Thursday, March 27, 2008

Physician Shortage - The Fix?

Suddenly, a chorus of voices are shouting - train more primary care doctors, pay them more, pay them as well as specialists, and empower them by giving them control over referrals.

“Let’s eliminate E & M codes. Let’s create financial incentives for serving as an ‘Advanced Medical Home’ Let’s pay primary care physicians for what they do – providing comprehensive and coordinated care for patients – rather than by fee-for-service for individual acts. Let’s tie this payment into the severity and complexity of the illness. Let’s encourage the primary care specialists to become involved in coordinating care with the specialists to whom they refer.”

Norbert Goldfield, MD, Internist, Springfield, Massachusetts, Head, 3M Informatics Group, 2007

“The Patient-Centered Primary Care Collaborative, a coalition of large employers and professional groups, has been advocating for changes in reimbursement and the roles of primary care physicians. By realigning the incentives, by using tools, data and programs to identify and manage risk at the level of primary care, and by enforcing downstream accountability from the primary care base, these models have the potential to reinvigorate primary care, and to drive tremendous new improvements in quality and efficiency, and to help re-establish health care stability and sustainability.”

Brian Klepper, PhD, health care analyst, The Doctor Weighs in Blog, March 27, 2008

United States is in the throes of a deepening physician shortage, and will experience a shortfall of 100,000 to 200,000 physicians over the next 15 years. Closing this gap will require an expansion of both medical schools and graduate medical education (GME) positions at the nation’s teaching hospitals. The Council also called for GME capacity to be increased by 30 percent. The Council warned that lifting the current cap Congress has imposed on Medicare-based funding for GME, while necessary, will not be enough.”

Press Release, Council on Physician & Nurse Supply, University of Pennsylvania Leonard Davis Institute of Health Care Economics, and AMN, Inc, America’s largest heath care staffing company

Even without health-care reform, the demand for family physicians is expected to surge by 2020, when the nation will need 140,000 family physicians. That’s a 40% increase over the family physicians at work in 2006. The fact is that costs are too high for an economically viable practice in many areas. Payments from the government and large insurance companies don’t adequately cover expenses and the burden of educational debt. The cost of malpractice insurance to practice the full range of primary care medicine, including obstetrics, is untenable. How can anybody rationally expect to build up the nation’s health on that crumbling foundation”

Benjamin Brewer, MD, family physician, The Doctor’s Office, “Primary Health Care Needs Fixing Before Universal Care Can Work,” Wall Street Journal, March 26, 2008.

“Perhaps these retainer practices, if they continue to flourish, will stimulate a resurgence of outpatient internal medicine. We will be able to continue to train internists who understand the spectrum and complexity of disease, because the retainer model provides an option for those who prefer the outpatient setting but also want complexity and comprehensiveness. Whereas many critics are concerned with the finances of this model and worry about inequities, supporters emphasize the retainer physician's ability to provide the level of care and attention that patients deserve. The retainer model originated and is succeeding because of classic market forces. Physicians and patients find our current arrangements undesirable, thus this new alternative model gives them an interesting choice. Perhaps it will save outpatient internal medicine.”

Robert M. Centor, MD, Professor and Director of General Medicine, U. of Alabama, Birmingham. March 20, 2008, Medscape Business of Medicine

An impossible dream? Not to every major industrialized country on the planet. This plan is called single-payer. You might have heard of it, perhaps when it's being disparaged by insurance and pharmaceutical companies. There are many controversial issues related to a single-payer healthcare system, but it is time for all of the stakeholders in medical care to realize that the consequences of our current quagmire of a healthcare anti-system are too important to remain intransigent to change. The work will be hard, and some sacrifices will have to be accepted on all sides. However, in the end, we will have a system that is not only fair and efficient but caring and personal as well.”

Charles Vega, MD, Associate Professor, Department of Family Medicine, U. of California, Irving, March 20, 2008, Medscape Business of Medicine

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