Wednesday § February 24, 2010
What could possibly be worse for patients as the current state of reform (tune in tomorrow) is more uncertain than ever? According to a JAMA study [PDF], the fact that more physicians are cutting hours — not just primary care docs, but most physician demos across most specialties. Reasons are myriad, but the one essential kernel remains: the increasing layer of oversight (administrative and managed care constraints) has slowly but steadily gained a prominent foothold into how much time a physician can actually devote to seeing patients. According to one family physician
“It added five or six years onto my practice life – and I love what I do,” [Virginia family physician] Dr. Ellington said. “I couldn’t have continued to do what I was doing. I couldn’t do it physically, emotionally and financially. It had become overwhelming.”
And it will only get worse — at the very least for the primary care physician who is already burdened with heavier admin and paperwork hassles, lower pay, increasing patient loads, and lower Medicare reimbursement schedules. | LINK
Friday § December 18, 2009
The pending shortage of physicians projected has been preached about for so long it seems as though the healthcare thought leaders and policy watchers must be wearing sandwich signs direct from their ivory podia as they make their pronouncements. This is not to deny that the country is in the midst of a looming physician shortage — something that is not to be helped by the rapid graying of America.[] The most convenient answers have centered around the simple increases in medical school class size and increasing the range of residency opportunities. Ambitious as these solutions seem, the problem of physician depletion and workforce shrinkage is much too complex to simply ascribe repletion as a mechanism for change.
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Wednesday § November 11, 2009
The battle to preserve both quality healthcare delivery and access to that care is the cornerstone of health reform. Amid all the bluster surrounding the reform debate, sometimes the solution is greatly obfuscated by the trees which populate the proverbial forest. One physician here in the Twin Cities is nabbing some front page attention as he attempts to reform health care delivery on his terms — one patient at a time.
In art terms, you might say [Dr. Sam] Willis leans toward minimalism — as in minimizing health care costs for his patients, and simplifying their dealings with the byzantine medical system. Rather than ask for proof of insurance, he offers monthly memberships priced at $60, much lower than the average comprehensive paid-through-employer insurance benefits.
The shift toward concierge care may be nothing new, but this young physician’s intrepid attitude — in a healthcare marketplace where primary care’s feast overrides famine with all of the help major staff model provider groups and health systems can generate — is extremely refreshing. I hope he’s even more successful in a year. | LINK
Don’t believe all of the hype about the “challenges” and “tribulations” and “massive bureaucratic paperwork”. While each of these irritating aspects of medical practice among primary care physicians is a well documented reason behind the antipathy and low morale suffered by so many in the specialty, its true loathing by soon-to-be-graduating med students all comes down to one thing, and only one thing: the lack of decent compensation.
More pay in a particular specialty tends to mean more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a … study. Family medicine had the lowest average salary last year, $186,000, and the lowest share of residency slots filled by U.S. students, 42 percent. Orthopedic surgery paid $436,000, and 94 percent of residency slots were filled by U.S students. Meanwhile, medical school is getting more expensive. The average graduate last year had $140,000 in student debt, up nearly 8 percent from the previous year, according to the Association of American Medical Colleges.
But is primary care membership a dying breed, as this foxnews.com article suggests? At this point, it seems to be the one aspect of medicine which will attract, at least in the near term, people who really want to make a difference. And the value on that is both priceless and indescribable.
Senior docs, primary care desperately needs you! In an era in which many training programs in primary care specialties (family medicine, pediatrics, internal medicine) seem to be filling up with more foreign medial graduates, an increasing number of the “old guard” are taking responsibility for keeping the legions of non-foreign physicians in the fold — all the while, the newly-minted grads seem to be heading toward specialty care.
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Monday § January 26, 2009
The attention this country, health systems, third parties, and the current presidential administration should be focusing on primary care is happening – in Africa. A nursing professor at the University of Wisconsin-Milwaukee who grew up in Liberia, recently published a book focused on improving health care delivery in war-torn African countries. He based the title of his work on what he sees as the best hope for health care improvement in Africa – the resilience of African peoples in the face of horrendous violence and painful loss. He sees the ideals of prevention and a strong primary care ethic as the path for the much needed improvement in delivery. Empowering Resilience: Improving Health Care Delivery in War-Impacted African Countries describes his plans as they apply to his Liberian homeland, but those descriptions could apply to all corners of the world’s second largest continent. | LINK
What should I do as a physician rounding on one of my many patients on my nursing home service with dementia, complicated by the fact that they are also are suffering from some of its effects on mood? While institutionalized skilled care remains the standard for these patients who are not able to care for themselves, the agitation and delusional thinking suffered by many patients with dementia syndromes puts a new wrinkle on the next level of care — other drugs which carry a certain risk of mortality.
Anti-psychotic drugs commonly used to treat Alzheimer’s disease may double a patient’s chance of dying within a few years, suggests a new study that adds to concerns already known about such medications. [...] Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer’s disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos. Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia
In this country, the risk associated with both the newer and older agents essentially requires physicians to frankly discuss risks and benefits with the patient’s family, principal decision makers, and other stakeholders in their care prior to using. For some, the use of these medications (which primarily are used in the mentally ill) represent the only option in dementia with extreme mood and behavioral instability. For others, options are myriad and should be sought. | LINK
The ongoing debate around healthcare reform often centers around what is best for the patient as consumer of healthcare. Sure, doctors are often brought into the mix, but are usually relegated to matters of the periphery — portrayed as forced to capitulate to the strong arm of the insurance companies and government payers. Well, in a way, that is partially true. The level of reimbursement from those physicians who see patients covered by Medicare, for example, can make up a significant amount of a primary care physician’s revenue. And, that is where the debate on healthcare reform should steer next, according to those it directly impacts on the front line — the primary care physicians. Bordering on seeming apocalypse, many primary care providers are presaging the death of the specialty — unless something is done to save it. | LINK
