Primary Care
In another recent Medical Economics article, they discuss the issue of primary care shortages over the next several years.
[Where's primary care headed? - It's at a crossroads, and its future may depend on forces beyond physicians' control. - Medical Economics]
Some of the important points mentioned in the article are as follows:
Major changes in our current system need to be made to ensure adequate primary care physicians
[Where's primary care headed? - It's at a crossroads, and its future may depend on forces beyond physicians' control. - Medical Economics]
Some of the important points mentioned in the article are as follows:
Nearly 30 percent of current primary care physicians are 55 and older and will retire in 5-10 years
More women are likely to go into primary care, but tend to work shorter hours and retire earlier
More than half of US medical school graduates now plan to do something other than practice medicine
The Council on Graduate Medical Education recently forecast that the US would require 85,000 more physicians by 2020. Another government report projected a need for 33 percent more doctors—and 28 percent more generalists—in 2020 than in 2000
The output of general internists dropped 35 percent from 2000 to 2003, and there's every indication that that decline is continuing.
Major changes in our current system need to be made to ensure adequate primary care physicians
posted by Anonymous at 5:54 AM
16 Comments:
eescuYou state these problems will cause disparity in the poor and uninsured. What about doctors that won't even take insured patients.(Unless the patient pays out of thier pocket)even though the insured is paying? That is disparity on the patients part. A FORMER patient of PA!!!!!!
Medical offices have to meet expenses and have to make tough decisons to survive. Dropping certain insurance companies is the only bargaining chip we have with these huge third party payors.
Continually accepting rates below Medicare levels will cause even more physicians to have to close their offices completely. This would create even more disparity.
This is a business. Patients have to understand that we cannot continue providing services while not meeting the costs of those services.
The cold reality is that we can't afford medicine as it is provided today. The following are portions of a AP news story out today:
"Workers won't find much comfort in the smallest increase in health insurance premiums since 1999. The 7.7 percent increase this year was still more than twice the rate of inflation."..."Since 2000, health insurance premiums have gone up 78 percent; wages 20 percent."..."The rising cost of health insurance is one reason that employers are finding it an increasingly difficult benefit to give their workers. Since 2000, the percentage of firms offering health benefits has fallen to 61 percent from 69 percent."..."Overall, the total cost of health insurance for individuals now averages $4,242 a year. For families, the costs average a whopping $11,480."
The current model is not going to work any longer. Medical practices are either going to have to undergo huge consolidations to control costs (including doctors' salaries) or medical insurance benefits will continue to be abandoned (like expensive pensions) by more and more companies. You may not like the level of reimbursement, but companies can't afford higher premiums and taxpayers can't keep spending more on Medicare and Medicaid. It won't be pretty, but economics will sort this all out eventually.
I find it strange when Pa dropped United Health because of so called low payments I recieved a list of many physicians that would gladly accept UH after Pa dropped them. If your office is having a hard time surviving now, keep dropping insurance networks and see what happens. It is hard to imagine physicians can meet thier costs with the fees they charge. A former patient of PA!!!!!!!
I find it hard to understand what the Primary Care Physcian's role is in a persons healthcare. Maybe the overhaul should be in the way Physicians conduct business. Now days if a person has something wrong, they go to their primary care Doctor, who listens and then in most cases refers them to another Doctor, who in turn listens and in some cases refers them to someone else. It seems that in todays Medical World, noone wants to really be responsible for a person's healthcare. There used to be a time when your Doctor was the one responsible for any decisions for your well-being. Now it seems that the more Doctors involved, the less chance of liability being
charged in case anything goes wrong. Its time that "Specialists"
see Patients without a "referral"
and cut out the "Middleman" (Primary Care Doctors). Times have changed and people are more educated and Primary Care Physicians may not be as necessary as they once were. People are smart enought to know when they have a sore throat or earache, to go to an ENT Physician, and do not need a Primary Care Doctor to do so. The sad part is most Specialist are dependant on a Primary Care Doctors recommendation. The Medical Profession needs to take a look at their practices before condemning Insurance Co. and others.
A specialist is just that -a specialist.
A man goes to an orthopod and says that his ankles are weak and he keeps falling down stairs. Many $'s spent on tests--nothing.
A good primary care physician would have known the answer--the man drinks too much!
I am not sure how many patients would really be able to figure out which specialist they need to see, but I can think of several ways to improve efficiency. Primary care docs see a lot of the same thing every day. Instead of having established and well known patients make an appointment and drive to the office for common ailments, why not create an internet website with a questionnaire that would lead to an accurate diagnosis in a high percentage of cases? Patient data on file in the computer could already have insurance info along with the name and location of the pharmacy used by the patient. Follow up questions could be handled by the doctor using email with a menu of pre-packaged responses. Once used to the system, a doctor could probably increase his/her efficiency by four or five times what could be done face-to-face. That might work for, I don't know, maybe 50% or more of the cases seen by a primary care doc. The computer could eliminate the Q&A and "small talk" portion of a patient's appointment without wasting the doc's or an assistant's time. How about greater use of the phone than is currently done? How about clustering multiple specialists in a single practice to eliminate some of the ping-ponging that goes on with patients bouncing between doctors? How about large practices having doctors available online or in person seven days a week, maybe even 24 hours a day. That would make more efficient use of overhead costs.
A lot of "old school" docs fight automation and are highly independent in their attitudes--kind of like family farmers who are losing out to large corporate farm operations. HB says reimbursements don't always cover expenses. But those expenses include office space and equipment that is idle most hours of the day and almost always on weekends. McDonalds figured out how to make more money by adding breakfast food at a relatively low incremental cost using existing facilities more effectively.
