Primary Care

California’s "doctor tax" is going to further drive students away from primary care

Reaction from a medical student after Schwarzenegger’s proposal of a doctor tax:

Even doctors in training are figuring out how the plan might affect them. Some physicians believe Schwarzenegger’s plan might drive doctors out of state, but University of Southern California medical student Julia Cormano says she would stay in California””but reconsider her choice of specialties. Cormano, co-president of the med school’s students’ association, says the talk on campus is …

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More PCPs shun the zoster vaccine

Looks great on paper, but good luck implementing it:

The zoster vaccine is terribly expensive and fragile, and it requires strict temperature control. Heaven help the practice that suffers a power outage. Patients will argue that Medicare or their prescription plan will cover the vaccine. When patients call their benefit plans, they will hear, “Sure, it’s covered! Just have your doctor call us for prior authorization!” Anyone who has traveled …

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"No more primary care . . . no more forms"

A physician is freed from the chains of primary care. And you wonder why medical students aren’t interested?

No more primary care. No more forms to fill out for workers comp, disability, SSI, student loan forgiveness, longer-term-care insurance coverage, FMLA, or temporary suspension of billing for credit card or mortgage or rental furniture payments owing to customer illness.

No more forms for nebulizers, commodes, handrails, oxygen, home health …

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Iraq vets will overwhelm the VA

Prior to Iraq, it was next to impossible to set up at primary care appointment. Imagine what will happen once the 750,000+ vets from Iraq and Afghanistan come in. (via The Health Care Blog)

The shingles vaccine: Not practice friendly

This internist has serious concerns about the vaccine for shingles:

Like it or not, my practice is a business with real expenses. At best, the cost of the vaccine will be covered but I will have to bear the initial outlay of $180 per dose. I still will also have invested significant staff time in storing, monitoring, and administering the vaccine, and doing the special paperwork.

At worst, I …

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Matthew Holt forecasts health care in 2007

Spot on with this one:

More sectarian strife among providers. The latest staving off of the Medicare Part B cuts papered over the cracks for a little while, but the difference between profitability among different specialties and different hospitals is becoming really politically visible. There’s no essential reason why diagnostic radiologists should earn four times the amount of primary care doctors, for example. At some point this discussion …

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Medical students opine on PAs

Some say physician assistants will eventually replace primary care physicians, as they are cheaper and almost act as autonomous providers. However, be aware that their training is 1/3 shorter. It is the minority of patients that present “outside the cookbook” that MDs are paid and trained to treat:

But as a physician, you’re going to be paid for your ability to handle the ten percent of cases …

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Pre-paid primary care

Concierge care for the masses. A look at an emerging primary care model:

These days, the soft-spoken, but formidable family physician is mixing it up in the role of healthcare reformer. Three years ago, Wood began advertising that his clinic would provide unlimited primary and urgent care for a monthly fee of $83 for an individual, $125 for a family. Wood immediately ran afoul of the state insurance commissioner, …

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Pay-as-you-go primary care

Some are capitalizing on the uninsured, a variation on the in-store urgent care clinics:

This year, a company called QuickHealth opened several clinics in Northern California “” some in pharmacies, one inside a Wal-Mart “” offering primary care on a pay-as-you-go, first-come-first-served basis seven days a week. For $39, a patient can have a 15-minute consultation with a licensed physician. A comprehensive physical is $59, while on-the-spot cholesterol tests, …

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Another EHR hurdle: Patients don’t care for them

Physicians are reluctant to adopt EHRs, now comes a study suggesting that patients don’t believe that they will improve healthcare:

“Our research shows that American consumers are not banging down any doors for an EHR or a PHR,” said James Fisher, national director for Health IT at PricewaterhouseCoopers. “The primary reason for the lack of public support is that the average American does not see a clear value proposition in …

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PCPs for physicians

Hypocritically, many physicians don’t have primary care docs. An ER doc talks about the difficulties for a physician to obtain one:

I think it’s hard for doctors to choose a personal physician. To be honest, there are not many physicians who I would trust enough to follow their recommendations over my own judgment. My standards are high. I’ve seen too many docs who just get by, floating with …

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The torcetrapib disaster: Blogosphere response

(Update 12/04 – This breaking news blog entry is moved to the top as the blogosphere continues to react.)

More on this HDL-raising drug’s stunning collapse. There’s talk Pfizer stock will drop to $20. I’m disappointed myself, since there is no reliable way to raise HDL, save for niacin and fibrates. I thought they were idiots not to test it alone, but only in conjunction with Lipitor. …

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A reader is pissed about the growing cosmetic medicine trend

She writes:

I’m disgusted. We train our best students to be doctors, and look what we get: a bunch of spoiled doctors squabbling over cosmetic surgery like kids over the last cookie.

Wake up! Some 16 percent of Americans don’t have health insurance, and numerous health disparities face our population. Working with underserved populations isn’t as glamorous as Botox, but it will do a lot more good.

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Patients feeling the primary care pinch

With poor primary care reimbursement from Medicare, this scenario was predictable. Vermont is now reaching out to high-schoolers to drum up primary care support:

Harrington said the only way to attract more doctors to primary care is to lighten the administrative load, increase Medicaid reimbursement rates and expand programs that help new doctors pay off medical school loans of up to $150,000.

Reardon says the Area Health Education …

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Solving the ER crisis?

Some are charging fees for non-emergent ER care. I expect, and encourage, this to be commonplace soon:

Federal and state laws ensure that anyone who comes to an emergency room for care is seen. But Bill Bell, general counsel for the Florida Hospital Association, said that doesn’t mean they all have to be treated there.

“If there is no emergency after screening, the law is no longer applicable,” …

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