Wednesday, February 11, 2009

Physician shortages,,independent doctors - Independent Doctors

Today I am thinking about independent thinking by independent doctors. Two happenings of this day trigger this line of thinking.

One is an article in today’s February 12 New England Journal of Medicine(S.L. Isaacs, P.S. Jellinek, and W.L. Ray, “The Independent Physician: Going, Going…” that laments the nearing end of independent practice. The article contains this chart.

Percentage of Independent Physicians in the United States.

Physician Type 1996-1997 2004-2005 Relative Decline
Primary Care 54.3% 51.8% -4.6
Medical Specialist 58.1 % 47.3% -18.6
Surgical Specialist 5.5 % 68.4% -9.4

The authors decry these declines, and, given the fact that independent practice has long been (and still is) the backbone of American medicine, assert the time has come to do something about these declines.

One of the authors, Walker Ray. M.D, a recently retired solo pediatrician from Atlanta and long a champion of independent practice, is a friend of mine and now serves at Vice-President for the Physicians’ Foundation, a national organization supporting the cause of independent practice.

To Walker I dedicate this verse.

With the Hippocratic Oath, Walker made his Declaration of Independence.
For he and his loyal patients, that oath was enough independent evidence.
Then came along third party foes,
Calling themselves HMOs and PPOs.
They threatens to make Independent
physicians a mere Remembrance

Two is a series of surveys now appearing in Healthleadersmedia. com, a prominent website for health care business leaders. One survey describes how doctors are fighting health plans tooth and nail, like the Hatfields and the McCoys. This is true, and doctors are winning lawsuits against such giants as United Health, Aetna, and Cigna. The survey quotes a disease management executive, who says, “Doctors are really hypersensitive of anything they see as an effort by managed care to influence or influence or manipulate them.

And why shouldn’t they? Independent doctors spent years learning their craft, and they resent being forced to march to set of rules, protocols, and guidelines, assembled under the guise of “evidence-based medicine.”

Which leads to this concluding bit of whimsy,

Health plans say independent doctors are hypersensitive.
But that may be because health plan leaders are insensitive.
To the fact that medicine is an Art as well as a Science.
That does not lend itself to blind compliance or a grand alliance,
With those who know little of what is to be with patients interactive

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