Physician

When specialists provide primary care, and why patients aren’t complaining

A study recent came out showing that specialists are providing a greater proportion of primary care services to patients.

According to the Annals of Family Medicine, “Researchers looked at more than 1 billion ambulatory visits to U.S. office-based specialists in 2002-04 and found that 46.3% of visits were for routine follow-up and preventive care of patients already known to the specialist, while referrals accounted for only …

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Hospitalists assimilate inpatient medicine, is resistance futile?

Hospitalists are here to stay, for good.

MedPage Today reports on a NEJM study, not surprisingly concluding that “hospitalists now account for nearly 40% of inpatient Medicare claims for general internist services, up from less than 10% in 1995.”

That’s a lot.

How will it affect primary care doctors, who increasingly are confined to the office? Well, it’s not a positive as you’d think.

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Should doctors go to work if they’re sick?

The work ethic instilled in most physicians may actually be a detriment to patient care.

In this piece in Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines write about the culture in medicine where doctors are expected to show up for work (via RangelMD.com), no matter what their malady is: “Sick doctors have been known to do rounds while dragging IV poles and receiving fluids for …

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The retail clinic era is over, and why pharmacy-based clinics are doomed to fail

Corporations are finding out what primary care doctors already know: it’s hard to make money only doing office visits.

CVS has announced they are closing 90 of the 550 MinuteClinic locations until next fall’s flu season.

As the WSJ Health Blog comments, “the clinics appear to be showing a pattern sort of like the dot-com bubble, in which some will go away while others survive.”

That’s …

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What is a health coach, and why are they paid $121 an hour?

The movement of “health coaching” is gaining some traction in health care circles.

PookieMD explores the phenomenon, and finds that a health coach, among other duties, “help people clarify their health goals, and implement and sustain behaviors, lifestyles, and attitudes that are conducive to optimal health; guide people in their personal care and health-maintenance activities; and, assist people in reducing the negative impact made on their lives by chronic …

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Should doctors learn to become dentists?

There’s such a shortage of dentists in Maine that primary care doctors are the ones pulling teeth.

Not only does the state have a severe shortage of dentists, poorer patients have trouble seeing one, since few accept those without insurance or with Medicaid.

So that leaves the primary care doctors to pick up the slack and learn to pull teeth, screen for tooth decay, or lance oral …

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Would you waive your right to sue a doctor to obtain free medical care?

What if a retired physician, Harvard-trained no less, wanted to give away medical care?

You’d think the huge demand would make it easier for him to accomplish this, but that’s not the case.

When funding dried up for New York physician Lloyd Hamilton’s free care clinic, he wanted to continue serving the same patients, even depriving himself of a salary. Unfortunately, it wasn’t so easy, as …

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Are academic physicians the next target on the inflated executive salary hit list?

First, Wall Street executives are vilified. Are academic physician-administrators next?

The WSJ Health Blog didn’t do the profession any favors by highlighting the fact that 3 of the top 4 highest paid college employees were physicians at academic medical centers, pulling in $3 million to $4 million per year.

Needless to say, that statistic comes out at an inopportune time, only reinforcing the false public notion that …

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Laborists, and how rising malpractice premiums and the physician payment system are fueling the rise of hospital-only obstetricians

Meet the obstetric version of hospitalists, known as laborists.

Faced with rising malpractice premiums, and the increasing financial pressure to see more patients in the office, more obstetrician/gynecologists are ceasing to deliver babies. In fact, according to Massachusetts’ largest malpractice carrier, more than half of the OB/GYN’s they cover have dropped obstetrics.

It’s no wonder, as “an obstetrician-gynecologist in Massachusetts generally pays between $75,000 and $100,000 …

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One doctor’s unnecessary procedure is another physician’s mortgage payment

“I make my living off unnecessary procedures.”

So will be the rallying cry of some doctors once the true impact of comparative effectiveness research (CER) is felt.

Proponents of CER have been very careful not to associate its evidence-based findings with the coverage decisions of Medicare and other health insurers.

