Study Shows ‘Invisible’ Burden of Family Doctors

[Moonglow]

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This analysis is from The New York Times, it concerns information origionally printed in The New England Journal of Medicine:

By STEVE LOHR

Published: April 28, 2010

A new study detailing the uncompensated work burden on family doctors points to the need to change how they are paid, medical experts say — particularly as the new health care law promises to add millions more patients to the system.

Sabina Louise Pierce for The New York Times

Dr. Richard Baron’s practice is part of a pilot project that compensates doctors for preventive and disease-management work, not just office visits.

Family doctors make up the embattled front line of the nation’s health care system. They earn about half the money of specialists who focus on treating particular ailments or parts of the body. That is a reason less than 10 percent of medical school graduates choose so-called primary care, which includes general internists and pediatricians.

Worsening shortages of family doctors were being predicted even before the recent health care legislation, which opened the door to an estimated 30 million newly insured people who will begin making appointments for checkups and other care.

“There is already enormous pressure on primary care, and more is coming,” said Dr. Thomas Bodenheimer, a professor of family medicine at the University of California, San Francisco.

Comparatively modest salaries and rising patient numbers are part of the challenge, medical experts say. But so is the breadth of the unpaid work performed by family doctors. A study published on Wednesday in the New England Journal of Medicine measured that problem precisely, using computerized patient records and reporting systems to track all the tasks done in a five-physician practice over a year.

http://www.nytimes.com/2010/04/29/business/29doctor.html?src=busln

 

[bronx43]

Classic example of supply and price curve. There are many ways to fix this problem. Let's see which way politicians want to go.

 

[Eta Carinae]

Is it possible to open new LCME-accredited med schools and start accepting well-qualified students with the aim of producing solely primary care physicians?

Instead of cutting corners and using nurses. Wouldn't it be better to just train full docs MD/DO who acknowledge a commitment to primary care? I think most students who've had to go to DO school (against their will; not that there's anything wrong with DO school/training for students who of their own volition choose it) instead or flee to the carrib would welcome the idea of going to MD school here even it meant they had to sign a contract binding them to pursue residency and practice in primary care.

yes?

No?

 

[badasshairday]

Is it possible to open new LCME-accredited med schools and start accepting well-qualified students with the aim of producing solely primary care physicians?

Instead of cutting corners and using nurses. Wouldn't it be better to just full train docs who acknowledge a commitment to primary care? I think most students who've had to go to DO school instead or flee to the carrib would welcome the idea of going to MD school here even it meant they had to sign a contract binding them to pursue residency and practice in primary care.

yes?

No?

Yes. But most DO and Carib students go into primary care anyways. We would need to build a ton of schools, STAT!

 

[filter07]

Is it possible to open new LCME-accredited med schools and start accepting well-qualified students with the aim of producing solely primary care physicians?

Instead of cutting corners and using nurses. Wouldn't it be better to just train full docs MD/DO who acknowledge a commitment to primary care? I think most students who've had to go to DO school (against their will; not that there's anything wrong with DO school/training for students who of their own volition choose it) instead or flee to the carrib would welcome the idea of going to MD school here even it meant they had to sign a contract binding them to pursue residency and practice in primary care.

yes?

No?

In an effort to address the U.S. shortage of primary care physicians, Texas Tech University Health Sciences Center School of Medicine (TTUHSC SOM) today announced the first three-year medical degree ever approved by the nationally recognized accrediting authority for medical education. The new Family Medicine Accelerated Track (FMAT) program will allow primary care students at the TTUHSC SOM to complete their degree in three years at half of the cost of the standard four-year program.

With the LCME approval, the TTUHSC SOM will begin accepting FMAT students from the incoming class this summer. TTUHSC SOM has presented its approved program to the national Council of Deans and other medical schools are expected to pursue similar programs in the future.

http://www.ttuhsc.edu/newsevents/search/Default.aspx?id=4874-4

 

[Maybeknot]

In an effort to address the U.S. shortage of primary care physicians, Texas Tech University Health Sciences Center School of Medicine (TTUHSC SOM) today announced the first three-year medical degree ever approved by the nationally recognized accrediting authority for medical education. The new Family Medicine Accelerated Track (FMAT) program will allow primary care students at the TTUHSC SOM to complete their degree in three years at half of the cost of the standard four-year program.

