Primary care about to collapse, physicians warn

Yahoo! News ^ | 1/30/06 | Maggie Fox

[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.

[Howlin]

Exactly what I said!

[Adiemus]

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.

[Investment Biker]

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.

[puppypusher]

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.

[libertarianPA]

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.

[Snoopers-868th]

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.

[Trust but Verify]

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.

[Kimmers]

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.

[Jack Black]

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

[Codeograph]

"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 :-)

[GovernmentShrinker]

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.

[Galveston Grl]

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.

[Pharmboy]

I question the timing of this...

[notbuyingit2]

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?

[therut]

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.