More U.S. Medical School Seniors to Train as Family Medicine Residents

emedpa

GlobalDoc
10+ Year Member
15+ Year Member
Aug 25, 2001
6,014
301
381
Taking an Away team....
Status
Post Doc
That's good news. I think folks are starting to see that primary care and family medicine in particular will be stable and profitable in the forseeable future.
 

VA Hopeful Dr

Senior Member
10+ Year Member
Jul 28, 2004
19,129
22,966
281
Status
Attending Physician
Does it say how many of those spots are a result of the scramble? If the numbers are higher using the results from Monday, that's one thing. If the numbers are as of noon yesterday, that's a very different picture.
 

GoodmanBrown

is walking down the path.
10+ Year Member
7+ Year Member
Jan 22, 2009
1,380
9
151
In the forest
Status
Resident [Any Field]
Does it say how many of those spots are a result of the scramble? If the numbers are higher using the results from Monday, that's one thing. If the numbers are as of noon yesterday, that's a very different picture.
Seems like it's people who matched, as the article states, "These individuals will be among the more than 16,000 U.S. medical school seniors who will learn today at noon where they will spend the next three to seven years of residency training in "Match Day" ceremonies across the country."

So, it doesn't seem like it's scramblers.


I agree with EMEDPA. FM seems like one of the most stable specialties in these crazy times. As a side note, did anyone else hear that the House bill has a provision to make Medicaid pay the same as Medicare. But so far only for primary care!
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
Damn...the secret's getting out. ;)
I got to agree that sounds good... the need is real. I hope all these new PCPs will pony up a little (along with other specialists) to get our professions needs understood and met. Too much underpayment going on around this country...
...As a side note, did anyone else hear that the House bill has a provision to make Medicaid pay the same as Medicare. But so far only for primary care!
don't know the ins & outs of this 3k page deal... but, I also heard there are some provisions to penalize/cut reimbursement for PCP that refer patients to "too many" specialists.
 

civic4982

FM => Geri
10+ Year Member
15+ Year Member
Jun 24, 2003
341
8
251
37
Where "The stars at night, Are big and bright"
Status
Resident [Any Field]

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,080
4,779
281
Status
Attending Physician
FM seems like one of the most stable specialties in these crazy times. As a side note, did anyone else hear that the House bill has a provision to make Medicaid pay the same as Medicare. But so far only for primary care!
Yes, starting in 2013.

I also heard there are some provisions to penalize/cut reimbursement for PCP that refer patients to "too many" specialists.
Link, please?

I don't think that's the case.
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
I didn't realize I was going into such an undesired field of medicine...
While not in Family Medicine.... I don't like to think of it in those terms. Rather, I prefer to see it as a poorly marketed, poorly represented specialty. I know far too many folks in other specialties, very unhappy, that I'm sure would likely be happy if they had understood the field of Family Medicine... cause it was likely a better fit for them.
...Link, please?

I don't think that's the case.
Ahhhh, BD.... I would have to find you the page in the 3k page monstrosity... it's someprovision in the medicare/medicaid thing... I can not quote you a page or link. But, I will keep my eyes open.

I know Obama's second cousin once or twice removed cited this concern on TV the other night too. This is hearsay/political linking and not citation from the bill:

Scan down to DrGottlieb portion on this site:
http://www.crossroad.to/articles2/010/garner/not-want-health-bill.htm


http://www.thenewatlantis.com/blog/tag/diagnosis/central-planning
 
Last edited:

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,080
4,779
281
Status
Attending Physician
This is hearsay/political linking and not citation from the bill
Correct.

If that sort of thing were actually in the bill, I think we'd have heard about it from somebody in organized medicine. Specialists would raise holy hell.
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
...If that sort of thing were actually in the bill, I think we'd have heard about it from somebody in organized medicine. Specialists would raise holy hell.
I guess.... but, I have seen a handful of physicians on TV over the past couple days referencing this.... Specialists, at least surgical going to get the patients eventually, cause if the appendix needs out, it needs out. The penalty is reportedly pointed at the PCPs.... so, I leave the leg work to you folks until it easily appears to me during my wandering:smuggrin:
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,080
4,779
281
Status
Attending Physician
I guess.... but, I have seen a handful of physicians on TV over the past couple days referencing this.... Specialists, at least surgical going to get the patients eventually, cause if the appendix needs out, it needs out. The penalty is reportedly pointed at the PCPs.... so, I leave the leg work to you folks until it easily appears to me during my wandering:smuggrin:
I'm guessing it's somebody's interpretation of something they read in the bill, along the lines of "death panels."