With the LCME approval, the TTUHSC SOM will begin accepting FMAT students from the incoming class this summer. TTUHSC SOM has presented its approved program to the national Council of Deans and other medical schools are expected to pursue similar programs in the future.

http://www.ttuhsc.edu/newsevents/search/Default.aspx?id=4874-4

😡 Isn't this just going to be more fodder for the DNP's who think that doctors don't need all the years of education and training? 😡

 

[Hernandez]

😡 Isn't this just going to be more fodder for the DNP's who think that doctors don't need all the years of education and training? 😡

Probably not. There is a do school with a 3 year track and it basically cuts all the vacation out and crams 2 years of basic science into 1.5 years and alows for quicker strting of clinicals. But it is primary care only and don't get any elective time for rotations. At least that's how I understand it.

 

[Apollyon]

Probably not. There is a do school with a 3 year track and it basically cuts all the vacation out and crams 2 years of basic science into 1.5 years and alows for quicker strting of clinicals. But it is primary care only and don't get any elective time for rotations. At least that's how I understand it.

If that's what it is, then it's not a new idea. Doing 4 years of med school in 3 was "in vogue" in the late 80s and early 90s. I know a guy that did that, then did EM, and is now a county health commissioner. (Then again, as I've also been told about people that do 6 or 7 year programs, the people that do 6 or 7, or med school in 3 years, are the ones that SHOULD do 4 years of college and 4 years of med school, for the social aspect.)

 

[carlosc1dbz]

Probably not. There is a do school with a 3 year track and it basically cuts all the vacation out and crams 2 years of basic science into 1.5 years and alows for quicker strting of clinicals. But it is primary care only and don't get any elective time for rotations. At least that's how I understand it.

PA are going to want to get paid more, if medical school is cut down to 3 years.

 

[Maybeknot]

Probably not. There is a do school with a 3 year track and it basically cuts all the vacation out and crams 2 years of basic science into 1.5 years and alows for quicker strting of clinicals. But it is primary care only and don't get any elective time for rotations. At least that's how I understand it.

I'm not speaking of the validity of this idea; I'm just saying that, at this juncture, cutting down the length of medical school is just going to provide more fuel for the DNP-as-independent-PCP's fire, and goes against our best argument -- that our education and training is vital in the process of becoming an independent health care provider.

 

[Rabbit Hole]

So.. their answer to the primary care shortage is to create a 3 year bastard MD program leading into a family medicine residency.

Besides all the obvious problems this will cause with the mid-level propaganda relations teams..

This "answer" has very dangerous implications. First of all, it tells me that the people behind this idea must smoke a hell of a lot of crack. Second, it bastardizes the specialty of family medicine - faster, easier, cheaper - that's the message I get. Third, my "used car salesman" warning bells are going off - how much trust would you put in a program who's sole purpose for existing is to siphon medical students into family medicine because they couldn't think of a better idea? Fourth, oh wait... I'll just skip this one.

F-MAT Family Medicine Accelerated Track

[YOUTUBE]http://www.youtube.com/watch?v=Gqfshpe7unQ&feature=player_embedded[/YOUTUBE]

 

[Hernandez]

So.. their answer to the primary care shortage is to create a 3 year bastard MD program leading into a family medicine residency.

You guys do realize that 3 year medical program were actually very common up till the mid 80s right?

You're getting your panties in a bunch over nothing. "oh my god they're making fm take 10 years to complete instead of 11. Or heaven forbid they take someone who's only done the bare minimum pre-recs in college and only have 90 hours that'll mean they became fm in 9 years!"

they will still have to take the boarding steps and pass they'll still have to take specialty licensure and the recent debacle with the dnp board that was suppose to be equivelent to step 3 had an attrocious pass rate and I'd dare to guess much simpler than the real step 3 shows that there is still a very large educational gap between midlevels and docs, even do who might have given up their Christmas and summer vacations to finish sooner

 

[Maybeknot]

You guys do realize that 3 year medical program were actually very common up till the mid 80s right?

What changed 25 years ago?

