NY Times gently slams FM...

[burlypie]

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http://www.nytimes.com/2006/08/30/opinion/30cook.html?ex=1157083200&en=6588eca1409e81f3&ei=5087

the quote: "Ideally, the hourly rate would not be the same for all primary care physicians, but would be assessed on a sliding scale, predicated on a doctor’s level of education. Internists and pediatricians — the primary care doctors who have had the most training — would receive a higher rate than general practitioners and family physicians would."

Otherwise an interesting piece, but I had a hard time getting past this quote.

BP

 

[DrMom]

how on earth did they come to the conclusion that IM and peds get more education than FM? You've gotta love it when the reporters take the time to get their information right. 🙄

 

[sophiejane]

I think a lot of people still equate GP with FP. There are still some GPs out there who did a year of intership then set up shop, but they are dinosaurs. I wonder how long that stigma will last?

 

[deleted87716]

The article isn't really anti-FP...if anything, it's a very pro-primary care argument: fix the way primary care gets reimbursed, and more people will go into primary care. Plus, patients will be able to spend more time with their doctors, which equals better care, in the opinion of the author.

Unfortunately, the author doesn't seem to really understand how insurance reimbursement works. I just about laughed out loud at this:

As it is now, insurance companies — following Medicare's lead — pay primary care doctors according to the number of patients they see. Each patient visit is generally reimbursed at a flat rate of slightly more than $50. The payment is the same whether the patient is a healthy, young person with a runny nose or an elderly person whose multiple chronic illnesses require many tests, referrals to specialists and detailed explanations to both the patient and his or her family.

Surprising, too...did you catch the article's author? Noted medical novelist, Robin Cook. You'd think a doctor would be a little less clueless. I think he's been out of clinical medicine too long.

Lawyers are already accused of nickel-and-diming their clients with their "billable hours" schemes. I don't think that's something we want to try to replicate in medicine.

 

[skb21]

how on earth did they come to the conclusion that IM and peds get more education than FM? You've gotta love it when the reporters take the time to get their information right. 🙄

Consider the source. I never believe anything that comes out of the New York Times.

 

[Son of a Sailor]

I read this article this morning and found it pretty worthless. At best it was a misguided view of reform in the world of primary care, at worst it was an 'overworked and underpaid' argument.

 

[Marigold]

So I like the idea that there needs to be some sort of reform in order to change attitudes about primary care and attract more med students to want to pursue primary care. But I'm definitely a bit offended by the part about "well, of course we should pay pediatricians and internists more, because everyone knows that they get more/better training than family physicians." Last time I checked they were all 3 year residencies.

I think Dr./novelist Cook has a point, that something needs to be done, but what he proposes is not the way to do it. He's definitely been out of clinical medicine too long.

 

[burlypie]

...as I said, I had a hard time getting past the quote, which I found to be very anti-FP. As someone who grew up seeing only FPs, who is told she's too smart to be "just an FP", I find I get a little upset when my goals are, in a way, belittled. And under the masthead of my most trusted news source, no less.

BTW I felt a little violated when the title of the thread got the [not really] added to it...I feel like that's something to be discussed in the forum and not just edited in as if I wrote it.

The article itself was interesting, and it's good that the plight of the primary care practitioner is getting major mainstream press. As for Cook's accuracy...obviously we've seen that he doesn't do his research. But I never said that the entire article wasn't pro-primary care. It just happened to (probably unintentionally) slam Family Medicine in a very ignorant way while it was rallying for more and better primary care.

 

[deleted87716]

BTW I felt a little violated when the title of the thread got the [not really] added to it...I feel like that's something to be discussed in the forum and not just edited in as if I wrote it.

Good point. Fixed.

I'd prefer that the things I edit be obvious.

 

[Jack Daniel]

Consider the source. I never believe anything that comes out of the New York Times.

At least it's instructive insight as to other people's perceptions.

 

[sjkpark]

Surprising, too...did you catch the article's author? Noted medical novelist, Robin Cook. You'd think a doctor would be a little less clueless. I think he's been out of clinical medicine too long.

