Is obama not good for family medicine?

[Dr McSteamy]

do you guys hope he fails?

he's calling for pay cuts, but he's slightly increasing reimbursement to primary care docs? how does that work?...

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[deleted87716]

Actually, Obama will likely be quite good for primary care. How will he do it? It's called "robbing Peter to pay Paul," a.k.a. "redistribution of wealth." Proceduralists lose, generalists win.

Oh, they'll kick and scream, but there's pretty much no other way to do it.

Of course, as he pushes primary care docs higher up the income ladder, he'll raise taxes on everyone earning more than $250,000/year so that a good chunk of the gains flow right back to Uncle Sam. Brilliant.

 

[dilated]

Actually, Obama will likely be quite good for primary care. How will he do it? It's called "robbing Peter to pay Paul," a.k.a. "redistribution of wealth." Proceduralists lose, generalists win.

Oh, they'll kick and scream, but there's pretty much no other way to do it.

Of course, as he pushes primary care docs higher up the income ladder, he'll continue to raise taxes on everyone earning more than $250,000/year so that a good chunk of the gains flow right back to Uncle Sam. Brilliant.

Obama's big proposal for primary care is a less than 10% pay raise. It's pretty obvious the target is pay cuts for specialists, approximately the same salary for PCPs. Except he's all about increasing scope of practice for PAs and NPs to practice primary care on an equal basis with MDs. That's a pretty high price to pay in the long term for a small pay raise.

 

[E Dubble]

Actually, Obama will likely be quite good for primary care. How will he do it? It's called "robbing Peter to pay Paul," a.k.a. "redistribution of wealth." Proceduralists lose, generalists win.

Oh, they'll kick and scream, but there's pretty much no other way to do it.

Of course, as he pushes primary care docs higher up the income ladder, he'll raise taxes on everyone earning more than $250,000/year so that a good chunk of the gains flow right back to Uncle Sam. Brilliant.

http://forums.studentdoctor.net/showthread.php?t=647234

 

[andwhat]

Actually, Obama will likely be quite good for primary care. How will he do it? It's called "robbing Peter to pay Paul," a.k.a. "redistribution of wealth." Proceduralists lose, generalists win.

Oh, they'll kick and scream, but there's pretty much no other way to do it.

Of course, as he pushes primary care docs higher up the income ladder, he'll raise taxes on everyone earning more than $250,000/year so that a good chunk of the gains flow right back to Uncle Sam. Brilliant.

agree completely... It is already in plan here locally... A work in process, that is finally going to be finished soon.
http://www.mdconsult.com/das/news/b...l?nid=210543&date=week&general=true&mine=true

 

[andwhat]

http://forums.studentdoctor.net/showthread.php?t=647234

NPs and RNs cannot function as Physicians. It is a fact. That is not a knock on Nursing, because Nursing is extremely important. However, you cannot compare a Nurse with a Physician, in practice. It is absurd. It is immaturity to think this. My company would love it if they could replace Physicians with Nurses, for less than one third the pay. It is just not possible. Perhaps in the outpatient or Urgent Care setting, for some cases. Overall, you cannot compare a Nurse or Physician Assistant with a Physician.

 

[Dr McSteamy]

So primary docs are gonna see pay cuts. just not as big a percentage as the specialists' pay cuts..

am I understanding it right?

so obama isn't good for the whole medical field in general.

 

[JaggerPlate]

do you guys hope he fails?

Yup ... on everything he tries to do.

 

[scubadoc78]

i honestly think this is the future anyway. obama clearly buys into ebm and any knucklehead who can read can follow the algorithm for "what to do when..." yes, i understand this is not always best for the patient but guess what, the fundamental idea is to cover everyone a little bit, not to cover one person a lot. it's too expensive.

 

[deleted87716]

So primary docs are gonna see pay cuts. just not as big a percentage as the specialists' pay cuts..

am I understanding it right?

Nobody has proposed cuts for primary care physicians.

 

[JMK2005]

i honestly think this is the future anyway. obama clearly buys into ebm and any knucklehead who can read can follow the algorithm for "what to do when..." yes, i understand this is not always best for the patient but guess what, the fundamental idea is to cover everyone a little bit, not to cover one person a lot. it's too expensive.

Are you serious??? Medicine is not black and white. Patients do not come in telling you the diagnosis like it seems in the text books.

