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Primary care about to collapse, physicians warn
Yahoo! News ^ | 1/30/06 | Maggie Fox

Posted on 01/30/2006 12:56:31 PM PST by libertarianPA

WASHINGTON (Reuters) - Primary care -- the basic medical care that people get when they visit their doctors for routine physicals and minor problems -- could fall apart in the United States without immediate reforms, the American College of Physicians said on Monday.

"Primary care is on the verge of collapse," said the organization, a professional group which certifies internists, in a statement. "Very few young physicians are going into primary care and those already in practice are under such stress that they are looking for an exit strategy."

Dropping incomes coupled with difficulties in juggling patients, soaring bills and policies from insurers that encourage rushed office visits all mean that more primary care doctors are retiring than are graduating from medical school, the ACP said in its report.

The group has proposed a solution -- calling on federal policymakers to approve new ways of paying doctors that would put primary care doctors in charge of organizing a patient's care and giving patients more responsibility for monitoring their own health and scheduling regular visits.

U.S. doctors have long complained that reimbursement policies of both Medicare and private insurers reward a "just-in-time" approach, instead of preventive care that would save money and keep patients healthier.

"Medicare will pay tens of thousands of dollars ... for a limb amputation on a diabetic patient, but virtually nothing to the primary care physician for keeping the patient's diabetes under control," said Bob Doherty, senior vice president for the

ACP.

The ACP plan called for innovations such as using e-mail to consult on minor and routine matters, freeing up expensive office visit time for when it is needed. Doctors would be compensated for an e-mail consultation.

The proposals include incentives for doctors to work more efficiently and to provide better care, ACP President Dr. C. Anderson Hedberg told a news conference. "ACP proposals would provide patients with access to care that is coordinated by their own personal physician," Hedberg said.

YOUNG DOCTORS AVOIDING PRIMARY CARE

The ACP cited an American Medical Association survey that found 35 percent of all physicians nationwide are over the age of 55 and will soon retire.

In 2003, only 27 percent of third year internal medicine residents actually planned to practice internal medicine, the group said, with others planning to go into more lucrative specialty jobs.

"Primary care physicians -- the bedrock of medical care for today and the future -- are at the bottom of the list of all medical specialties in median income compensation," the ACP said.

The group, which represents 119,000 doctors and medical students in general internal medicine and subspecialties, joins others that warn the U.S. health care system is untenable.

"If these reforms do not take place, within a few years there will not be enough primary care physicians to take care of an aging population with increasing incidences of chronic diseases," said Dr. Vineet Arora, chair of the College's Council of Associates.

Dr. Sara Walker, a Missouri physician, said she believed doctors were leaving general practice because of drops in Medicare reimbursement to doctors.

"A drop in Medicare payments will not only force me to stop taking Medicare patients but could force me out of business," agreed Dr. Kevin Lutz, a solo practitioner in Denver.


TOPICS: Business/Economy; Government; Miscellaneous
KEYWORDS: acp; doctors; doctorshortage; primarycare
The group has proposed a solution -- calling on federal policymakers to approve new ways of paying doctors that would put primary care doctors in charge of organizing a patient's care and giving patients more responsibility for monitoring their own health and scheduling regular visits.

I'm not a health care expert, but I know enough to know that MORE government intervention is not the answer. If anything, these doctors should tell government get out right now and let the health care industry become more competitive and more attractive to these young doctors.

If there's one thing I want the state governments to do is to initiate tort reform. But that's it!
1 posted on 01/30/2006 12:56:34 PM PST by libertarianPA
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To: libertarianPA

Too late. It has already failed.


2 posted on 01/30/2006 12:57:47 PM PST by mtbopfuyn (Legality does not dictate morality... Lavin)
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To: libertarianPA

Why would these stupid doctors want more government interference in their work? What could they possibly gain other than increased ways to defraud the patient and the feds?


3 posted on 01/30/2006 12:58:45 PM PST by caver (Yes, I did crawl out of a hole in the ground.)
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To: libertarianPA
U.S. doctors have long complained that reimbursement policies of both Medicare and private insurers reward a "just-in-time" approach, instead of preventive care that would save money and keep patients healthier.

