Interesting perspective piece on CNN

[cchoukal]

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This is a commentary by a primary care physician in CA. I think it's interesting because it describes a cost:benefit ratio of primary care physicians and details a little bit just how terrible the reimbursement is for thinking through a patient problem and taking the conservative approach, as opposed to just ordering tests and images to satisfy the patient.

http://www.cnn.com/2009/HEALTH/08/25/harris.primary.care.doctor/index.html

 

[pgg]

This is a commentary by a primary care physician in CA. I think it's interesting because it describes a cost:benefit ratio of primary care physicians and details a little bit just how terrible the reimbursement is for thinking through a patient problem and taking the conservative approach, as opposed to just ordering tests and images to satisfy the patient.

http://www.cnn.com/2009/HEALTH/08/25/harris.primary.care.doctor/index.html

It's hard for me to read those comments and not start hating patients. So many angry, entitled, whiny people who hate - of all people - the overworked and underpaid primary care physicians.

They deserve whatever midlevel they'll wind up with when this "everything free for everybody" national healthcare thing implodes.

 

[Gimlet]

Thanks for posting that.

I like where he's going in the beginning of the paragraph below, but he loses me in the last sentence. I would have to see some numbers to back that statement up. My school is by no means focused on churning out primary care physicians, and IM was the second-best represented specialty in the match for my class this year (behind anesthesiology 😛). Are there that many internal medicine residents subspecializing after residency, or is this guy just resorting to hyperbole?

No one is talking about this on the national level. If they don't address these issues, then good luck having physician assistants provide the safety net with two years of training. Good luck getting newly trained physicians once they see our salaries. Good luck finding internists in your community with only 1 percent of medical students going into internal medicine.

 

[pgg]

Thanks for posting that.

I like where he's going in the beginning of the paragraph below, but he loses me in the last sentence. I would have to see some numbers to back that statement up. My school is by no means focused on churning out primary care physicians, and IM was the second-best represented specialty in the match for my class this year (behind anesthesiology 😛). Are there that many internal medicine residents subspecializing after residency, or is this guy just resorting to hyperbole?

1% clearly isn't correct as any year's match stats would show.

I'm very dubious that enough subspecialize to even change that to "1% stay in internal medicine" ... then again, practically everyone I knew who picked IM had their eyes on something afterwards.

 

[lord_jeebus]

There was a recent survey where 1 or 2% of graduating medical students had plans to go into "general practice internal medicine." This did not include family medicine, but is still remarkably low.

 

[Taurus]

I think it was a brilliant move by the AAMC a few years ago to expand med school enrollment by 30%. That will guarantee that more US grads will go into primary care, whether they want to or not. If there wasn't an enrollment increase and the govt decided to expand primary care slots by 15%, you can bet that the NP's would have more strongly argued, like they have in the past, that NP's should be allowed to enter medical residencies to fill in the gap. The AAMC's move effectively undercut that argument.

 

[Gimlet]

There was a recent survey where 1 or 2% of graduating medical students had plans to go into "general practice internal medicine." This did not include family medicine, but is still remarkably low.

Interesting. "Plans" doesn't necessarily equate to what actually will happen, though. I doubt there are enough IM subspecialty fellowship spots available every year to allow all but 1 or 2% to subspecialize. Not every schmoe who matches into IM will be good enough to get the GI fellowship they've been coveting since first year of medical school. I still say this guy is hyperbolizing the shortage issue.

According to the 1st year cards fellow sitting next to me, about 20% of his residency class went into General Internal Medicine after graduating.

 

[pgg]

I think it was a brilliant move by the AAMC a few years ago to expand med school enrollment by 30%. That will guarantee that more US grads will go into primary care, whether they want to or not. If there wasn't an enrollment increase and the govt decided to expand primary care slots by 15%, you can bet that the NP's would have more strongly argued, like they have in the past, that NP's should be allowed to enter medical residencies to fill in the gap. The AAMC's move effectively undercut that argument.

Since they didn't also increase residency positions by 30%, the only change we're likely to see are fewer FMGs getting residencies in the US and more tuition $ collected by US medical schools. Certainly not a substantial increase in the number of primary care physicians.

 

[cchoukal]

Since they didn't also increase residency positions by 30%, the only change we're likely to see are fewer FMGs getting residencies in the US and more tuition $ collected by US medical schools. Certainly not a substantial increase in the number of primary care physicians.

Although, if I'm not mistaken, many residency positions in FP and IM (and others) go unfilled every year, so I guess it's possible that increasing the number of medschool grads might fill some of those spots. Anyway, I think his point is a good one, that he basically takes the liability upon himself NOT to do a million-dollar-work-up every time someone comes in with GERD or chest pain, and the rewards for doing so are very small. I'm really glad he put the dollar values in there. I don't think the public knows how little physicians get reimbursed for some things. In casual conversations with my non-medical friends, it's clear that none of them know we don't actually get paid what we bill and that it's possible to LOSE money taking care of certain patients.

 

[pgg]

Although, if I'm not mistaken, many residency positions in FP and IM (and others) go unfilled every year, so I guess it's possible that increasing the number of medschool grads might fill some of those spots.

That's a good point, one I hadn't considered.