A Modest Proposal: A “Realistic” Rather Than A "Mystery Shoppers” Survey of Primary Care Practice

June 28, 2011- I have a modest proposal – that the Obama administration make an up-front, as opposed to a stealth "mystery shoppers'" survey of primary care doctors to see why these doctors act as they do and why they accept some patients and turn down others.

My proposal stems does not come from out of the blue. It comes from the controversy surrounding the Obama administration’s proposal to send “mystery shoppers" around to check on doctors’reasons for accepting or rejecting patients, and from a June 27 LA Times article “”What Happened to the Family Doctor?”

Here would be some of my questions for family physicians and general internists, who, some claim, are going the way of the Dodo Bird.

Q: Are you optimistic about the future of primary care? If not, why not?

Q: If you had it to do over again, would you pick primary care as a specialty?

Q: How many patients a day do you have to see to break even in your practice?

Q; Do you think you have enough times to spend with patients?

Q: What are your “take-home” revenues each month?

Q: Are you still paying off your medical school debt? And if so, how much is that payment per month?

Q: What are your malpractice premium payments each month?

Q: How many members do you have on your staff? And what do you have to pay them each month?

Q; How many of these employees are involved in direct patient care? and who many are engaged in processing and justifying claims?

Q: How much time outside the exam room do you spend on non-revenue producing activities - renewing prescriptions, talking on the phone, writing emails to patients, filling out paperwork forms?

Q: Most health insurers, including Medicare, pay only for face-to-face visits. You are only paid for using 5 codes suggested by Medicare and commercial insurers.
Do you think this is realistic – or fair?

Q: Are you considering entering another specialty – such as dermatology, anesthesia, or hospitalist care – with set hours and a regular salary?

Q: Have you considered becoming a concierge physician where you could spend more time with patients?

Q: Do you think the Medical Home Concept has legs. i.e., is a realistic alternative to your current mode of practice? Will it provide more access to primary care?

Q; Do you believe a capitation-like system – in which you are paid a set fee for managing a patient’s total care – is preferable to the present fee-for-service practice?

Q: Are you in favor of Accountable Care Organizations, led by teams of primary care physicians acting in concert with hospitals?

Q: Do you believe you ought to be at financial risk for untoward patient outcomes?

Q; Do you believe electronic health records in every doctor’s office and every hospital department will reduce costs and errors and improve outcomes?

Q: Do you favor the current Patient Protection and Affordability Act? Do you think it will protect patients and make care more affordable for most patients?

Such a survey would remove much of the mystery of why a primary care shortage is growing and spreading.