Doctors say, "Just don't get sick!"

4 posted on 01/30/2006 1:01:07 PM PST by Lunatic Fringe (North Texas Solutions http://ntxsolutions.com)
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To: mtbopfuyn

It's only a matter of time before the government starts to determine which doctors can go into special practice and which must go into primary care.

Right now, what's the incentive to go into primary care when your fees are pre-determined by medicare and the government regulates insurers to the point where they must deny any claim for procedures or therapies that aren't guaranteed solutions?


5 posted on 01/30/2006 1:09:51 PM PST by libertarianPA (http://www.amarxica.com)
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To: caver
What could they possibly gain other than increased ways to defraud the patient and the feds?

Bingo!

6 posted on 01/30/2006 1:10:29 PM PST by Shalom Israel (Pray for the peace of Jerusalem.)
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To: libertarianPA
The only purpose of primary care physicians is to provide lawsuit targets for trial lawyers.
7 posted on 01/30/2006 1:11:14 PM PST by E. Pluribus Unum (Islam Factoid:After forcing young girls to watch his men execute their fathers, Muhammad raped them.)
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To: caver
Why would these stupid doctors want more government interference in their work?

Because it's worked so well in the past. /sarcasm

8 posted on 01/30/2006 1:12:45 PM PST by <1/1,000,000th%
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To: libertarianPA; caver

The harsh truth is that the government has already confiscated huge amounts of money from the people who are already at, or near an age to be eligible for Medicare. That large chunk of the population has been forced into a position where they have little choice but to support the continuation of the government-paid health care system, since the government already has their money. Doctors know this all too well.


9 posted on 01/30/2006 1:14:43 PM PST by GovernmentShrinker
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To: libertarianPA
"Primary care physicians -- the bedrock of medical care for today and the future -- are at the bottom of the list of all medical specialties in median income compensation," the ACP said.

Well, yeah, what do they expect? Human med doctors make more than veterinarians, yet they both had to go to medical school. Is that fair?

10 posted on 01/30/2006 1:15:04 PM PST by Yo-Yo
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To: libertarianPA

HillaryCare is here.


11 posted on 01/30/2006 1:49:30 PM PST by ikka
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To: libertarianPA

bump


12 posted on 01/30/2006 1:56:18 PM PST by kimosabe31
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To: caver

I think the biggest thing these docs are asking for is a restructure in the reimbursement plans of most of the HMOs. They will reimburse the regular family doc who is smart enough to diagnose a huge range of problems next to nothing- while a specialist who has one small field to dwell on a huge chunk of money. In my opinion, both are very important to our medical practices.


13 posted on 01/30/2006 2:00:47 PM PST by Cate
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To: libertarianPA

People need to quit going to the Dr. for every little ache/malady...and make them pay cash.....


14 posted on 01/30/2006 2:03:02 PM PST by dakine
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To: GovernmentShrinker

"The harsh truth is that the government has already confiscated huge amounts of money from the people who are already at, or near an age to be eligible for Medicare. That large chunk of the population has been forced into a position where they have little choice but to support the continuation of the government-paid health care system, since the government already has their money. Doctors know this all too well."

That bears repeating! And as another poster said, people need to quit going to the doctor for every time they sniffle.


15 posted on 01/30/2006 2:05:54 PM PST by caver (Yes, I did crawl out of a hole in the ground.)
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To: Yo-Yo

"Well, yeah, what do they expect? Human med doctors make more than veterinarians, yet they both had to go to medical school. Is that fair?"

AGGGH

LET THE FREE MARKET WORK

SHORTAGE OF PRIMARY CARE DOCTORS = PRIMARY CARE DOCTORS EARN MORE MONEY = MORE PRIMARY CARE DOCTORS = PRICE STABILIZES DEPENDING ON THE ELASTICITY OF PRICE.

A freshman microeconomics student could solve this.


16 posted on 01/30/2006 2:07:13 PM PST by adam_az (It's the border, stupid!)
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To: libertarianPA

Isn't this request what HMOs were set up to do ????? In an HMO you must go to a primary care physician first; so where's the real gripe ?

