Questions about the future of Family Medicine

[sherman1]

Several questions...


Is it possible that there could be shortage of primary care physicians in the next 10-20 years because of the aging baby boomer population ?

Could FP realistically be replaced by mid level providers in 10 -20 years ?

Will compensation for FP physicians likely increase or decrease in the next 10 -20 years ?


I am very interested in the field of FP because of its wide breadth of opportunities available and flexibility as to type and location of practice

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[deleted6669]

1. YES, WITHOUT A DOUBT. THE BABY BOOMERS ARE GOING TO STRESS THE AMERICAN HEALTH SYSTEM LIKE NEVER BEFORE.
2. NO. PA'S/NP'S WILL SUPPLEMENT PRIMARY AND SPECIALTY CARE, BUT THERE IS ENOUGH WORK TO GO AROUND FOR EVERYONE.
3. INCREASE. AS FP DOCS START DOING MORE OFFICE PROCEDURES TRADITIONALLY DONE BY SPECIALISTS( SIGS, VASECTOMIES, BIOPSIES, TREADMILLS, MINOR DERM PROCEDURES LIKE COSMETIC LASER, ETC) THEY WILL SEE INCREASED REVENUE.

 

[MacGyver]

Originally posted by sherman1
Could FP realistically be replaced by mid level providers in 10 -20 years ?

Absolulutely. NPs are the biggest threat. They can write their own scripts, admit their patients to hospitals, all with no MD supervision in most states.

Will compensation for FP physicians likely increase or decrease in the next 10 -20 years ?

Decrease in terms of standard of living and earning power, but increasing in terms of gross numbers (due to inflation, etc). However, compared to specialists, their salary will be more stable. Specialists are going to take a big hit when some kind of universal health care deal rolls around. No way a universal health care system continues to prop up neurosurgeons with their 450k avg salary, or ob/gyns with their 300k avg.

 

[Freeeedom!]

There goes MackyG talkin to himself again!!! Admitting pts to hospitals?? Who?
Dude you smoke crack.
"Most states" actually can be interpreted as "in MacGuyvers delusional world, where he is the King and wears robes of paranoid purple, and idiotic idigo...and a crown of inexperience"

 

[CambieMD]

I think that the practice of medicine is ever changing. The primary care physician will exist in twenty years. I do not think that he/she will function as they do today. Our role will become more that of care coordinators.

I do not think that there will be a huge shortage in primary care physicians. The bean counters who predicted this is the past were wrong and they will be wrong again. The relationship between the number of physicians and the amount of patients is not a linear relationship.

Universal health care will never make it in the US. Universal health care has not been the answer in any of the countries where it is emplyed. Americans will not tolerate a system that removes a financial reward for hard work.

Do not believe those who say that the sky is falling. However, I think that our incomes will remain at present levels.

The sky is not falling. Change is occuring in FP. Change is not always bad. What is taking place in FP is merely a reflection of what is taking place in the market. This is not necessarily a bad thing.

CambieMD

 

[edfig99]

you can read what the FP experts are thinking about the future of family medicine...

http://www.annfammed.org/content/vol2/suppl_1/

fm will be undergoing some changes.

 

[BellKicker]

Originally posted by CambieMD

Universal health care will never make it in the US. Universal health care has not been the answer in any of the countries where it is emplyed. Americans will not tolerate a system that removes a financial reward for hard work.

You say it like it's a bad thing! It just means more time for patients. Why wouldn't it reward hard-working FPs? How would that change in a universal health care system?

FPs in my country, Denmark, are paid per visit or procedure just like in the US. Only difference is that they scan the patients social security card into their computer and they get the money automatically by the end of the month.

FPs here make 100-120K for a 37 hour work week.

Don't automatically think Cuba or USSR when you hear universal health care. If there's one area where universal health care works, it's in primary care.

 

[CambieMD]

The United States is very different from Denmark. Medicare is going to run out of money in twenty years at present spending levels. This program is designed mainly for senior citizens. Where will the money come from to insure everyone.

Europeans pay a lot more taxes then we do in the US. The health care sector needs some major changes but universal health coverage is not the answer.

CambieMD

 

[MacGyver]

Originally posted by BellKicker
FPs here make 100-120K for a 37 hour work week.

1) Whats the mean/median income in Denmark?

2) Whats the tax structure like?

3) Whats the standard deviation of income in Denmark?

4) How much do engineers, scientists, and other equivalently trained people make in Denmark?

 

[MacGyver]

Originally posted by Freeeedom!
Admitting pts to hospitals?? Who?

Sorry to break it to you, but NPs can in fact admit patients to hospitals without an MD's approval/supervision in many states.

 

[PACtoDOC]

Hey Dufus Mac, as usual you are wrong again. NP admissions to hospitals is in no way connected to state law. It is about hospital policy. In fact in all 50 states there is not legislation barring a PA or an NP from admitting patients, but the hospital policies themselves decide this. Based on the fact that I have worked in various large cities in some of the most prominent hospitals and hospital corporations (compared to your basement viewpoint), I can tell you I have never seen a hospital allow an NP to admit and follow their own patients without a physician. It just doesn't happen. Once again you are smoking MDMA.

 

[Freeeedom!]