They'll have every combination of symptoms and it'll take experience and knowledge to filter out certain diagnosis. The shot-gun workup is what drives up healthcare cost as it is. Now, if you have NP and PA starting and completing workup, healthcare cost will rise, negating the savings on the salaries.

 

[andwhat]

Nobody has proposed cuts for primary care physicians.

not at all, as Blue very correctly states. There will be no Medicare cuts for Primary Care physicians. Just bonuses. Cuts will be going to the specialists.

AVATAR OF THE CENTURY GOES TO DR. MCSTEAMY LOVE IT

 

[Octagonecology]

Yup ... on everything he tries to do.

Normally I'm with you on your posts Jagger but your way off on this one. You are essentially saying you hope the country fails. What's wrong with you?

 

[lowbudget]

Well if the family doc owns an MRI or PET scanner, yea, I think you're gonna lose some money. But who cares, more people will be insured, so there will be less charity care/write offs. And better access to stuff when you need it.

Not worried about midlevels. They're stopgaps. Just plugging in the holes for now. Once you fix the payment system, there will be more FM docs out there... which, might drive a lot of midlevels out of town/business.

 

[lowbudget]

Blue Dog, You're being talked about in the news.
http://news.yahoo.com/s/ap/20090721/ap_on_go_pr_wh/us_health_care_overhaul

And dear Time, Howard Dean is an internist, dammit. Get it right. Maybe he was primary care track, I don't know, but get it in your vocabulary. Internist. Not intern. Internist. Not that I really care, but they act like it's a foreign language. Like they need to dumb it down for the American people. Like people don't understand when you say Internist.
http://news.yahoo.com/s/time/085991...xBHNlYwN5bi1yLWItbGVmdARzbGsDLXEmYTpob3dhcmRk

Ok, fine maybe people don't understand what Internist means. I don't give a hoot, don't do it then! You don't see me going around saying I'm a pediatrician, do you? Or an allergist, or even an upper respiratory infectious disease specialist, do you? Ok then, so don't get to call yourself a family doctor, and take all the sympathy that goes with it, unless you've gone through the training & BS that we've gone through.

If you wanted to be a family doctor, you should've done a family medicine residency. Get it right, Time.

(And, lastly, at the bottom of the article... No... the expensive things that happen to <30 y/o's: Malignancy, Accidents... and PREGNANCY, duh?!! Dude, you're a FAMILY DOCTOR. You should know this. Remember all those deliveries you did during your internal medicine residency?)

 

[JaggerPlate]

Normally I'm with you on your posts Jagger but your way off on this one. You are essentially saying you hope the country fails. What's wrong with you?

I think you took it the wrong way/I wrote it way too extreme. I hope everything he tries to touch with healthcare doesn't happen. The system needs a big overhaul, but socializing the whole thing and stealing from one set of docs to pay another is NOT the way to do it. I also want him in and out in four years, however ... as you stated ... I would never want America as a country to fail. If that makes any sense, hahaa.

 

[deleted87716]

Blue Dog, You're being talked about in the news.

Heh...that's my cousin.

 

[scubadoc78]

Are you serious??? Medicine is not black and white. Patients do not come in telling you the diagnosis like it seems in the text books.

They'll have every combination of symptoms and it'll take experience and knowledge to filter out certain diagnosis. The shot-gun workup is what drives up healthcare cost as it is. Now, if you have NP and PA starting and completing workup, healthcare cost will rise, negating the savings on the salaries.

The problem is your argument is reasonable. We do not live in a country of reason. How many people (voters) still think Saddam was linked to 9/11? If the media tells them something the people will believe it. Physicians may know patients don't come black/white but patients, politicians and businessmen either don't realize this or simply don't care. Businessmen, politicians and the voters who put them there happen to make many of the BIG decisions which have made healthcare unbearable for primary care.

I like Obama and he's not a stupid guy. He knows that he'll entice some good docs to family medicine through reassurance and simply because it's a great field. On the other hand he knows he's got to prepare an army of independent providers to cover all the healthcare he's promising. What better way to fill the gaps than by quickly raising an army of mid-level DNPs (ala Clone Wars) to memorize the EBM cookbook and provide coverage? The "research" supports their effectiveness and he's pushing legislation through now to give them the same scope/reimbursement as FP MDs. Pretty smart strategy I think.

I don't invest much faith in the AAFP to effect change. I have a great deal of respect for Ted Epperly and believe he is a genuinely good man, but he's fighting a tough battle.

