Primary Care

Texas, liability caps, and the influx of physicians

Maybe Florida can learn something:

Texas today is licensing an average of 400 more doctors per year than before reform. The Texas Medical Board expects a record 4,100 new applications for physician licenses this year — 38 percent more than last year, which was the previous record!

The number of medical specialists is growing rapidly. Since reform, Texas has gained 146 obstetricians, 127 orthopaedic surgeons and …

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The allure of dermatology . . .

. . . or why medical students shun primary care:

While a family practice doctor often works long days and endures crammed waiting rooms for $155,000 a year, dermatologists average $197,000 — and many don’t work even five days a week.

Dermatologists, who treat diseases of the skin, hair and nails, also tend to draw more insured patients who can afford to pay for their care. As a result, …

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Dr. Charles on family physicians

More challenges facing primary care. Why do I get the feeling this is just protesting on the Titanic?

The average Medicare patient sees seven physicians over a 2-year period

This includes two primary care and five specialists. This sort of fragmented age presents another barrier for P4P, and is reflective of the bloat plaguing American health care.

A shortage of PCPs

Family medicine applications plummet while the need continues to rise. Readers of this blog know why.

Primary care will soon be taken over by foreign-trained physicians

Yes, it’s because of the money:

As more U.S. doctors opt for better-paying specialties such as cardiology and orthopedics, residency programs for family physicians here are increasingly drawing doctors from abroad.

This year, 28 of the 78 first-year residents in family practice programs in Minnesota came from foreign medical schools. At Hennepin County Medical Center, eight of 10 places were filled by foreign graduates. At the University of Minnesota’s …

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A doctor commits suicide for "caring too much"

He let the job get to him:

A doctor cared so much for his patients he took his own life when he feared he had let down an elderly woman in his care . . .

. . . The father of two, who worked at the Priorslegh Medical Centre, was investigated by the Eastern Cheshire Primary Care Trust after an accusation against him. The complaint was not upheld.

The primary care crisis hits home

Concord, NH – about 30 miles from Nashua – is feeling the primary care crisis up close. Some straight talk from this local editorial:

A study of physician recruitment offers by a national health care search firm goes a long way to explaining the primary care shortage. Family practice doctors were offered an average of $145,000 per year, cardiologists $342,000, radiologists $351,000 and orthopedic surgeons $370,000. Doctors several hundred …

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This is what happens when physicians are avoiding primary care

And it’s only going to get worse.

"Lost chance of survival": Guaranteed to increase defensive medicine?

A new trend is occurring, taking “failure to diagnose” to extreme measures. A warning to primary-care physicians everywhere:

The growing acceptance of the lost chance doctrine represents a real threat to primary care physicians, who are often the first line of defense in diagnosing potentially serious conditions. But it also provides an alternative means of compensation for malpractice plaintiffs whose cancer or other conditions should have been diagnosed earlier …

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NEJM on primary care

A must-read article on the challenges facing primary care today:

No serious proposals to narrow the income gap between primary care physicians and specialists are on the national agenda. Fee-for-service payment rewards quantity rather than quality, fostering the rushed visits that underlie primary care’s shortcomings. Pay-for-performance programs appear to be insufficient to make a substantial difference; physicians could increase their income more -— with less additional work -— by …

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Medicine is simply a revenue-driven business

Many offices are starting to charge for administrative requests in this time of declining reimbursement. Hey, that’s what you get in a fee-for-service system:

Doctors – particularly primary care doctors – are increasingly billing for services that patients have long expected to get gratis: prescription refills, photocopies of medical records, phone consultations, family medical leave forms, medical disability forms, waivers of insurance premiums, waivers for handicapped plates.

Automotive …

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Pay primary care by the hour

The physician/author, Robin Cook, explores this idea in the NY Times:

As it is now, insurance companies “” following Medicare’s lead “” pay primary care doctors according to the number of patients they see. Each patient visit is generally reimbursed at a flat rate of slightly more than $50. The payment is the same whether the patient is a healthy, young person with a runny nose or an elderly …

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A union is angry that colon cancer screening is withheld for the elderly

They are up in arms about this leaked memo:

Richard Thomason, the policy director for SEIU United Healthcare Workers West, which is based in Oakland, said a leaked memo indicates that the physicians group, which is based in Walnut Creek, may be in violation of state and federal laws and regulations and of its own stated policies.

Thomason said the memo, which is dated March 6, 2006, says “primary …

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Classic post: More people are using walk-in clinics for primary care

May 2005 – One of many posts lamenting what the death of primary care means:

No one wants to wait two weeks to see a doctor. In fact, no one wants to wait an hour in my waiting room. People are much more concerned about getting things done on demand, and they have difficulty finding a primary care doctor who will see them promptly.

Classic post: The future of primary care – the ACP responds

March 2005 – Some frank talk with the ACP on the future of primary care:

Small steps indeed, but we still have a long ways to go. It is encouraging that the ACP is listening, and our continued vigilance in providing real-life feedback to our leaders will be essential in primary care’s future.

Classic post: Spectrum of waiting

May 2005 – What kind of physician do you want, one who runs on time, or one who spends the time? You can’t have both:

A typical visit to a primary care physician’s office is allotted 15 minutes. Each physician session lasts 4 hours. Think about that. If the doctor merely spends 5 “extra” minutes with each patient, the last patient of the session will be over 1 …

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News flash: Many ER visits are not emergencies

Better primary care could have prevented almost half of ER visits:

Nearly half of emergency room visits in New Jersey by people who were not sick enough to be admitted to the hospital might have been avoided with primary care, a Rutgers researcher said Wednesday.

Derek DeLia of the Rutgers Center for State Health Policy also found that 31 percent of hospital admissions made through the emergency department were …

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Expect more of this in the future

A primary care practice goes bankrupt in Miami but its affiliated concierge practice remains open:

Even though the university expected Merino’s office to lose $50,000 to $80,000 a year, in the past 12 months it was almost $250,000 in the red, said Jerry Broderick, assistant chairman of the university’s department of medicine.

“The loss was far greater than what we’d planned for,” Broderick said. “Professional fees and patient revenues …

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Arguing against hospitalists

This writer wants life to go back to the old (pre-hospitalist) days:

Somewhat reduced length of hospital stays and lower costs are touted by the hospital and health insurance industries–but hospitalists with subspecialties actually raise costs, and I am aware of no studies of overall costs or number of readmissions after the initial hospital stay.

In-house hospitalist programs do not typically pay their own way, and we needn’t …

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