Primary Care

Family medicine is on life support

A family medicine director is scared for the future:

Medicine is again overspecializing, fueled by a market-driven health-care system that promotes the expansion of procedural medicine and specialty practices that create large profit margins. Primary-care physicians are increasingly employed by health-care corporations that judge and pay them mainly on the basis of productivity. Our reimbursement system is not designed to reward spending time with patients to counsel, educate and to …

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Doctors suing doctors over a turf war e-mail

This exposes the turf wars that are present in every hospital:

According to the suit filed in the Philadelphia Court of Common Pleas, Feldman’s e-mail stated:

“I have been informed now on multiple occasions by our house staff at Methodist, as well as by one of our cardiology fellows who moonlights there, that the ED attendings (at the instigation of the ED director) are urging and pushing …

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The Starbucks model for urgent and primary care

NYT on in-store health clinics. Since they will be on the front-line with limited resources (i.e. no lab, no x-ray, staffed by mid-level practitioners), I would like to see how they do after a few well-publicized malpractice cases.

Once again, primary care leaders are out of touch

I harped on this before, now another physician feels the same way:

As a practicing general internist, I feel like an endangered species.

I am in my mid-50s, and planning my retirement. I have watched many of my colleagues leave the practice of general internal medicine, and I have seen few younger colleagues replace them.

There are many factors that cause general internists to leave the practice, …

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British Columbia gets it

If you want more people to go into primary care, you have to increase salary. Nothing is a stronger incentive for medical students.

Dr. Crippen probably won’t be happy about this:

Nurse practitioners are gaining broader acceptance by health insurers and medical regulators. In Iowa, Oregon and a dozen other states, nurse practitioners can operate without doctors’ collaboration or supervision. Most states allow the nurses to prescribe the vast majority of drugs, with the exception of controlled substances such as narcotics.

Medicare, the U.S. insurance program for the elderly and …

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The future of primary care? Dr. Crippen takes aim at mid-level providers:

Medical judgment is acquired gradually over a long period of time. A bedrock of two to three years scientific training, supplemented by three years clinical experience, followed by many more years of medical apprenticeship before you become an independent doctor working as a GP or consultant.

This process of acquiring medical judgment is also known as …

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Liability is driving out board-certified ER docs, allowing internal medicine physicians to benefit:

Ironically, he credits the state’s years of high malpractice insurance premiums and fears of litigation with driving out the competition: board-certified emergency medicine physicians who, although they may live in Pennsylvania, commute across the river to work in New Jersey.

“As an ER doctor, I can make more money than I can as a hospitalist, more …

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Cardiologists are excited about high-dose Crestor. Primary care physicians are more cautious. Does anyone know if Christopher Cannon gets contributions from AstraZeneca?

Is the stethoscope becoming a useless prop of doctorhood? You betcha:

As physicians rely on more accurate and expensive tests of cardiac function, including echocardiography, the art of listening to the heart has fallen on hard times. In recent years, a spate of studies has shown that as few as 20 percent of new doctors and 40 percent of practicing primary-care doctors can discern the difference between a healthy …

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Medpundit preaches to the choir on primary care:

The trick is to get family medicine (and pediatrics and general internal medicine) to be as attractive as specialty medicine and rural and poor urban areas to be as attractive as suburbia. One way would be to pay primary care doctors better. (Like that’s going to happen.) Or the field more “glamorous.” (Even less likely.) Specialty fields are attractive not just …

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Some say mid-level providers, like NPs and PAs will be taking over primary care in the future. Not so fast:

Board documents describe Caggiano’s treatment of four patients, including a child who came to the clinic in July 2004 with a high fever. The board said Caggiano, 40, ordered blood work, X-rays and antibiotics for the child. On a second visit, her parents asked for test results and were …

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Sounds like those truth ads may be working:

A survey of successful former smokers suggests that anti-tobacco spots on TV were instrumental in helping them break the habit.

That finding was reported in the American Journal of Preventive Medicine. The former smokers, all from Massachusetts, said that TV ads were a significant help as they struggled to stay smoke free for more than six months.

ER overuse – “the crisis is near”:

The number of Central Florida hospital beds, meanwhile, has grown just 13.7 percent during that time, from 4,278 in 2000 to 4,865 last year. And even if there are empty hospital beds, there are not enough nurses and doctors to treat patients in those beds.

The issue is compounded further by the state’s medical malpractice insurance crisis, which has resulted in fewer …

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What happens when there’s no primary care? You get bounce-backs and “yo-yo” admissions:

Researchers said repeat admissions from these people were costing the NHS £2.3bn a year and the situation was set to get worse as the population aged in the next few decades.

The NY Times wants to declare war . . . on diabetes:

Care as basic as regular visits to a nutritionist are not typically covered by insurance. Reimbursement is easier when the disease is far along, and the patient needs dialysis or amputation of toes or limbs.

Until primary care and prevention is appropriately reimbursed, expect nothing to change.

This frustrated doctor wants to get back at the system:

As a primary care physician, I’ve found that the most therapeutic way to combat the horrendous medical climate we practice under is to do your best to bankrupt it. Over the past few years, I’ve probably quadrupled my ordering of diagnostic testing (up to the point of patient safety) not only to CYA, but also to help financially melt the …

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JAMA reports that low-fat diets disappoint for cancer and heart disease:

Despite the long-held hope that a diet low in fat and high in fruits and grains could reduce the risk of these ailments, no benefit was found, according to results from the Women’s Health Initiative Randomized Controlled Dietary Modification Trial.

However, Medpundit and retired doc have their doubts about the findings.

A man names his racehorse after his primary care physician. That’s pretty cool.

Dr. Charles writes on the importance of primary care:

I chose to become a family doctor for many reasons, but foremost among these was the fact that I believed in the specialty. The family doctors I learned from knew their patients not simply as anonymous diseases and puzzles from which to profit, but rather as spirited and poetically unique individuals with whom building a continuous doctor-patient relationship would provide the …

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