Penalizing primary care physicians for referring to specialists is, frankly, unworkable on a number of levels.

First, Medicare currently doesn't require referrals. Neither do most private insurance plans these days, some HMOs being the occasional exception. CMS would have to go to the expense of implementing a formal referrals process in order to have any kind of tracking ability whatsoever, which would involve the creation of an entire new layer of bureaucracy...the same thing that most insurance companies are moving away from because they realized that it really didn't save them any money.

Second, with the shortage of primary care physicians, particularly those who accept Medicare, forcing seniors to be seen by a primary care physician prior to getting a referral to a specialist would create an even bigger access problem than the one we're almost certainly going to face already. Of course, many specialists require patients to be referred by their primary care physician even if their insurance doesn't mandate it, simply because they don't want to see undifferentiated B.S.

Third, penalizing physicians for referring obviously creates a perverse incentive to deny referrals. While this may (in theory) cut down on specialist utilization, it would certainly increase physician and patient dissatisfaction with Medicare, and drive even more primary care physicians and specialists to stop seeing Medicare patients altogether. Patients may also find ways to circumvent such a process, such as by going to the ED instead of their primary care physician's office.

I see no way that such a process would save the system more money than it would cost.
 
Last edited:

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
...Penalizing primary care physicians for referring to specialists is, frankly, unworkable on a number of levels.

...Second, with the shortage of primary care physicians...

Third, penalizing physicians for referring obviously creates a perverse incentive to deny referrals...

I see no way that such a process would save the system more money than it would cost.
I appreciate your sentiment... but it presumes the bill is truly based on achieving cost cuts and all the other pie in the sky. Call it a conspiracy theory but the incongruentcy between the political speaches and reality suggests at best there is a different motive then stated.

Of course, we have the doctor fix/SGR issues, reported substraction from medicare and then double counting.... And of course the great winner....TRUSTFUNDED. That is to say, reform will save money because we will pay for it up front for 4 yrs. This of course suggests these dollars are put into some sort of savings account, to accumulate to actually pay for the entitlment in a few years. Didn't we hear something about that with social security, medicare, medicaid? Insuring more people (~30 million), mandating unlimited coverage, no pre-existing conditions also mathematically makes sense that the cost of healthcare will go down and improve access. Also, there are 52 USA states, the reform "will cut employer health costs by 3000%", there will be "no increased taxes", etc, etc, etc....

Some special considerations of how this will be paid used by CBO.... well, employers will spend less by paying the penalty to not insure, the employers will then give these savings to their employees, the employees will now be in higher tax brackets and there will be a windfall of increased revenue to the IRS.....

Again, I definately encourage you to look or ask your FP reps to look at the reported clause that penalizes PCPs for "too many" referrals to specialists.... I do not presume it won't happen because "it makes no sense". Frankly, this bill makes little sense.

Final point... if none of the "accusations" or "interpretations" are believed... we at least know the USA Fed government has never really run a good, fiscally sound program of any kind.
I'm guessing it's somebody's interpretation of something they read in the bill...
I say don't guess.... call the AAFP and pin someone down. Again, If a patient needs an organ removed cancer or otherwise they will get to the specialist... it is the PCP & pt being hurt at the front end. None of my procedures are "elective".
 
Last edited:

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,080
4,779
281
Status
Attending Physician
I asked somebody who's "in the know" about that, and this was his reply:
what this is probably referring to is to accountable care organizations (ACOs) where docs/hospitals are "capitated". If you do too many referrals and your narrowist order too many tests or do too many procedures you are financially penalized in the end. In ACOs the docs and hospitals wil lhave to figure out how they provide quality care without doing too many tests or procedures. If they figure it out everyone wins is the theory.
So, yeah...right-wing rhetoric.
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
I asked somebody who's "in the know" about that, and this was his reply:
BD Source said:
...what this is probably referring to is to accountable care organizations (ACOs) where docs/hospitals are "capitated". If you do too many referrals and your narrowist order too many tests or do too many procedures you are financially penalized in the end. In ACOs the docs and hospitals wil lhave to figure out how they provide quality care without doing too many tests or procedures. If they figure it out everyone wins is the theory..
Interesting. Again, hope your faith and belief pan-out.... Alot of "too many", etc... in your example/explanation.... not sure of who is defining acceptable levels... thus setting the bar of what is acceptable and what is excessive... aka "too many..."