You're getting your panties in a bunch over nothing. "oh my god they're making fm take 10 years to complete instead of 11. Or heaven forbid they take someone who's only done the bare minimum pre-recs in college and only have 90 hours that'll mean they became fm in 9 years!"

I'm going commando, so nothing is in a bunch over nothing. There's a set curriculum, and for schools to drop graduation requirements, regardless of what specialty you're looking to go into, should send up alarm bells to anyone.

they will still have to take the boarding steps and pass they'll still have to take specialty licensure and the recent debacle with the dnp board that was suppose to be equivelent to step 3 had an attrocious pass rate and I'd dare to guess much simpler than the real step 3 shows that there is still a very large educational gap between midlevels and docs, even do who might have given up their Christmas and summer vacations to finish sooner

There's a lot made of this "simplified step 3," and I don't think it's a good point to hang our hat on. If this becomes an issue, I'm sure Kaplan or USMLEWorld will offer courses or what-not, the DNP's pass rates will increase, and our own position on licensing exams will soon be used against us.

 

[bronx43]

So.. their answer to the primary care shortage is to create a 3 year bastard MD program leading into a family medicine residency.

Besides all the obvious problems this will cause with the mid-level propaganda relations teams..

This "answer" has very dangerous implications. First of all, it tells me that the people behind this idea must smoke a hell of a lot of crack. Second, it bastardizes the specialty of family medicine - faster, easier, cheaper - that's the message I get. Third, my "used car salesman" warning bells are going off - how much trust would you put in a program who's sole purpose for existing is to siphon medical students into family medicine because they couldn't think of a better idea? Fourth, oh wait... I'll just skip this one.

Three points that can be summarized into "I don't like this idea, but I have no real arguments against it" doesn't count as "dangerous implications."

 

[Rabbit Hole]

Three points that can be summarized into "I don't like this idea, but I have no real arguments against it" doesn't count as "dangerous implications."

You're right, I was just channeling my inner rage earlier. 😡
Feel better now so that's good 🙂

What I mean by "dangerous implications" is that I believe this program structure will be used as a model for other medical schools who may want to adopt similar programs. I think this is dangerous because it creates another class-divide amongst physicians. What do we have already? Off the top of my head - MD DO MD/PhD and this new program will be MD family med fast tracks. A few concerns I have if this model becomes widely adopted: How will this affect selection criteria in family medicine residency programs? Family medicine is perceived as a less desirable specialty right now, how does this program fix that image? Is it really a good idea to recruit medical students to a fast track in family medicine after they have only taken 2 blocks of year 1 courses? Most of all, I don't understand why this is their "answer" to the primary care physician shortage. It seems like this program is designed for the bottom line.

Of course, the mid-level impact. Without going into too much detail - I feel that this program will be used to promote expansion of scope of practice by nurse practitioners. They will have a field day with this. Again, the family medicine specialty will become even more undesirable because who wants to deal with that kind of crazy anyway?

Just my opinion after a cursory review of what I read on their website.
I still don't like this idea.

 

[Dr.Millisevert]

You're right, I was just channeling my inner rage earlier. 😡
Feel better now so that's good 🙂.

There are a few 3 year med schools in Canada now. I think Calgary and McMaster to name a couple.

 

[deleted87716]

Just my opinion after a cursory review of what I read on their website. I still don't like this idea.

How is this any different than a combined residency program?

The program is condensed, but it still meets Board requirements, and the entry criteria and exit criteria are exactly the same.

If you want to complain, complain about those combined undergrad/medical school programs that let you skip the MCAT. 😉

 

[Rabbit Hole]

How is this any different than a combined residency program?

The program is condensed, but it still meets Board requirements, and the entry criteria and exit criteria are exactly the same.

If you want to complain, complain about those combined undergrad/medical school programs that let you skip the MCAT. 😉

It's different because the years spent in medical school are like the "formative" years that most students have in common. You know what I mean? Maybe I'm just nostalgic.

 

[deleted87716]

It's different because the years spent in medical school are like the "formative" years that most students have in common. You know what I mean?

Actually, no.

 

[Rabbit Hole]

Actually, no.

My threshold for making sense was crossed about 4 hours ago when I should have went to sleep. You may never "know what I mean". 😳