 

[deleted87716]

I don't invest much faith in the AAFP to effect change.

Well, thanks for nothing, then.

Faith in what we're trying to do and investment in the FamMedPAC are precisely what we need right now. Tough battles are won all the time by people who do what it takes to win.

 

[andwhat]

The problem is your argument is reasonable. We do not live in a country of reason. How many people (voters) still think Saddam was linked to 9/11? If the media tells them something the people will believe it. Physicians may know patients don't come black/white but patients, politicians and businessmen either don't realize this or simply don't care. Businessmen, politicians and the voters who put them there happen to make many of the BIG decisions which have made healthcare unbearable for primary care.

I like Obama and he's not a stupid guy. He knows that he'll entice some good docs to family medicine through reassurance and simply because it's a great field. On the other hand he knows he's got to prepare an army of independent providers to cover all the healthcare he's promising. What better way to fill the gaps than by quickly raising an army of mid-level DNPs (ala Clone Wars) to memorize the EBM cookbook and provide coverage? The "research" supports their effectiveness and he's pushing legislation through now to give them the same scope/reimbursement as FP MDs. Pretty smart strategy I think.

I don't invest much faith in the AAFP to effect change. I have a great deal of respect for Ted Epperly and believe he is a genuinely good man, but he's fighting a tough battle.

we will see, right here......
"DNPs" cannot possibly "fill gaps" in health care. If you truly believe this, then you are delusional. A Physician is the only one truly capable of providing quality and focused health care.
It is an insult to health care, and is quite far from reality, to believe that Nurse Practitioners will compete with Primary Care doctors. That is a joke.
DNPs will not even come close to making a dent in the overall improvement of Health Care. The problem is, clearly, overpayment of specialists, and overutilization of procedures. The results of which have clearly shown a disastrous outcome.
Improvement of Primary Care, through cuts in reimbursement to specialists, and increased reimbursement to Primary Care, is clearly the way to go.
Our current system
70% specialists, 30% general practitioners, is horrendous. This is the biggest problem with our current health care system. Overpaid underworked specialists.

 

[Dr McSteamy]

today in the surgical wing of the hospital, I heard some CT surgeons bitching about obama's bill.

these 2 doofuses were bitching about how their $500,000 would be cut to like $400000, and they wouldn't be able to put food on the table.

and they said something interesting- obama's bill will divide the specialists and generalists like moses and the red sea. there will be a huge rift among doctors as a whole. that's what they think..

 

[sestamibi]

Improvement of Primary Care, through cuts in reimbursement to specialists, and increased reimbursement to Primary Care, is clearly the way to go.
Our current system
70% specialists, 30% general practitioners, is horrendous. This is the biggest problem with our current health care system. Overpaid underworked specialists.

Really? You see specialists as the problem with our current health care system?

You do realize physician spending accounts for less than (roughly) one third of all healthcare dollars, right?

You do realize redistributing the pay from specialists to primary care physicians is merely shuffling of the deck and not enactment of any real change, right?

You do realize that even if we were to cut physician spending fully in half (not redistribution, we're talking removal. Complete slashing of pay) would not result in fiscal solvency for current federal programs, right? (Not to mention newly proposed programs that would cost even more to extend health care coverage further)

It is shocking that some people can become attendings with little to zero knowledge of how our medical system currently functions.

 

[deleted87716]

You do realize redistributing the pay from specialists to primary care physicians is merely shuffling of the deck and not enactment of any real change, right?

Physician reimbursement, however, is a major factor in many of the issues that we face.

Because specialists are more highly compensated than primary care physicians, most medical students in this country choose to become specialists. As a result, our nation has a reversed ratio of specialists to primary care physicians compared to most other first-world countries. This situation alone breeds quite a few other costly consequences, including:

- Underutilization of primary care by the general public, leading to neglect of treatable or preventable conditions until they become serious (and expensive)
- Overuse of hospital emergency departments for problems that could be handled less expensively in a primary care setting
- Excessive referrals to specialists by primary care physicians forced into a hamster-wheel model of reimbursement that doesn't allow them the time to manage things themselves
- Overuse of lab tests and diagnostic imaging modalities due either to a lack of time to take a proper history and perform an appropriate physical examination, or financial benefit
- Overprescribing of expensive brand-name medications for health problems that could be treated with lifestyle modification
- Overuse of costly procedures because of the skewed nature of our present RVU-based compensation system, which undervalues cognitive work
- Additional costs arising from complications of said procedures, as well as further referrals, testing and followup required for "incidentalomas" found on shotgun lab panels and dubious imaging studies
- Duplication of effort and redundant testing when care coordination is lacking.

