controls by ratcheting down reimbursements or ...

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There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction. The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts ...

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