Sunday, May 3, 2009

Physician shortage, Doctor shortage, primary care -Primary Care Doctors: Doing Good, Doing Well

For primary care doctors, hours are long, waiting rooms crowded, pay is half that of specialists, debts after medical schoolas high as $200,000, their numbers short 50,000 of those needed, and less than 2% of medical students choosing general internal medicine.

Small wonder, a primary care crisis looms.

Relief may be in sight. Medical schools are expanding, some states are paying tuitions of medical students who promise to enter primary care, Congress is considering a 5% bonus for primary care practitioners, and support is growing for primary-care based medical homes.

Unfortunately, since it takes10 years to produce a newly minted primary doctor, a shortage of generalist doctors will persist.. In the meantime, some innovations may help primary care professionals weather the storm. Ideally, these innovations do good for the patient, and do well for the primary care doctor, enhancing their income and leaving more time to see patients.

Here are a few modest suggestions doing good and doing well

1. Instant Medical History – This online tool, driven by the patient, produces a narrative history guided by clinical algorithms. It allows your patient to enter their chief complaint and history from home before visiting the office or even in the waiting room and in the process save 6-10 minutes per patient and get paid a code higher for “complete workup.” This is good for patients because they can tell their history from their point of view and have a complete history and physical findings before the leave the office. It is good for the doctor because he/she can zero in quickly on the problem and have compete documentation of what occurred for billing and referral purposes.

2. National Procedure Institute – Do simple procedures in your office, and in the process, save the system money, offer your patient convenience, and generate more revenues than by cognitive visits alone. This is good for the patient because it saves time, arrives quickly at a diagnosis, e.g. for skin lesions, and takes care of problems at one visit. It is good for doctors because they can be trained to develop important clinical skills.

3. Train your staff and yourself to anticipate “moments of truth” by which patients judge a practice and in the process keep and find loyal patients who will spread the news by word of mouth (see “Managing Patient Expectations by Susan Keane Baker). This is good for patients because it generates satisfaction and humanizes office visits, and it is good for doctors because it sensitizes them and their staff to patient needs.

4. Make it a point to see patients on time or your money back and post a notice in your office to that effect, waiting is the bĂȘte noir and most common complaint of patients. This is good for patients because it assures them won’t waste their time and they will be seen promptly for their problem. It is good for doctors because it shows they respect their patient’s time is valuable.

5. Restructure your practice into three types of visits - simple, medium, and long, and charge predictable fees, e.f., $59, $79, and $99 for 10 minute, 20 minute, and 30 minute visits. Under this structure, you will see more uninsured patients, avoid 3rd party payment, and cut staff. ( See Simplecare. Com). This is good for patients with limited incomes or without insurance because of the predictable pricing. It is good for doctors because it cuts time spend on third party paperwork and reduced\s overhead.

6. Have a member of your group rotate as a hospitalist while at the same time retaining your clinical office skills. Hospitals are the fastest growing primary care subspecialty. This is good for patients because they have 24 doctor coverage in the hospital. It is good for doctors because they become skilled at in-hospital procedures, have regular hours, and have coverage for themselves and their partners on nights and weekends.

7. Dispense drugs from your office using inventory of commonly prescribed drugs and in process make $6 per prescription, save patients money, offer convenience, and assure compliance (see chapter 5 in my book “Innovation-Driven Health Care”). This is good for patients because they can get prescriptions at the doctor’s office, usually at lower prices than at the local pharmacy (Wal-Mart’s $4 generics may be an exception). It is good for doctors because it is a source of extra income and helps make sure patients take their medicine (1/3 of patients never fill their prescriptions).

8. Charge a modest fee for answering email requests for advice on non-emergent problems or for canned advice on common problems. This is becoming common among some insurance plans, especially on the West Coast. It is good for patients because it saves time and money, and it is good for doctors because it cements patient relationships and takes care of some minor problems which do not require an office visit, such as prescription refills.

9. Concentrate on preventing vascular deaths in patients who from part of the metabolic syndrome (hypertension, diabetes, dyslipidemia, obesity) See Bestermann in The big killers in America are heart attack and strokes, and many these can be prevented by diligent attention to preventive –protocols. This approach has been adopted in the Southeastern United States by an organization known as COSHEC (Consortium for Southeaster Hypertension Control). It is good for patients because it prevents many vascular deaths; it is good for doctors because it can easily part of a routine practice and saves many lives.

10. Become a partner in setting up a multispecialty ambulatory care center in underserved physician-short areas. Many retirees in the United States are relocating in states with warmer climate but in doctor-short regions. IN response to this, doctors in North Carolina are setting up multispecialty ambulatory care centers with co-located pharmacies, fitness centers, and physical therapy facilities. This is good for retirees who seek all purpose ambulatory facilities. It is good for doctors who seek new patients and who wish to have an ownership stake.

1 comment:

Unknown said...

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