Lawyers are already accused of nickel-and-diming their clients with their "billable hours" schemes. I don't think that's something we want to try to replicate in medicine.

I thought Robin Cook was a doctor. An MD.

 

[deleted87716]

I thought Robin Cook was a doctor. An MD.

He is. That's why it's surprising that he's so clueless.

 

[secretwave101]

I intend to write in to the NYTimes to contest that specific quote. Hopefully with my op-ed along with 5000 others from FP's around the country, the NYTimes will give in print one. To discount the NYTimes is a respectable personal choice, but it must be recognized that it IS the most powerful and popularly-read newspaper in the world. FP's have been ineffective, flaccid interlocutors between their specialty, the public, and policymakers for decades and it needs to stop. Perpetuating this notion - that FP's deserve less money than IM's or any other doc - is inane.

Cook is an internist. He obviously feels he is better educated than FP's. But IM and Peds are 3 year programs. So's FP. Different emphases, but same amount of education. It is absurd to suggest otherwise and outrageous to suggest that IM's deserve more money.

In fighting for primary care, Dr. Cook would be wise to fire his guns directly at the problem rather than shooting more than half of his own army in the process.

 

[sophiejane]

An op-ed from the president of the AAFP might be nice, too.

Anyone with connections want to bring this to his attention?

I'd rather read the Times than just about any other paper any day, especially fluff-filled rags like USAToday, and this won't make me feel any differently. Just because a paper's editorials doesn't express one's particular political beliefs at every turn does not make it without merit.

 

[lowbudget]

Stupid.

How would paying by the hour based on "education" promote primary care? It actually promotes specialization. People would overtrain to underwork, and possibly work outside their scope. Under this system, Ob-Gyns would start doing more primary care, for example, and we know what a disaster that would be. Totally inefficient system.

And why would any smart policymaker pay someone by the hour anyways? Nothing would get done on time because there is no economic pressure to do anything quickly. You'd simply stay on the clock longer to get paid more. I used to sort mail in college and was paid by the hour. Why bother finishing the task when you could put it off until tomorrow and get paid more for the same amount of work?

 

[deleted87716]

And why would any smart policymaker pay someone by the hour anyways? Nothing would get done on time because there is no economic pressure to do anything quickly.

Exactly. Working an eight-hour day, I could see eight patients, and spend an hour with each of them, and make the same amount of money as if I saw 32 patients for fifteen minutes each. Which option do you think more people would gravitate to? And who would see all of the patients? Primary care is already in short supply...cutting back our volume would only exacerbate the access problem.

 

[burlypie]

I emailed the head of the FCM department at my school school, and he forwarded me the emails that have been shooting around the academic community. They definitely mentioned formulating a formal response from the Academy.

 

[iatrosB]

I emailed the head of the FCM department at my school school, and he forwarded me the emails that have been shooting around the academic community. They definitely mentioned formulating a formal response from the Academy.

What would this response entail?

 

[secretwave101]

It would hopefully address both the stupidity of the proposal as well as Dr. Cook's ignorance and professional racism toward FP's.

One would hope the Academy has a short discussion and acts quickly. One would hope....there's not much to talk about on this one.

 

[McDoctor]

I emailed the head of the FCM department at my school school, and he forwarded me the emails that have been shooting around the academic community. They definitely mentioned formulating a formal response from the Academy.

A formal response, to what?

For suggesting that a pediatrician who is trained exclusively to see children get reimbursed slightly more for their extra training? Big deal. Actually, this was probably the only reasonable proposal in the whole article. I'd rather see competent Pediatrician's salaries increased for treating complicated illnesses in children than have these children turfed to specialists in distant tertiary care centers. As it stands now, pediatricians don't get paid enough to deal with the liability of managing illnesses of moderate complexity and sick kids end up getting turfed to distant hospitals, making transportation a significant problem for families.

The article, in essence, was actually pro FP and pro Primary Care. And, as mentioned, was quite out of touch with the realities of clinical medicine anyway. If this article generates a formal response from the AAFP, then I would say the AAFP needs some serious perspective on choosing its appropriate battles.

 

[deleted87716]

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