But let’s face it, that eventually has to happen. I see CER as the initial baby …

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How will the economy affect hospitalist salaries?

It’s been said that hospitalists are the fastest growing specialist field in the history of medicine.

Hospitals are constantly recruiting, and the increasing demand is continually pushing salaries up. But, in the midst of the current recession, what does the future hold?

Writing in Today’s Hospitalist (via Dr. RW), Erik DeLue predicts that salaries are likely to plateau, or even fall. Most hospitals …

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Do doctors who use physician-only social networking sites expose themselves to malpractice risk?

One of the newer trends is doctors using social networking sites like Sermo and iMedExchange.

Likened to a “virtual doctor’s lounge,” physicians can ask questions and speak freely knowing their posts will not be seen by, or released to, the public.

Often times, questions about patient management are asked, and it’s nice to have a quick response to queries by a variety of specialists.

In this piece …

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How following hospital quality measures can kill patients

Here’s what happens when you give so much attention and influence to such a crude instrument.

Following quality measures can make or break a hospital’s reputation, especially if they are being widely advertised. Patients often make health care choices based on whether doctors following quality measures.

However, as these measures are currently constructed, they often ignore the nuance surrounding many cases.

Emergency physician WhiteCoat cites …

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What role should nurse practitioners play in primary care?

One proposed way to control costs is to replace primary care doctors with mid-level providers, like nurse practitioners and physician assistants.

Merely bringing up this idea brings out the worst in turf battles, with most discussions devolving into nurse versus doctor cat-fights.

The ACP comes up with their vision of how nurse practitioners fit within the primary care spectrum. It wisely takes a balanced approach, but, …

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Poll: Should doctors apologize after a medical error?

Despite the fact that almost 100,000 patients die from medical mistakes each year, only 30 percent of those errors are ever disclosed to patients. Saying “I’m sorry” is morally and ethically proper. It re-establishes trust and empathy between doctor and patient, and makes it easier for everyone involved to learn from the incident. Hospitals that have instituted full disclosure programs have seen a decrease in the number of …

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California’s balance billing ban, are hospitals about to give patients refunds?

The fallout from California’s balance billing ban is about to get much, much worse.

A patient is suing an emergency physician group for the $57 he spent last year on the balance bill he had to pay for services his insurance didn’t cover.

If successful, the results for already near-bankrupt hospitals are chilling, as “hospitals and ER doctors could be on the hook for hundreds of millions of …

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Walter Reed Army Medical Center to close, was lazy staff a factor in the decision?

Washington DC’s infamous Walter Reed Army Medical Center is set to close in 2010.

In an effort to subsidize the city’s subway system, the medical center purposely limited the number of parking spots, forcing staff to use public transportation.

Combined with the fact that buildings are subject to a height restriction in DC, the campus became increasingly sprawled as it expanded, forcing staff to walk longer distances.

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Are the days of the independent physician coming to an end?

I think so.

The NEJM has a perspective piece on the declining percentage of doctors who practice independently. Depending on the source, the number ranges from 29 to 61 percent.

It is becoming increasingly difficult for doctors not to be supported by a hospital or large integrated health system. With reimbursements declining, many doctors are opting for the relative security of a salary.

Furthermore, …

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Can we rely on IMGs to help with the primary care shortage?

Studies show that international medical graduates (IMGs) see a disproportionally high number of Medicaid patients when compared to their American counterparts.

Like most doctors, if they had a choice, the incentives are such that they too would choose to practice in cities rather than in rural areas.

Less-restrictive visa requirements are making it harder to recruit IMGs to rural areas, and compounded by the fact that American …

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How to drive a doctor out of primary care

A family physician chronicles his journey from an HMO to urgent care to practicing outside of the insurance system.

Steve Simmons notes that doctors out of residency rarely have any training in the business of medicine, including the all-important skill of coding.

“I needed to learn this’skill’ on the fly,” observes Dr. Simmons, “using a code book to translate each medical diagnosis into a five digit number, …

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