There are plenty of things wrong with our current healthcare "system." However, the crisis in primary care is certainly one of the more fundamental issues that has to be addressed before any other sort of reform can take place. Reimbursement is the basis for the current situation we're in. There's no getting around that.

Addendum: I should add that I suspect that we're in for a rough ride, because the proposed timeline for providing universal coverage in one form or another is far shorter than the amount of time it would take to shore up our primary care infrastructure. If we suddenly grant everyone some kind of health coverage overnight, but they can't get a doctor to see them, we haven't done very much.

 

[mwest]

Have we considered that the private insurers will be put out of business by the govt plan and it'll be a monopoly of the govt insurance with zero negotiation? Like pushing medicare down your throat with zero autonomy? How about the waiting times for procedures for patients who need an MRI or a Hip Replacement? And oh, the rise in taxes so the working/rich will pay for unemployed?

This is the end of what America stands for, sorry!

 

[andwhat]

Really? You see specialists as the problem with our current health care system?

You do realize physician spending accounts for less than (roughly) one third of all healthcare dollars, right?

You do realize redistributing the pay from specialists to primary care physicians is merely shuffling of the deck and not enactment of any real change, right?

You do realize that even if we were to cut physician spending fully in half (not redistribution, we're talking removal. Complete slashing of pay) would not result in fiscal solvency for current federal programs, right? (Not to mention newly proposed programs that would cost even more to extend health care coverage further)

It is shocking that some people can become attendings with little to zero knowledge of how our medical system currently functions.

awww somebody upset?
If reimbursement is 'shuffled' as you call it, this can boost enrollment in Primary Care. Hence improving health care overall, by preventing unnecessary E.D. visits, cut down my time in the E.D. admitting rough 'sick as hell' patients with no doctor, who have several comorbidities. Primary Care is the way to go, clearly. Preventive Medicine is clearly the direction to go, to manage comorbities, and reduce health care costs.
Improving the state of Primary Care, by cutting down the vastly unnecessary procedural costs, and poor outcomes, is clearly the way to go.
Is the current situation working? Unnecessarily overpaying specialists?
I think it is quite evident how the current health care system works. Overutilization of specialists, wasted money (millions yearly), equaling poor outcomes. Hence, millions of uninsured.
Is there any denying this fact?
Wasted money of health care costs is proportional, to wasted money on Proceduralists.

 

[lowbudget]

Have we considered that the private insurers will be put out of business by the govt plan and it'll be a monopoly of the govt insurance with zero negotiation? Like pushing medicare down your throat with zero autonomy? How about the waiting times for procedures for patients who need an MRI or a Hip Replacement? And oh, the rise in taxes so the working/rich will pay for unemployed?

This is the end of what America stands for, sorry!

LOL. End of what America stands for... Really?

Out of business:
1. Name 1 industry where Gov't is more efficient than the private sector. I doubt Gov't can be more "efficient" than private insurers, although private insurers haven't exactly set the bar that high.

2. Gov't can provide the money, but they don't know the insurance business better than private insurers do. I'm guessing that private insurers will still "administrate" public plans, so efficiency will still be the same.

3. The concern here is the classic economic argument that public investment "crowds out" private investment. But, the assumptions that underly that argument doesn't apply to health insurance, which is highly regulate, where the market is incredibly distorted. Insurance companies exist on a state-wide basis and therefore already do not compete nationally. Insurance works best with "pooling" (pooling of risk, pooling of funds), so there is no such thing as a small business insurance company. Given that, new investments into insurance companies are very few and far between to begin with. So this argument is currently irrelevant.

4. As such, the public option would break up current oligopolies that exist in various markets, such as Pennsylvania, where there's only 2 or 3 major insurers who corner the market. Like I said above, there's such a high barrier to entry to the insurance business that those that make excessive profits don't see new entrants to compete for profits.

5. The key thing we can be happy about is portability. This was half-ass attempted with COBRA. As PCP's, we can be happy that when our patients whom we see continuously can continue to have coverage (i.e. pay us) when they become unemployed. I like that.