Medicare. Medicare. Medicare. Forcing doctors to see patients for lower rates than they want to charge.

Get the government out of healthcare, go to high deductible type insurance, rein in the trial lawyers, and see the vast majority of problems disappear.


17 posted on 01/30/2006 2:08:03 PM PST by cinives (On some planets what I do is considered normal.)
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To: libertarianPA
Can't we hire Paco and Jose' from the restaurant down the street to "do these jobs that Americans aren't willing to do"?


LOL
18 posted on 01/30/2006 2:15:37 PM PST by taxed2death (A few billion here, a few trillion there...we're all friends right?)
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To: libertarianPA
It's only a matter of time before the government starts to determine which doctors can go into special practice and which must go into primary care.

This is already happening. The federal government, through its grants supporting research and teaching hospitals, has a great deal to say about how many specialists are trained. I am told that since Hillary decided that specialists are too expensive, the government has tried to curtail the supply in some fields.

I know a young medical-school graduate who wanted to be a surgeon. (He had a real talent for surgery.) But he was told that there were not enough surgery slots. He ended up in psychiatry.

19 posted on 01/30/2006 2:40:03 PM PST by Logophile
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To: libertarianPA
It's only a matter of time before the government starts to determine which doctors can go into special practice and which must go into primary care.

That's exactly what Hillary's healthcare was all about.

20 posted on 01/30/2006 2:43:24 PM PST by Howlin (Why don't you just report the news, instead of what might be the news? - Donald Rumsfeld 1/25/2006)
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To: ikka

Exactly what I said!


21 posted on 01/30/2006 2:44:32 PM PST by Howlin (Why don't you just report the news, instead of what might be the news? - Donald Rumsfeld 1/25/2006)
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To: E. Pluribus Unum
The only purpose of primary care physicians is to provide lawsuit targets for trial lawyers.

That's the real problem. We need laws protecting doctors from scum-bag ambulance chasing lawyers. That is one place where government can help. Otherwise they need to butt out.

22 posted on 01/30/2006 2:45:13 PM PST by Adiemus
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To: libertarianPA
I agree, less government intervention. First, legalize all pharmacists to dispense nonnarcotic drugs without prescription. Second, let non-doctors do more, like putting in stitches.
23 posted on 01/30/2006 2:47:47 PM PST by Investment Biker
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To: libertarianPA

Medical care in the U.S. is going to collapse because we have millions of non-paying non-American citizens stealing us blind getting health care they don't deserve. The U.S. government needs to start a mass ejection of these illegals before the average American taxpayer go's broke trying to foot the bill.


24 posted on 01/30/2006 3:21:52 PM PST by puppypusher
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To: dakine

Couldn't agree more. Health insurance should work exactly like car insurance. You pay for doctor visits and tests. If anything catastrophic happens - necessary surgery, serious injury, etc - that's when insurance should step in and pay for it (with a deductible). People will pay $2000 to get their car fixed, but won't even think of paying for their own health care.


25 posted on 01/30/2006 3:42:00 PM PST by libertarianPA (http://www.amarxica.com)
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To: libertarianPA
In my opinion the patient, who has the most to lose is the lowest person on the communication chain-of-command. How do they get information if communication is guarded? The primary physician is next to them. The medical field (specialists) has created the equivalent of the corporate world. It has so many layers filling their pockets along that chain it is no wonder health-care costs have skyrocketed. Seems to me the general physician only makes the referral based on some type of diagnosis and receives a written report that is carefully worded to avoid any liability.

I know of a heart specialist that is not allowed to read the actual x-ray results (nuclear) because the hospital has a contract with some radiology outfit. Yet the radiologists are qualified in a general manner to be able to read all x-rays. Who would you trust? Myself, it would be the specialist, the one that knows me and my issues.

I quit wondering why it is that cancer is not discovered until it is too late. My contention is that most radiologists are no different than the accounts payable clerk in the corporate world thus it takes some emergency to discover it.

I stand with the primary care doctor and would like to see the old country doctor come back into vogue. Might it be that the medical field and especially the specialists not the general practioner, is pricing itself out of business.

