And so it goes . . .

Maryland is confronting a growing, statewide shortage of practicing primary care and subspecialty physicians, a trend that could lead to much longer waiting times in physician offices while increasing emergency room visits for minor afflictions and ailments.
The solution of "increasing the number of residency slots" isn't going to work. Primary care residencies don't fill anyways. The key is incentivising medical ...

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Reforming the physician reimbursement system is a recurring theme here, as the perverse incentives of a fee-for-service system is a primary driver of health care costs.

Any talk about comparing US physician salaries with those abroad has to be accompanied by the context of the larger medical school debt and malpractice insurance that American physicians face.

So, would you accept lower physician salaries in exchange for a fully ...

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In a "pioneering" effort to solve the reimbursement issue, a major Massachusetts health insurer proposes the following:

Blue Cross and Blue Shield of Massachusetts wants to stop paying doctors and hospitals for each patient visit or treatment, a common arrangement that most experts agree has led to unnecessary, inefficient, and fragmented care that is sometimes harmful to patients.

Instead, they want to pay doctors and hospitals a flat ...

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See what is happening as more specialists are taking on primary care responsibilities:

"Would you be my primary care doctor?"

Specialists are hearing this more and more as the primary care shortage intensifies. Especially if we have to see them more than once for ongoing medical concerns like a pacemaker, defibrillator, heart failure or more recently, diabetes. It's becoming increasingly challenging for patients to obtain appointments with ...

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Why yes, it's primary care physicians. Can't catch a break:

In the physician community, the AMT is most likely to affect those at the lower end of the physician income range, said Joseph Nicola, tax manager specializing in the health care field for Sisterson & Co. LLP in Pittsburgh. Specialists typically are not affected by the AMT because they are in higher tax brackets and owe more under the ...

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Occasionally, I'll publish some of the reader mail I receive. Here's one from a former PCP in California. Fed up with the downward spiral of primary care, he chose to leave primary care altogether. I assure you he's not alone:

"I am an Internist for over 20 years, and I recently closed my primary care practice as I cannot make a living at it. I ...

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Their interpretation of the recent ER wait study:

The researchers attribute the longer waits primarily to an increase in the number of emergency room visits coupled with the closure of many emergency rooms. Both factors are driven by the lack of universal health coverage. Uninsured patients "” and those who have no primary care doctor "” flock to emergency rooms for routine coverage, clogging the system. Meanwhile, hospitals lose ...

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Are retail clinics inevitable? Perhaps. Primary care is already in a fight for survival, and they'd best be ready to compete with these clinics. My advice? Preemption. In areas where there are no retail clinics, open up your own first.

Cash-only primary care

An innovative option in RI, where PCPs are experimenting with scaled-down retainer practices:

In this program, she pays $30 a month for a "membership" in her primary care doctor's practice, essentially keeping him on retainer. That means that even without insurance, she can get frontline medical help whenever she needs it, paying just $10 for each office visit.

Today’s "Long ER Wait" article

Brought to you by the WSJ:

ER times dragged out 36% longer between 1997 and 2004, according to a Health Affairs study by a gaggle of Harvard docs out today. Researchers say there's every reason to think the trend has worsened, thanks to the closing of some ERs and increased volume at the rest, the WSJ reports.
Like most of today's health care problems, a lack of primary care ...

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