Pushing Medicare down our throats:
You don't have to accept the public option if the contracted price isn't good for you. You can always opt out and just take cash. Agreed, not the best solution to have a huge gov't set prices, but it's better than what we have now. Ideally, you want insurance companies to compete across state lines, that's how you make it more of a free market. But until they pass those laws, we gotta go with this one.

Waiting times:
There's a waiting time now already. And that's to see your PCP. Or see your county health district doctor. MRI/Hips waiting time is a theoretical thing. I'll worry about when it's time to worry about it.

Rise in taxes:
Again, you pay for the uninsured/unemployed now. You just don't know you are because the health care market economy is so incredibly distorted.

 

[buffdoc]

You guys/gals aren't PO'd because Obama said last night that doctors would prescribe tonsillectomies to children with sore throats in order to make more money?

"Right now, doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there. And the doctor may look at the reimbursement system and say to himself, 'You know what? I make a lot more money if I take this kid's tonsils out."

 

[sestamibi]

awww somebody upset?
If reimbursement is 'shuffled' as you call it, this can boost enrollment in Primary Care. Hence improving health care overall, by preventing unnecessary E.D. visits, cut down my time in the E.D. admitting rough 'sick as hell' patients with no doctor, who have several comorbidities. Primary Care is the way to go, clearly. Preventive Medicine is clearly the direction to go, to manage comorbities, and reduce health care costs.
Improving the state of Primary Care, by cutting down the vastly unnecessary procedural costs, and poor outcomes, is clearly the way to go.
Is the current situation working? Unnecessarily overpaying specialists?
I think it is quite evident how the current health care system works. Overutilization of specialists, wasted money (millions yearly), equaling poor outcomes. Hence, millions of uninsured.
Is there any denying this fact?
Wasted money of health care costs is proportional, to wasted money on Proceduralists.

Aww, somebody slow?

Flip the payscales so that primary care docs make what some specialists make now and yeah, maybe primary care becomes the hot field that medical graduates aspire to.

The other stuff is a pipe dream. Your "sick as hell patients with no doctor" aren't suddenly going to see start seeing doctors just because there may be more PCPs.

 

[andwhat]

Aww, somebody slow?

Flip the payscales so that primary care docs make what some specialists make now and yeah, maybe primary care becomes the hot field that medical graduates aspire to.

The other stuff is a pipe dream. Your "sick as hell patients with no doctor" aren't suddenly going to see start seeing doctors just because there may be more PCPs.

This is the sad part, that naïve people like yourself just do not get. There will be a significant improvement in compliance, with more affordable, and easy access health care. Sorry you don't get that.
Health care will improve significantly. I think that you're feelings are hurt, and you are becoming more and more argumentative and insecure.

 

[sestamibi]

This is the sad part, that naïve people like yourself just do not get. There will be a significant improvement in compliance, with more affordable, and easy access health care. Sorry you don't get that.
Health care will improve significantly. I think that you're feelings are hurt, and you are becoming more and more argumentative and insecure.

Yes, all those people out there are non-compliant because there aren't enough PCP's. Naive indeed

Increasing the number of PCPs will create easier access to health care but I don't see how this makes it more affordable.

And I certainly don't see how it will improve significantly. Doctors can harp all they want, if the patients aren't going to walk the walk, it doesn't matter if we have enough PCPs so that we can send each patient home with their own live-in doctor.

I think you can't comprehend this and are resorting to the same name-calling techniques that worked for you in middle school.

 

[andwhat]

Yes, all those people out there are non-compliant because there aren't enough PCP's. Naive indeed

Increasing the number of PCPs will create easier access to health care but I don't see how this makes it more affordable.

And I certainly don't see how it will improve significantly. Doctors can harp all they want, if the patients aren't going to walk the walk, it doesn't matter if we have enough PCPs so that we can send each patient home with their own live-in doctor.

I think you can't comprehend this and are resorting to the same name-calling techniques that worked for you in middle school.

awww sumbuddy still upset ;-]]
Yes, increasing the number of PCPs will indeed improve health care.
If it didn't, then it would not be an issue currently. The problem is throwing money away, on countless procedures that do not impact longevity.
Providing quality affordable health care is the way to prevent innumerable conditions. Noncompliant patients that do not want anything done? Well why would they even seek assistance for care in the e.d.? They cannot afford health insurance, and a regular doctor.
Preventive medicine is the key to longevity. True that there are non compliant patients, very very small minority. As there are incessant posters on this board. grrrr go get em tiger!!

