Thoughts?

[stonewall22]

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

Clearly a problem. I'm not sure what the answer is.

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[DrMattOglesby]

interesting article (and video).
it highlights certain faults of the medical profession and yet, illustrates the need to bring more doctors to work in these same faulted arenas.
I dont know what the answer is either, in fact, no country has a perfect health care system . . . but ours is definitely hurting.
My suggestions are to petition the government for more loan repayment programs for docs entering primary care as well as alleviating some of that nasty red tape insurance companies impose on the way doctors practice medicine.
but the better questions are; where is the funding for those loan repayment programs going to come from?, and how can insurance companies be litigated so they are less restrictive on medical care?

 

[Jnye33]

My wife actually saw this and made me watch the clip online. My response to her was, "yeah, of course its headed that way...our generation is going to have to do something about it!"

I'm with DrMattOglesby in that the answer is not known, that there is no one (perfect) answer, and that our system is hurting. I also agree that we need to petition for more loan repayment programs, but why stop there? The entire private medical community needs to do more petitioning to get their views across to our elected officials. Write to your governors, representatives, senators, and anyone else you think has some influence. Eventually, change has to happen - whether that change is in a positive direction or not depends on a lot of factors, most of which are out of our direct control!

 

[BCLumas]

I think the problem is that there is no incentive to drive Medical Students towards the PCP life. Although there is a Rural Medicine program, giving more incentives in the form of loan forgiveness might begin to drive students towards that route. I know that one reason I was turned off from being a general Pediatrician (other than that I'm learning to loathe Embryology and Congenital defects) is that after staffing, building maintenance, malpractice insurance, mortgage, car insurance, food, electricity, water, and family maintenance, there just is not a lot of money left over to pay your loans back in a timely period.

We could get into the breakdown of medical school loans, but I think that it is a little bit beyond the scope of our discussion. Simply put, giving medical students who enter primary care some kind of loan forgiveness (20%, 30%, 40%, or more, depending on location and need in that area) would draw more students to that lifestyle.

I cannot comment too much more, as I am only just beginning my medical school career. I have heard from people in the outside world that our President Elect has been tossing a similar idea around, but I have neither the time nor the energy to do anything but study, sleep, and, occasionally, drink.

Good luck.

 

[smtort]

Primary care doctors need to find ways to make patient management a billable item. Historically, doctors have been paid for procedures and tests, which is not cutting it in primary care fields where procedures are not always warranted, patient consultations are longer and management is broader.

 

[Jnye33]

Primary care doctors need to find ways to make patient management a billable item. Historically, doctors have been paid for procedures and tests, which is not cutting it in primary care fields where procedures are not always warranted, patient consultations are longer and management is broader.

I agree with you - that we need to change how primary care physicians are compensated for their time. However, I don't see the responsibility of change falling only on the shoulders of primary care physicians. "Finding ways to make patient management a billable item" without an institutional change sounds either like it would cost patients more, or it sounds like fraud.

 

[189362]

It just doesnt make sense to me how insurance companies make a crap load of money from employers, employees, and well, overall consumers and not have to pay the PCP for the services.

To me that seems like ordering soup salad apps. and steak at dinner and only paying for the soup and salad. Someone needs to wash some dishes, if you know what I mean.

 

[scpod]

Primary care doctors need to find ways to make patient management a billable item. Historically, doctors have been paid for procedures and tests, which is not cutting it in primary care fields where procedures are not always warranted, patient consultations are longer and management is broader.

There is a possibility that the "medical home" will eventually become a reality and PCPs will be able to be for time on the phone, emails, etc. but it's a good ways away still. Yet, PCPs can do a lot of procedures in the mean time and make good money. I'm doing family practice this month. The doc I'm working with does tons of things in the office-- x-rays, stress tests, nuclear stresses, bladder scans, etc. and those things pay good money. You don't have to be a specialist to do all that. He makes 3 to 5 grand on a day that he's not even there because of those things. He has one day a week for "surgical" stuff. Today, I did a few minor surgical procedures and my first punch biopsy. Those things pay pretty well. He recently added a fulltime ARNP because he was so busy. It all depends on how much money you really want to make and what you are willing to do to get it done.

 

[stonewall22]

I think the problem is that there is no incentive to drive Medical Students towards the PCP life. Although there is a Rural Medicine program, giving more incentives in the form of loan forgiveness might begin to drive students towards that route. I know that one reason I was turned off from being a general Pediatrician (other than that I'm learning to loathe Embryology and Congenital defects) is that after staffing, building maintenance, malpractice insurance, mortgage, car insurance, food, electricity, water, and family maintenance, there just is not a lot of money left over to pay your loans back in a timely period.

We could get into the breakdown of medical school loans, but I think that it is a little bit beyond the scope of our discussion. Simply put, giving medical students who enter primary care some kind of loan forgiveness (20%, 30%, 40%, or more, depending on location and need in that area) would draw more students to that lifestyle.

I cannot comment too much more, as I am only just beginning my medical school career. I have heard from people in the outside world that our President Elect has been tossing a similar idea around, but I have neither the time nor the energy to do anything but study, sleep, and, occasionally, drink.

Good luck.

I think that's a good idea, but that money has to come from somewhere...

