Saturday, March 20, 2010

Perspective: Who Speaks for America's 650,000 Independent Private Physicians


-observesthat independent physicians care for 80% of America’s patients,

-describes the physician culture – its belief system, desire for autonomy, and reliance on clinical judgment,

-deplores independent private practice decline, which has shrunk by about 10 % over the last 10 years? (See “The Independent Physician: Going, Going ….” NEJM. February 12, 2010),

accelerating departures of private doctors into retirement, non-clinical careers, hospital employment, and new practice models devoid of 3rd party interference.

- comments at length on a fast-growing movement, locum tenens, traveling physicians for hire.

-says that much of American medicine’s costs stem from lack of competition, open-ended comprehensive plans, mandated guaranteed benefits, restrictive regulations, physician malpractice expenses, ensuing defensive medicine practices, and litigious practice environments,

- discerns that much of the so-called fraud and abuse occurs in Medicare and Medicaid and is perpetrated by non-physicians using stolen identities, rather than physicians in their practices,

-notes that hospital-based medicine, with salaried physicians, as opposed to ambulatory-based medicine conducted by private physicians, drives costs up,

-warns the American people about the impending doctor shortages, the coming access crisis, and longer waiting lines for doctor appointments,

-highlights polls indicating patients trust their doctors more than government data-wielding bureaucrats,

Americans that only 2% of medical students are entering primary care, and that these are the physicians they are expected to visit to sort out problems and to coordinate care,

-points out to Americans that many of the new 31 million who may gain insurance will be assigned to Medicaid rolls and that fewer and fewer doctors will accept new Medicaid recipients because of low reimbursements,

-explains problems imposed by third parties that erode time spent with patients,

-documents that for every hour spent seeing patients, another hour is spent on paperwork and getting permission to perform a test or a procedure,

of doctor’s desire for more personal patient relationships and the patient’s distaste for doctor switching , both caused by health plans changing physician networks,

- appreciates that most patients do not know doctors are forbidden to enter into private contractual relationships with patents should patients desire treatment outside of Medicare,

the often-heard liberal message that the U.S. system ranks 37th in the world is based on a deeply flawed 10 year old WHO study that has since been repudiated by WHO itself,

-has ever heard of another WHO study ranking U.S. health care number one among other nations in “responsiveness” – more attention to patients, shorter waiting times, more amenities, and greater access to world-class care,

shortcomings of evidence-based care, i.e., care based on statistical data on large populations, which may have little relevance to individual patients,

-talks of diagnostic uncertainties, that vast gray zone of vague symptoms of unknown cause, which may require multiple tests and procedures before a diagnosis surfaces.

patients that physicians can spend little time with them in order to gain the revenue to pay malpractice fees, staff overhead, rent, and other costs of doing business,

-has the courage
to say that poor outcomes may rest on what patients do after leaving the doctors, i.e., returning to adverse life styles, not filling prescriptions, resorting to ineffective alternative therapies, rather what the doctor does or recommends in the presence of the patient.

of shortcomings of electronic medical records among doctors – the expense, maintenance costs, lack of return on investment, practice disruptions, 30% dies-installment rate, 25% drops in productivity, mixed records of efficiency and quality improvement, and lack of relevance to solo and small practices.

- forewarms government policy wonks that electronic medical records are virtually useless to doctors as communication tools unless physicians are able to enter progress notes using speech-recognition information, or to have access to useful diagnostic support information,

- to sum up, informs the outside world of the story of independent practitioners - the backbone of American medicine?

Who articulates these things?

Medinnovationblog does.

Coming blog: the Physician Leadership Problem, Reality-Based Health Care, and the Role of the Physicians Foundation

I welcome comments - bad, good, and neutral, and I shall comment on your comments.


頭痛 said...

寂寞又無聊 看到你的BLOG 加油喔!!........................................

Richard L. Reece, MD said...

I'll take this as a compliment.