 

[Dr McSteamy]

You guys/gals aren't PO'd because Obama said last night that doctors would prescribe tonsillectomies to children with sore throats in order to make more money?

tonsillectomies aren't performed by family docs. so people here are probably not offended.

Yes, all those people out there are non-compliant because there aren't enough PCP's. Naive indeed

Increasing the number of PCPs will create easier access to health care but I don't see how this makes it more affordable.
.

i would agree with this. so many people in the city are too lazy to even get $4 generic rx filled. you think they're gonna come and see a doctor in the first place?

no amount of preventative medicine can save the craploads of fatasses in this country

 

[andwhat]

tonsillectomies aren't performed by family docs. so people here are probably not offended.






i would agree with this. so many people in the city are too lazy to even get $4 generic rx filled. you think they're gonna come and see a doctor in the first place?

no amount of preventative medicine can save the craploads of fatasses in this country

It is a start though, and anything could be better than the current situation. Affordable health care is the biggest issue, and one of the problems is throwing it away on countless unnecessary procedures.
A regular doctor who is more readily available, will reduce health care costs, and prevent illnesses. This is a well studied fact.

 

[Dr McSteamy]

A regular doctor who is more readily available, will reduce health care costs, and prevent illnesses. This is a well studied fact.

they probably have to go and recruit patients too.

many potential pts are sitting on their fat ass all day watching afternoon soaps and eating ice cream.

maybe TV ads like "that ice cream in your hand is contributing to heart disease... come to Dr McSteamy's for your check up today, and live 10 years longer!!"

 

[buffdoc]

tonsillectomies aren't performed by family docs. so people here are probably not offended.

Sure, but the public doesn't distinguish between ENT docs and primary care docs. I'm just a med student, and I was offended.

 

[scubadoc78]

we will see, right here......
"DNPs" cannot possibly "fill gaps" in health care. If you truly believe this, then you are delusional. A Physician is the only one truly capable of providing quality and focused health care.
It is an insult to health care, and is quite far from reality, to believe that Nurse Practitioners will compete with Primary Care doctors. That is a joke.
DNPs will not even come close to making a dent in the overall improvement of Health Care. The problem is, clearly, overpayment of specialists, and overutilization of procedures. The results of which have clearly shown a disastrous outcome.
Improvement of Primary Care, through cuts in reimbursement to specialists, and increased reimbursement to Primary Care, is clearly the way to go.
Our current system
70% specialists, 30% general practitioners, is horrendous. This is the biggest problem with our current health care system. Overpaid underworked specialists.

You're missing the point. It's not about what you or I believe, it's about what voters, politicians and businessmen who control our vocation think. Those are the people who make policy decisions that provide the framework within which we work.

I don't see how moving money from specialists to pcps will change anything when you're adding more to the pcps. Obama has explicitly stated he plans to increase the number of mid-levels and legislation is moving forward to not only give DNP/NPs the scope of FPs but to have insurance reimburse them equivilently as well. More hands in a fixed pot equals less per person.

Besides, the biggest problem with primary care is it's increasingly a pain to practice. Even if we get a marginal increase in salary we'll still be working at an increasingly regulated job. We're just trading insurance companies calling the shots for the government calling the shots. I believe the government is LESS likely to screw people to make money, but it's MORE likely to screw people due to inefficiency. Either way patients will be screwed, but government regulation will be a HUGE increase in inefficiency for docs.

 

[sestamibi]

You're missing the point. It's not about what you or I believe, it's about what voters, politicians and businessmen who control our vocation think. Those are the people who make policy decisions that provide the framework within which we work.

I don't see how moving money from specialists to pcps will change anything when you're adding more to the pcps. Obama has explicitly stated he plans to increase the number of mid-levels and legislation is moving forward to not only give DNP/NPs the scope of FPs but to have insurance reimburse them equivilently as well. More hands in a fixed pot equals less per person.

Besides, the biggest problem with primary care is it's increasingly a pain to practice. Even if we get a marginal increase in salary we'll still be working at an increasingly regulated job. We're just trading insurance companies calling the shots for the government calling the shots. I believe the government is LESS likely to screw people to make money, but it's MORE likely to screw people due to inefficiency. Either way patients will be screwed, but government regulation will be a HUGE increase in inefficiency for docs.

andwhat isn't the sharpest crayon in the box.