 

[andexterouss]

I think the problem is that there is no incentive to drive Medical Students towards the PCP life. Although there is a Rural Medicine program, giving more incentives in the form of loan forgiveness might begin to drive students towards that route. I know that one reason I was turned off from being a general Pediatrician (other than that I'm learning to loathe Embryology and Congenital defects) is that after staffing, building maintenance, malpractice insurance, mortgage, car insurance, food, electricity, water, and family maintenance, there just is not a lot of money left over to pay your loans back in a timely period.

We could get into the breakdown of medical school loans, but I think that it is a little bit beyond the scope of our discussion. Simply put, giving medical students who enter primary care some kind of loan forgiveness (20%, 30%, 40%, or more, depending on location and need in that area) would draw more students to that lifestyle.

I cannot comment too much more, as I am only just beginning my medical school career. I have heard from people in the outside world that our President Elect has been tossing a similar idea around, but I have neither the time nor the energy to do anything but study, sleep, and, occasionally, drink.

Good luck.

I know University of Kansas forgives your entire tuition if you wanna practice in its rural parts. But programs like these are scattered, sometimes hard to find and school specific. We need a federally funded mandate that wipes the slate clean for anyone going to PCP in underserved area.
Family medicine is nice job and $150,000 is a salary comparable to that of some investment bankers. Very low malpractice insurance and you have a life after work.

 

[Dissected]

well, this is the field we all have chosen . It will be interesting to see how much has changed in the next 10 or so years when we start practicing. Hopefully things are a little better organized by then or we will be in a similar spot as the physician on that video. Especially as the new kids on the block fresh out of residency.

 

[GreenShirt]

I know University of Kansas forgives your entire tuition if you wanna practice in its rural parts. But programs like these are scattered, sometimes hard to find and school specific. We need a federally funded mandate that wipes the slate clean for anyone going to PCP in underserved area.
Family medicine is nice job and $150,000 is a salary comparable to that of some investment bankers.Very low malpractice insurance and you have a life after work.

A life after work after you complete hospital rounds and after you finish charts and after being on call. Charts can keep you in the office well after 8:00pm while rounds will have you out of bed at 5:00am.....it can be a 5-8 kind of a job rather than a nice 8-5 job of an investment banker. You can gain some time by spreading out call amongst a couple of docs or having a hospitalist oversee your in-patient load, but the charts will still overwhelm you.

I won't even go into how much of that 150,000 you actually take home after loans and taxes.

I'm wondering if maybe the best thing would be to allow mid-levels to take over the PC arena and have doctors just specialize. Medicine is now so deep and wide in terms of knowledge that need more specialists.

 

[troponin31]

two topics that i dont know much about wondering if people can weight in:

-england was having a PCP shortage and started some new program for it. where they are increasing the salaries more... anyone know anythinh about it?

-also ive heard that DO's are gonna start billing for OMM time seperately. so that they can make it separate from the visit and then get more $. anyone?

 

[stonewall22]

I know University of Kansas forgives your entire tuition if you wanna practice in its rural parts. But programs like these are scattered, sometimes hard to find and school specific. We need a federally funded mandate that wipes the slate clean for anyone going to PCP in underserved area.
Family medicine is nice job and $150,000 is a salary comparable to that of some investment bankers. Very low malpractice insurance and you have a life after work.

And where will that money come from? I'm not arguing here that I disagree with the idea (although I don't think the Govt is responsible for fixing every problem that comes along), but to fund this taxes will have to be increased, and the cost gets passed right back to the consumer, and voila, we have the same problem.

I like the idea of states providing this service better (like Kansas) since they can more appropriately assess the needs of the state and use state revenue to do this.

 

[mrbayoubengal]

I know LSU’s Med Schools offer full tuition exemption for anyone who is will to go into practice in rural areas. I think the insurance companies are the problem. They are making a killing while everyone else is struggling to get by. I don't see how Obama's med plan is going to work either. Hopefully, its all lies, and he will just spend his four years planning on how to win his second term. What the government really needs to do is offer tuition exemptions for anyone majoring in the health, sciences, and engineering fields and then we wouldn't have any of these shortages. Let everyone else foot the bill because their jobs aren't of any significance to the health of our people or state of the economy. Instead billions on top of billions of dollars are invested in the sands of Iraq. Maybe, if we would have our priorities in order, we wouldn't be worrying about these issues to begin with.

 

[premedrod]

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html

Clearly a problem. I'm not sure what the answer is.

to be frank, it pisses me off. the compensation for family practice doctors is crap. this is one of the hardest specialties and they aren't appreciated as much as other specialties. you need to know a wide range of conditions and treat psychiatric problems at times. its ridiculous that in some specialties you just sit around and pick and choose the cases you want and how big of a workload you want and still make a bunch of money.

i agree there needs to be changes. i am hoping that the current administration makes dramatic changes that will lessen the red tape so that doctors can actually do their jobs effectively without spending os much time on paper work and making phone calls. i was surprised at how much paperwork and phone calls doctors have to make throughout their day.

 

[Dissected]

i was surprised at how much paperwork and phone calls doctors have to make throughout their day.

charts charts charts see a few patients dictation dictation charts charts charts dictation...and so it continues...