I'm not sure that economics will sort this out; HB tells us nearly daily that healthcare is not like other markets -- and he might be right.
http://www.pupress.princeton.edu/
chapters/s6918.html
WebMd is great, but what happens when you have a serious problem? You will not have a relationship with a Doctor because you have diagnosed and treated yourself on the internet for small issues.
The internet can be a great resource, but I believe we need to be careful because it can hurt as much as it can help. I personally would rather go see my Dr and get his opinion than some random website/Dr that knows and cares nothing about me.
I am fortunate enough to have a Specialist that diagnosed my condition after 1 office visit, and after a follow-up visit 3 months later, he followed my progress via e-mails and the internet. He even corresponded with me while on vaction. I have been seeing him now for 3 years and only have to personally go into the office once a year. If a problem developes, all I have to do is send an e-mail and he answers most times within the hour. At the same time my "Primary Doctor" will not even send me a prescription for an earache or sore throat. If any new prescriptions are written, you have to be seen in the office, which results in a delay of at least 3 or more days and the usual office call charge of $75.00 or more. I'm sure that many Doctors could be more efficient in their services, but either want the added income or just afraid of the liability if someone had a problem with their services, but it tends to irk me to go to a Doctors office for a sore throat and he tells me to get something over the counter, which results in a $75.+ office call. Maybe that is why people hesitate to see Doctors, because believe me, it happens more times than you might think. If any Doctor has you for a patient, they should be well aware of your past ailments and at least refer to your chart and see that you have been treated for a condition and at least prescribe a medication that you have taken before, without seeing you in the office. My thoughts are, they either don't want to take the time OR they just want the $ that the office visit is going to generate.
Anonymous 3:14,
I understand it is frustrating having to take time out to see a Dr, we all have busy schedules. I am sure many doctors have been burned by just calling in a prescription for an earache or sore throat. I don't believe the doctor is asking you to come in so he can get paid. It is probably not in your best interest to get an antibiotic called in every time you don't feel well. If you question your doctor's intentions ask why you have to come in. I think you would find it has to do with more than money.
Medrep,
Yes, WebMd may help the physician it may also hurt if someone has already diagnosed themselves with the wrong disease and doesn't listen to the doctor. Also, I think it is more important to have a relationship with a Dr than to save on an office visit. People tend to think Dr's are paid too much, but I think we need to take care of them or the good ones won't be around. I am not saying we need to go to the Dr for every little thing, but I want to know and trust the Doctor when I need one. It has to go both ways.
Risks come with the territory. I
can not believe that Doctors are any different than anyone else. If everyone had that attitude, the world would soon come to a standstill. There would be no planes in the sky, no food being produced and the list could go on and on. Doctors are providing a service the same as anyone else that provides a service. If a person performs his duties, to the best of his abilities, they should not worry about the repercussions if something goes wrong. It is only when someone makes a mistake that they are held accountable. I don't believe that anyone is wrongfully charged unless there was evidence that there was wrongdoing on his/her part. By the way I wonder how an airline pilot's
salary compares with a Physician's
salary?
Runaway Doc like I said the risks come with the territory. I would venture to say if you are worried that you may be sued each time that you make a diagnoses, you are not very happy or confident in your work. In time this will soon take a toll on your own well-being. If you read some of these messages again, noone suggested that a Doctor diagnose anything over the phone. It was stated that a person that has had a medical condition BEFORE is smart enough to know if it is occurring again. No intelligent person is going to self-diagnose an ailment, but on the flip side someone that has had an ailment has sense enough to recognize the recurring symptoms. It all comes down to TRUST between a patient and their Physician. It seems that you trust noone, as you stated that I would "call a lawyer". Well, let me be the 1st. to tell you I have had several chances to call a lawyer and even had a Physcian willing to back me up. Did I? No, because I realized that the error made by my Doctor was no different than any other service that I received that did not work out to my satisfaction. Also I had sense enough to realize that my Doctor was a human being, just as I was and noone is perfect.
I did use my prerogative to find another Doctor. So don't lump me in with your low esteem of the general public, which likely includes many of your own patients.
Anonymous 5:18,
I am going to take Runaway Doc's side on this one. It has nothing to do with confidence or being happy in the work of a Doc. It has everything to do with people and there unwillingness to take responsibilities for their actions. People now days are always ready to get something for nothing and blame others. The medical field has changed.
I work in a Veterinary practice and it has changed too. A person can let their dog out without a leash and get hit by a car. They will bring it in to a Vet clinic a day later and if the dog dies it is the Vets fault.
Like I said people want something for nothing and it is always someone else's fault.
I will have to disagree with the last anonymous, its wrong to make a statement that people want something for nothing. When you say people that assumes everyone has that attitude. I for one resent being labeled with the group of people that fall into that category. I would have agreed wholeheartly if you had said SOME people. I and many like me pay for any services rendered and take responsibllity for any actions that are under our control. I would never shift the blame elsewhere. Not all people play the Blame Game, just as all Physcians do not think first about the risk factor in their daily work.
I am sorry, you are correct I should have said SOME people. I assumed that was known because I would have been talking about myself too. (We all know what assuming does:)) I do have to think we are in the minority with the taking responsibility for our own actions.
My point earlier was that some doctors policies are not because of money, incompetence, or confidence reasons, but because society is changing. You have to be sensible or you will get burned.
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