Primary Care

HMOs and Medicare have the wrong target

Instead of targeting PCPs as they have, they should be making big pharma a cost-cutting focus. What HMOs and Medicare have done is virtually destroy primary care in the US:

It remains a mystery why managed care and Medicare have centered their cost reduction efforts for so long on physicians, and particularly on the least well paid physicians, while apparently willingly paying out ever more for pharmaceuticals . …

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About 10 percent of doctors in Ontario are accepting new patients

Primary care is facing the same challenges and deterrents in Canada as well:

Dr. Brian Berger, who has a family practice in Richmond Hill, says many young doctors stay out of family medicine because it’s too time-consuming. He says young doctors have other priorities, like spending time with their families or pursuing other interests.

“More doctors want to do sort of part-time family practice. A lot of people may …

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Insurers are waiving copays for walk-in clinics

It’s all about the cost, forget the physician relationship:

FP Michael J. Morris of Willmar, MN, thinks the insurer’s approach to this issue works against its efforts (and those of other plans) to encourage primary care doctors to manage patients’ overall health. A nurse at a walk-in clinic, he says, isn’t likely to check patients’ cholesterol, make sure they’re up on their immunizations, and talk to them about their weight …

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Obvious news of the day: ERs are overwhelmed

Yes, ERs are in crisis. A favorite topic here. A major part of the problem can be traced to poor primary care access and “defensive medicine”. Let me elaborate:

1) Lack of access
Lack of primary care incentives for medical students and providers = dwindling primary care access = patients going to the ER for “routine” or non-emergent care = ER overcrowding = eventual collapse. Simple.
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This PCP crosses the line in his frustration

He’s doing all of this just to get more Lunesta for his patient? Ridiculous:

When Tufts Health Plan cut a patient’s prescription for the sleep aid Lunesta from 30 pills to 10 pills a month, her physician, Dr. Stephen A. Hoffmann, decided to circumvent state regulations by writing a second prescription in the name of her husband so she could get 10 more pills per month.

Hoffmann …

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Chris Rangel wonders about fast-food outpatient medicine

Welcome to primary care in the USA:

To use the same fast food analogy, imagine a situation where price was no longer an issue (because of insurance) and the hungry masses started demanding the best burgers in the world . . . . but they wanted to wait no longer than they did for the regular “McDonaldized” burger. The problem is that the amount of money that the restaurant gets …

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Foleys for convenience

Perhaps this speaks more for the nursing shortages in the country:

Nearly one in four older hospitalized patients received a urinary catheter without any medical reason for one, and these patients tended to be the ones who would need the most help going to the bathroom if left un-catheterized, said Seth Landefeld, M.D., of the San Francisco Veterans Affairs Medical Center here.

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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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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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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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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