In my opinion, preventative medicine is only the government's way to accumulate statistics. Mortality is what they really care about.

26 posted on 01/30/2006 3:47:05 PM PST by Snoopers-868th (Borrowed tagline: Who do I vote for-the Republicans are socialist and the Democrats are Communist)
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To: cinives
Politicians have a lot of nerve criticising HMO's when the reimbursement rates for seeing a medicare patient are pathetic.

Here's an example: An elderly woman who has suffered a stroke and is in a nursing home MUST, by federal law, be seen by a doctor every 60 or 90 days, whether there is any change in her health or not. For that visit, Medicare reimburses the doctor $25. The doctor must write orders for medication and lab tests and follow up the lab results with new medication or treatment orders. All for the $25 she got from medicare.

I wouldn't go to school all those years for that kind of compensation either.

27 posted on 01/30/2006 3:50:17 PM PST by Trust but Verify (( ))
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To: libertarianPA
You are wise my friend...Docs are going into private practice and not taking Medicare or Medicaid....and asking the patients to pay up front and then the patients can deal with their own insurance companies for reimbursement.
28 posted on 01/30/2006 4:04:20 PM PST by Kimmers
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To: GovernmentShrinker

Good point. Perhaps refunds, with full compounded itnterest is in order for Medicare as well as Social Secuity. "The millionaire next door" indeed.


29 posted on 01/30/2006 4:05:07 PM PST by Jack Black
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To: taxed2death

"Can't we hire Paco and Jose' from the restaurant down the street to "do these jobs that Americans aren't willing to do"?

LOL "

No, we will just bring Sanji and Apu over from India :-)


30 posted on 01/30/2006 4:07:14 PM PST by Codeograph
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To: Jack Black

It's scary how socialism uses this tax-for-the-future technique to secure political support from large swathes of the population who really DON'T support socialism. There are lots and lots of people out there who don't think Social Security or Medicare should exist, but it's mighty difficult to find one over age 40-45 who would really truly support immediate abolition, just because of the "but I already paid in all that money" factor.


31 posted on 01/30/2006 4:11:12 PM PST by GovernmentShrinker
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To: libertarianPA

This is a really odd pronouncement by a physican group. The idea of using E-mails to discuss problems with docs rather than having to run into the office is a good one.
They could spend more time with patients in office visits w/o losing money if they got paid for visit's on phone or in e-mail.


32 posted on 01/30/2006 4:20:36 PM PST by Galveston Grl (Getting angry and abandoning power to the Democrats is not a choice.)
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To: libertarianPA

I question the timing of this...


33 posted on 01/30/2006 5:09:11 PM PST by Pharmboy (The stone age didn't end because they ran out of stones.)
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To: libertarianPA

Doctors can just cry me a river! If it's so hard to make a living as a doctor these days why is a new hospital being built on every corner here in my town?


34 posted on 01/30/2006 5:11:42 PM PST by notbuyingit2 (Don't let your Ifida's pile up.)
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To: adam_az

This will not work. Let be tell you why. I can charge any dang amount I want. But my charges have absolutely NOTHING to do with what I am payed. That is determined by Medicare, Medicaid and Private Insurance. Medicare pay is horrible. Maybe you will break even. Medicaid is a little better in office. Hospital care is Very poor payment. Private insurance is O:K. Let me give you an example. The charge to admit a patient to the hospital is 200.00. Medicare will pay me 80.00. Now you tell me if that is appropriate for taking care of a person with acute MI and CHF add in a little DM. I get payed the same no matter how complicated the case. Now lets take a medicaid OB patient. I get 1,080 for 9 months of care,delivery and post partum vist 6 weeks later. I get payed not one dime difference if I have a diabetic mother who I spend 24 hours in the hospital with doing a pitocin induction and finally a C-section. Private insurance pays 2,600.00. To fill up your car with gas is more than I get payed for an office visit. Now you wonder why I get upset when my front office staff gets cussed out because they made someone pay their 15.00 co-pay before being seen.


35 posted on 01/30/2006 10:11:11 PM PST by therut
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