Sorry to break it to you big mac...no.

While your little brain confuses the NP being called on behalf of the MD, and coming down and writing orders (like many interns do)...they do not admit the patient themselves!! Yeah, a NP may say to a patient, "go to the ER, you need to be admitted", but they don't admit.
What a doofus...dude, 99% of FP's don't even admit anymore, let alone a NP!

You are simply confused about terminology, as you are not in medical school nor are you a resident...nor are you a college graduate. You speak a language you don't understand.

 

[BellKicker]

Originally posted by CambieMD
The United States is very different from Denmark. Medicare is going to run out of money in twenty years at present spending levels. This program is designed mainly for senior citizens. Where will the money come from to insure everyone.

Europeans pay a lot more taxes then we do in the US. The health care sector needs some major changes but universal health coverage is not the answer.

CambieMD

My humble opinion is this:

I don't think taxes are key here. Medicare and medicaid are already very costly. Creating a basic universal health care package for everyone wouldn't cost a lot. Also, it would save employers a lot of money and doctors a lot of time.

I'm not just blowing the Scandinavian horn here. The ideal system, in my view, would be a combination of private insurance and a (very) basic universal health care system. Medicaid, as it is, is actually way too generous. Some of that money could easily be derouted to health care for lower middle class people without health insurance.

 

[BellKicker]

Originally posted by MacGyver
1) Whats the mean/median income in Denmark?

2) Whats the tax structure like?

3) Whats the standard deviation of income in Denmark?

4) How much do engineers, scientists, and other equivalently trained people make in Denmark?

1) The mean is lower than the US. The median is higher. A person on minimum wage makes more then the median American.

2) Very progressive tax scale. I'm poor so it works for me. Between me, my wife and our 2 kids we made a little more than $30K (a lot of work as a respiratory assistant for me). In total, we paid maybe 20% of that in taxes.

For every dollar made after 40K you pay 68% in taxes. I know, I know.

3) Obviously very low. Minimum wage is maybe 15 dollars. 50-60K is considered a decent income. 120K (for the FP) is near the top in the distribution. A subspecialist in private practice might pull home 150-200K. When you factor in the tax scale, the distribution is pulled together even more.

4) My good friend is an engineer straight out of grad school. He makes $60K a year. That's considered a good starting salary for any position; probably about the highest anyone straight out of school could hope for. Less than in America, I know.

Crap, that took me like 15 minutes to type. MacG, you've done hit and runs on me before. I hope this won't be one of them.

BK

 

[Finally M3]

http://www.ama-assn.org/amednews/2004/04/12/prl20412.htm

Synopsis of 'Future of Family Medicine' study. Pretty interesting reading.

 

[dr.smurf]

can anyone tell me what the recommendations of the family medicine project mean exacly? i mean i read the article but maybe im just brain dead today, but im not too sure what implimenting electronic med records and increasing flexibility of office hours is going to do for fp. any thoughts?

 

[PACtoDOC]

Basically what they are saying in the report only applies to urban and suburban FP's. There are many rural FP's who will never have to provide this type of service in order to keep patients happy. In the cities though medicine in changing and patients and physicians alike are realizing that it is easier to provide some aspects of care without a patient visit. But in order to do this, the physician will need immediate access to patient records from cars, home, and while walking to the hospital. PDA's will soon have all this and more for doctors and patients will start demanding more and more over the phone (and soon email). Its actually a useful concept but it comes close to being dangerous at times. In modern day FP offices patients often have to wait 2 days to get a callback telling them they will get their script called in. In my old practice every provider got an average of 30 calls a day from patients, and we needed a physical chart in order to really answer their questions and call something in. This process is slow and tedious as finding a chart in an office can be seriously an hour long task at times. EMR's and email communication is a good thing and will make FP's more viable. Rural though, it really makes no difference!

 

[drboris]

Does this mean that salaries/reimbursemens are going to increase and hours/call will remain the same?

 

[dr.smurf]

we can only hope! but seriously...i would think its going to come to that eventually. there should be more incentive to keep pts aware from unnecessary specialty visits and more compensation for those of us who take care of a vast array of multiple coexisting problems. not to mention the baby boomers are getting older!

 

[sdude]

My humble opinion is this:

I don't think taxes are key here. Medicare and medicaid are already very costly. Creating a basic universal health care package for everyone wouldn't cost a lot. Also, it would save employers a lot of money and doctors a lot of time.

I'm not just blowing the Scandinavian horn here. The ideal system, in my view, would be a combination of private insurance and a (very) basic universal health care system. Medicaid, as it is, is actually way too generous. Some of that money could easily be derouted to health care for lower middle class people without health insurance.

I agree wholeheartedly. I have worked in medical coding and billing, and I have been nauseated by situations where interventionalists make tens of thousands of (medicare) dollars from procedures done on terminal patients, while millions of people can't even afford to see a doctor for strep throat.

A basic single-payer program (limited by necessity--there would still be a place for private insurance) would save incalcuable amounts of money by letting anyone--unemployed, poor, young, ineligible for private insurance--get basic preventative and acute care. Productivity would increase, people wouldn't have to let their kids suffer for days with otitis media before having to take them to the ER, the list could go on forever.