braluk

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CNN. http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

Quite disheartening. Comments?

Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

The survey, released this week by the Physicians' Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

A U.S. shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week's American Medical Association annual meeting.

In the survey, the foundation sent questionnaires to more than 150,000 doctors nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies.

And if that many physicians stopped practicing, that could be devastating to the health care industry.

"We couldn't survive that," says Dr. Walker Ray, vice president of the Physicians Foundation. "We are only producing in this country a thousand to two thousand primary doctors to replace them. Medical students are not choosing primary care."

Dr. Alan Pocinki has been practicing medicine for 17 years. He began his career around the same time insurance companies were turning to the PPO and HMO models. So he was a little shocked when he began spending more time on paperwork than patients and found he was running a small business, instead of a practice. He says it's frustrating.

"I had no business training, as far as how to run a business, or how to evaluate different plans," Pocinki says. "It was a whole brave new world and I had to sort of learn on the fly."

To manage their daily work schedules, many survey respondents reported making changes. With lower reimbursement from insurance companies and the cost of malpractice insurance skyrocketing, these health professionals say it's not worth running a practice and are changing careers. Others say they're going into so-called boutique medicine, in which they charge patients a yearly fee up front and don't take insurance.

And some like Pocinki are limiting the type of insurance they'll take and the number of patients on Medicare and Medicaid. According to the foundation's report, over a third of those surveyed have closed their practices to Medicaid patients and 12 percent have closed their practices to Medicare patients That can leave a lot of patients looking for a doctor.

And as Ray mentioned, med school students are shying away from family medicine. In a survey published in the Journal of the American Medical Association in September, only 2 percent of current medical students plan to take up primary care. That's because these students are wary of the same complaints that are causing existing doctors to flee primary care: hectic clinics, burdensome paperwork and systems that do a poor job of managing patients with chronic illness.

So what to do? Physicians don't have a lot of answers. But doctors say it's time to make some changes, not only in the health care field but also with the insurance industry. And they're looking to the new administration for guidance.

One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American. But some health experts, including Pocinki, are skeptical.

"People who have insurance can't find a doctor, so suddenly we are going to give insurance to a whole bunch of people who haven't had it, without increasing the number of physicians?" he says. "It's going to be a problem.
 

IHeartNerds

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I'm a little baffled by the "2% will go into primary care" number. Does this not include pediatrics? At every school whose match list you look at, fully 20-25% of the class ends up matching into pediatrics. Do that many people subspecialize from peds? Or is this just in reference to adult medicine?
 
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hardy

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So what they are saying is that half of all primary care doctors would leave medicine, if they found a job paying just as much with less work involved. And that's on CNN's front page? Slow news day...
 

Taurus

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Look on the bright side.

"One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American."

I give Barack credit for supporting physicians and not NP's. The easy thing to do is simply fill that primary care gap with more minimally trained NP's, but Barack is more thoughtful and I think he sees that the American people deserve to be seen by physicians. He got my vote.
 

FatPigeon

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Look on the bright side.

"One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American."

I give Barack credit for supporting physicians and not NP's. The easy thing to do is simply fill that primary care gap with more minimally trained NP's, but Barack is more thoughtful and I think he sees that the American people deserve to be seen by physicians. He got my vote.

I too give him credit for that, but I bet he'll throw his support behind the NP and PA thing as soon as he realizes that his idea won't work. His degree of liberal idealism is almost comical...and it's referred to subtly at the end of the article.

Not enough primary care physicians, getting paid too little...can NOT be remedied by giving MORE people health insurance (and most of the people currently without it are unhealthy, i.e. the ones who would use it most if they were to have it), thereby creating a greater need for such physicians, and almost certainly cutting reimbursements even further to dispense such free care.

Obama seems like a good man with ambitious ideas, and he's certainly intelligent....but in my opinion his plans just aren't practical. Universal healthcare in a country with open borders and the greatest multicultural mix and economic disparities in the world? Without sacrificing the quality of the care? Give me a break. I doubt he himself even believes this will actually work.

My prediction: The few remaining PCPs will quit, and nurses will take over the entire field.
 

NonTradMed

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....well, if the health insurance actually reimburses PCPs better, giving people health insurance would work.

A lot of people I know assume that when someone has 'government insurance', they have equal access to good quality health care like someone with private insurance and that isn't the case since the insurance reimuburses so poorly. So they think expanding medicare/medicaid is the solution, not understanding that just having insurance doesn't mean one can easily access doctors (or drugs, procedures etc).
 

soccergl31

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I'm a little baffled by the "2% will go into primary care" number. Does this not include pediatrics? At every school whose match list you look at, fully 20-25% of the class ends up matching into pediatrics. Do that many people subspecialize from peds? Or is this just in reference to adult medicine?