I guess it is just the right wing.... but not what I am seeing from the physicians actually coming out on TV in reference to these concerns.
 

Blue Dog

Fides et ratio.
Gold Donor
10+ Year Member
Jan 21, 2006
12,080
4,779
281
Status
Attending Physician
Interesting. Again, hope your faith and belief pan-out.... Alot of "too many", etc... in your example/explanation.... not sure of who is defining acceptable levels... thus setting the bar of what is acceptable and what is excessive... aka "too many..."

I guess it is just the right wing.... but not what I am seeing from the physicians actually coming out on TV in reference to these concerns.
Personally, I'd never belong to an ACO. Too close to an HMO for comfort.

http://healthcare-economist.com/2010/01/26/what-are-accountable-care-organizations/
 

tony montana

Dr. G-Spot
10+ Year Member
7+ Year Member
May 6, 2006
270
1
141
Status
Attending Physician
Interesting. Again, hope your faith and belief pan-out.... Alot of "too many", etc... in your example/explanation.... not sure of who is defining acceptable levels... thus setting the bar of what is acceptable and what is excessive... aka "too many..."

I don't like the too many phrase either
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
Maybe....
But as I have followed this entire thing for the last year a few points are clear... especially with the latest tactic of planning to pass legislation without actually voting.

1. Government has no history of actually running a fiscally sound system
2. There is no such thing as a government program lock box/trust fund... as to date it is all run ponzi/pyramid scheme fashion. Money is spent immediately, no preserved, saved, invested, etc...
3. Got to be worried when the president and speaker both say ~well everyone will know what's in the legislation AFTER we pass it
4. While they keep claiming in their speaches an intent to decrease costs, CBO and almost elementary school level mathematics are clear it doesn't add up

So, while I don't know what their real agenda is, it clearly is not what they are political stumping cause their rhetoric does not match the legislation. Again, very confused cause it is so obviously in contradiction.
 

2000 Man

No Limits
10+ Year Member
Sep 17, 2008
90
1
0
Status
Medical Student
Don't forget that they attached government control of student loans to this bill as well (what that has to do with healthcare reform I don't know). So now the feds will be the sole providers of student loans. It's becoming clear that this bill is more about setting up a framework for a future goal, single payer healthcare. Because once they have you in debt to them they can set up all kinds of "loan forgiveness" that has you working for them at some cut rate salary in a speciality they "deem" as critical. The future of medicine in this country (if this bill makes it past the legal and constitutional challenges) does not look good at all.

I mean honestly, can someone tell me how this bill is going to insure more people, provide our current standard of care, and save money? It does not do this. What it does is set up a system that will destroy insurance companies and create a crisis in about 5-10 years where the government will "have to step in to save the day". Oh, and the best thing about this bill is that there is absolutely no way it can be funded. The country is broke. and the only way to save it is to start CUTTING spending/services, not adding to them. This may well end up being the straw on the proverbially camel's back. I hope not.
 

JackADeli

10+ Year Member
Aug 28, 2008
2,635
13
0
South
Status
Non-Student
That's good news. I think folks are starting to see that primary care and family medicine in particular will be stable and profitable in the forseeable future.
Damn...the secret's getting out. ;)
I got to agree that sounds good... the need is real. I hope all these new PCPs will pony up a little (along with other specialists) to get our professions needs understood and met. Too much underpayment going on around this country...
Again, congrats to FP and other under-represented specialties.... There is great need out there. I hope specialties can recruit & train the next generations to fill this need.:)
 
Last edited:

George85

Member
10+ Year Member
7+ Year Member
Apr 22, 2006
123
1
141
Florida
Status
Attending Physician
>>That's good news. I think folks are starting to see that primary care and family medicine in particular will be stable and profitable in the forseeable future.

I guess you believe we're winning the war in Afganistan as well.