Wednesday, December 26, 2012

Ten Impure and Complex Primary Care Truths
The truth is rarely pure and never simple.
Oscar Wilde (1854-1900), The Importance of Being Earnest (1895)
It’s like the patient is bleeding faster than we can transfuse.
“Where Have All the Primary Care Doctors Gone? Pauline Chen, MD, New York Times, December 21, 2012
December 26, 2012
One -  No matter what Obamacare proposes or does, the primary care shortage will keep relentlessly growing.
Two – Medical students know primary care doctors work longer hours , make half as much as specialists, and hve more balanced lives.
Three – Medical students’ medical school mentors and heroes  are specialists, whom they follow and emulate.
Four -  Congress has put a funding lid on primary care residencies.
Five- Society tends to respect the specialists’ opinions and technologies more  and to reward specialists more than primary care doctors.
Six -  Medical homes and accountable care organizations, designed to empower primary care, are unproven concepts.
Seven -  Given average educational debts of $150,000,  medical students pick higher paying specialties.
Eight -  Primary care is more difficult to master than specialty care because of the overwhelming amount of information required.
Nine -  One practical way to equalize specialty care pay is for primary care doctors to perform more procedures (see National Procedures Institute).
Ten  -  Another practical way to enhance primary care is to cut expenses and to increase revenues by switching to concierge and cash-only practices.
Eleven –  The AMA, CMS, and specialists stack the  deck against primary care by controlling the Reimbursement Update Committee (RUC), which sets the codes for Medicare and Medicaid.
Tweet:  Eleven  factors stunt the growth of primary care and make it likely the primary care shortage will escalate.

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