The JAMA study where that 2% comes from was only asking about general internal medicine, and therefore doesn't include family medicine or pediatrics. So it's a bit misleading...
 

Dakota

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There's also a difference between what medical students plan to do and what the realities of their Step I (or internal medicine residency) performance forces them into.
 

GZA

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Look on the bright side.

"One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American."

I give Barack credit for supporting physicians and not NP's. The easy thing to do is simply fill that primary care gap with more minimally trained NP's, but Barack is more thoughtful and I think he sees that the American people deserve to be seen by physicians. He got my vote.
Hear, hear!
 

rachmoninov3

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Solution? Student Loan Bail-out for all physicians chosing primary care (EM, IM, FP, and Peds):idea:
 
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Leefa

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I could probably post this in a few different forums, but I came upon this article online

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

Basically says that half of all primary care doctors would be willing to switch fields/professions, because of red tape, regulation, and the transformation of certain fields of medicine into a business.

Being a medical school hopeful, I'm looking forward to any changes that may be made in the medical field in terms of social programs (medicare/medicaid), and insurance, among other things.

Responses? What does the future hold?
 

braluk

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Read forums before posting. It's already been posted here.
 

nowanmd

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I'm a practicing primary care doc in an inner city hospital in NYC. The solution will be to "shuffle the funds around" decreasing reimbursement in fields like radiology and increasing primary care payments. Another solution there is an opportunity to streamline administration ( that is fire administrative people) in hospitals and insurance companies.
 

FatPigeon

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I'm a practicing primary care doc in an inner city hospital in NYC. The solution will be to "shuffle the funds around" decreasing reimbursement in fields like radiology and increasing primary care payments. Another solution there is an opportunity to streamline administration ( that is fire administrative people) in hospitals and insurance companies.

This is quite the communist idea and I find it objectionable. While I agree that radiologists make far too much money for what they do, it should be decreased and deducted from patients' expenses...not redistributed to other types of physicians. :thumbdown:
 

Dirt

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I'm a practicing primary care doc in an inner city hospital in NYC. The solution will be to "shuffle the funds around" decreasing reimbursement in fields like radiology and increasing primary care payments. Another solution there is an opportunity to streamline administration ( that is fire administrative people) in hospitals and insurance companies.

No doubt, RBRVS needs to be adjusted to benefit PCPs, or the problem is going to keep snowballing.
 

badasshairday

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I bet they could do a survey and get a headline that looks like this:
Half of Nation's Medical Students in Survey Would Leave Medical School.
 

bcat85

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....well, if the health insurance actually reimburses PCPs better, giving people health insurance would work.

A lot of people I know assume that when someone has 'government insurance', they have equal access to good quality health care like someone with private insurance and that isn't the case since the insurance reimuburses so poorly. So they think expanding medicare/medicaid is the solution, not understanding that just having insurance doesn't mean one can easily access doctors (or drugs, procedures etc).

I wish the federal government would figure this out. Increased reimbursement + improved student loans - bureaucratic bull**** = Everyone having a primary care physician.
 

badasshairday

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I wish the federal government would figure this out. Increased reimbursement + improved student loans - bureaucratic bull**** = Everyone having a primary care physician.

Print this **** and send it to your legislatures and Obama.
 

badasshairday

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Yes, because government is always effective at trimming its own bureaucracy and forcing huge lobbying groups like the insurance industry to make less money.

True. Obviously the only solution would be to get me elected president in 2012. Also you and a bunch of other cats on SDN need to get into the senate and house. :thumbup:

I can dream, can't I?
 

howelljolly

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I found an interesting article that mentioned that PCPs would rather see fewer patients, than have their reimbursement increased.

The European model for primary care makes the primary care visit longer than the 15 minutes thats alotted by the US insurance companies. They also have protected time to coordinate the patients care with specialists, pharmacists, and from what I gather - nurse educators.

There is a team approach to primary care, and the its the PCPs responsability to coordinate it for each patient.

I think this is a good model, and would help our current primary care "crisis". I think more students would go into primary care if they didnt have to know everything about everything, and do it all in less than 15 minutes.

Thoughts?
 

sirus_virus

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It's all about reimbursements, and any fool who thinks this squeeze is going to stop at PCPs is in for a surprise. Insurance companies have decided to use medicare tactics; wherever medicare cuts, insurance companies will too. All physicians are going to feel the squeeze any second. Primary care is just the first front.
 

GZA

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It's all about reimbursements, and any fool who thinks this squeeze is going to stop at PCPs is in for a surprise. Insurance companies have decided to use medicare tactics; wherever medicare cuts, insurance companies will too. All physicians are going to feel the squeeze any second. Primary care is just the first front.
Thoughts on who will be second?
 

howelljolly

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Um, no

There are already plenty of student loan bailouts for primary care. Noone wants to take them, because you'll have to work your pants off, and it isnt worth it as is.
 
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