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Doctors Revolt
 
 
  The USA system of healthcare is different than anywhere else and so reform might have to be different. Don't forget doctors when talking about industry and government in healthcare reform. Some would say we need to make doctors or people who want to be doctors happy too. Reimbursement practices by private and public insurers has destroyed medical practice in the USA.
 
Put primary care doctors at the center of reform
 
By Deep Shah
 
For the Atlanta Journal-Constitution
 
Tuesday, May 12, 2009
 
As a future physician in Georgia, I care deeply about the reshaping of our health care system. We need reforms that meaningfully enhance the ability of primary care doctors to care for their communities and attract the brightest students to their ranks.
 
An insufficient number of physicians want to enter primary care. In a 2008 JAMA report, investigators found that only 2 percent of medical students intend to pursue careers in general medicine. The results of this year's national residency match program showed 9 percent of family practice seats remained unfilled, and less than half of those entering the branch graduated from a U.S. medical school.
 
The last time primary care received any attention was during the 1990s managed care "revolution." Instead of rescuing health care, though, the movement burdened physicians with paperwork and moral dilemmas.
 
It also brought lower reimbursement rates and increased red tape, both of which still plague medical practices.
 
These have culminated in great dissatisfaction within the field. A recent survey by the Physicians Foundation showed that 49 percent of primary care doctors would seriously consider closing their practices if an alternative existed.
 
Historically, medical students have sought to enter more lucrative branches, such as dermatology and surgery. This trend continues today. UGA professor Mark Ebell revealed a strong correlation between salaries and popularity of specialties in a JAMA study published last year.
 
The relatively low salaries in primary care, at the very bottom in medicine, deter prospective candidates.
 
With careers characterized by relatively low pay, high stress and long hours, what incentive do we give students to enter primary care? To attract the best minds, we must properly reward effective primary care physicians in a way that improves the value of every health care dollar spent. We should:
 
> Forgive medical school loans for anyone entering primary care.
 
> Re-evaluate primary care payment systems. Stagnant fees, including the marginal 5 percent Medicare increases, will further exacerbate the crisis. The current model does not even keep pace with inflation.
 
> Make pay-for-performance real by valuing quality over volume. Incorporate the medical professional associations in the development and evaluation of these practices for public accountability, ensuring transparency and cooperation. The private industry will follow suit.
 
> Encourage primary care physicians to work after hours through moderate fee increases. Paying doctors to work nights and weekends will increase continuity of care. It also is one of the most effective strategies to reduce the congestion and costs incurred by unnecessary emergency room visits.
 
> Reward experience. Doctors with successful records should be paid more than those fresh out of residency. The current system reimburses uniformly across the spectrum of experience. A revamped approach will motivate physicians to sharpen their skills throughout their career.
 
Recent forecasts from the University of Missouri estimate a nationwide deficit of 44,000 family physicians and general internists by 2025. Georgia currently ranks 40th in aggregate physician supply. Our state has taken measures to boost its number of medical seats, such as developing the new Medical College of Georgia satellite campus in Athens.
 
If we want to draw the best and brightest to our state, though, we must be on the forefront of strategic efforts to value primary care. I hope our leaders have the vision and courage to take us there.
 
Deep Shah, a UGA graduate and Rhodes Scholar, begins medical studies at Harvard in August.
 

Editorial: Where are all the doctors?
Shortage impacts vital care

 
Sunday, May 10, 2009
http://www.venturacountystar.com
 
Medicine's frontline of defense - the primary-care physicians, the family doctors, if you will - is crumbling. And no national healthcare reform plan is likely to succeed unless that critical problem is solved.
 
The issues of access and affordability are almost beside the point without addressing the shortage of primary-care physicians.
 
In his series "The Doctor Is Out," Lee Bowman of Scripps Howard News Service found that as many as one in five Americans does not have a family doctor. And this translates directly to higher rates of illness and death and higher costs.
 
Mr. Bowman, with SHNS computer-assisted reporting specialist Thomas Hargrove, surveyed databases and found that counties with more primary-care physicians had significantly lower death rates than those with fewer family doctors and they also had lower death rates from detectable and preventable diseases like heart disease and colon cancer. For hypertension - elevated blood pressure that is treatable - the difference in death rates was 32 percent.
 
In a well-ordered medical system - which, after all, is what healthcare reform is all about - the family doctor would act as a quarterback, directing a team of nurses, nurse practitioners and technicians and referring patients to specialists as needed.
 
The government says there are 326,000 family doctors in the nation but not all of them provide primary care. By one measure, that assumes the doctors are putting in brutal hours with a full load of patients, the country is short 60,000 to 80,000 primary- care doctors.
 
That situation is about to get markedly worse and the best health insurance in the world is of no help if there aren't frontline doctors to accept it.
 
One survey found almost half of all primary-care doctors say they plan to retire or curtail their practices in the next three years. And their replacements are not in the pipeline.
 
Another recent survey found that only about 7 percent of medical students said they planned to pursue family care and only 2 percent of med school grads trained for internal medicine - the source of most family doctors - planned to enter primary care.
 
One reason is the pay - $150,000 a year or less, half as much as specialists are paid and a disincentive to medical students who graduate with an average debt of $140,000. Medicare, Medicaid and private insurance generally don't pay for a family doctor to quarterback his patients' medical care or for single visits that deal with multiple medical issues.
 
The alternative shaping up is a patchwork of emergency-room visits, walk-in clinics, hoping to luck into a doctor who is accepting new patients or simply forgoing seeing a doctor, resulting in higher costs long term. If, as is generally agreed, our healthcare system is broken, primary care is the place to start fixing it.
 
 
 
 
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