Throwing more PCPs into the mix isn't going to fix anything unless you fundamentally change the way people approach healthcare.

Take the patient I spent 90 minutes discharging today.

Refused to pay for her own Plavix despite agreeing to kick a smoking habit that easily costs her $10 a day. (Gee, I wonder if spending that $10 on 1 Plavix pill a day would be a wise idea)

Refused to get her followup INR checked because her family was going to a big city for the weekend and she was unsure if her marginal insurance would cover alternate site lab testing.

Refused to return for followup because parking at the local hospital was too expensive.

You could flood the market with enough PCPs that they'd surround her house. And it wouldn't change a thing. People who don't take care of themselves know (and in turn, drain the precious limited resources of healthcare) aren't going to suddenly take care of themselves because they have slightly easier access to a PCP.

Of course, as a politician, it's much easier to blame the "greedy doctors who perform unnecessary tonsillectomies" than to take a look towards the people who voted for you and call them fatties who need to take responsibility for their own health.

 

[andwhat]

andwhat isn't the sharpest crayon in the box.

Throwing more PCPs into the mix isn't going to fix anything unless you fundamentally change the way people approach healthcare.

Take the patient I spent 90 minutes discharging today.

Refused to pay for her own Plavix despite agreeing to kick a smoking habit that easily costs her $10 a day. (Gee, I wonder if spending that $10 on 1 Plavix pill a day would be a wise idea)

Refused to get her followup INR checked because her family was going to a big city for the weekend and she was unsure if her marginal insurance would cover alternate site lab testing.

Refused to return for followup because parking at the local hospital was too expensive.

You could flood the market with enough PCPs that they'd surround her house. And it wouldn't change a thing. People who don't take care of themselves know (and in turn, drain the precious limited resources of healthcare) aren't going to suddenly take care of themselves because they have slightly easier access to a PCP.

Of course, as a politician, it's much easier to blame the "greedy doctors who perform unnecessary tonsillectomies" than to take a look towards the people who voted for you and call them fatties who need to take responsibility for their own health.

You are taking a few bad examples, and misconstruing the entire broad based concept.

Primary care physician supply is associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year, or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year. This is strongly correlated with reduced Health Care costs, and illnesses.
Is this true or not?
Also, please keep discussions with your family members to yourself.
Sestamibi Sr. perhaps?

 

[scubadoc78]

"Primary care physician supply is associated with improved health outcomes, including all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life expectancy; and self-rated health. This relationship held regardless of the year, or level of analysis (state, county, metropolitan statistical area (MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that an increase of one primary care physician per 10,000 population was associated with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year. This is strongly correlated with reduced Health Care costs, and illnesses.
Is this true or not?"

Nobody's debating the importance of primary care. My points center on how I think the system is changing to deliver that care and whether Obama is good for family medicine as per the OP.

Did those studies define what the PCPs did? Did they practice outpatient and inpatient medicine? Were they strictly in outpatient doing well-child exams, health maintenance and counseling people on cancer prevention/smoking cessation/diet?

 

[sestamibi]

You are taking a few bad examples, and misconstruing the entire broad based concept

Denial, stage 1. It makes me wonder if you've even worked at a hospital clinic.....

Primary care is important. But it's not as simple as throwing more PCPs into the mix as you would suggest.

Scubadoc brings up excellent points: "Did those studies define what the PCPs did? Did they practice outpatient and inpatient medicine? Were they strictly in outpatient doing well-child exams, health maintenance and counseling people on cancer prevention/smoking cessation/diet?"

Because if it's the latter (the preventative medicine counseling that you seem to preach so strongly), guess what, NPs/DNPs/and other midlevels can deliver that too. After all, it's just access to that kind of counseling that will make the difference right?

 

[scubadoc78]

Role of Nurse Practitioners


The legislation also would allow nurse-practitioner-managed practices to serve as medical homes, as long as they meet the same standards applied to physician practices. Not surprisingly, this has prompted concern from the AAFP.

"We have some concerns with the way that the legislation includes nonphysician providers in a role similar to that of physicians, especially in the implementation of the patient-centered medical home," King said. "Without data showing the comparability of nonphysician providers to primary care physicians -- whose training and experience are much more intense and extensive -- it is a risk to allow these providers to deliver these services without the standard level of supervision."

The above is a quote from AAFP Board Chair Jim King and was taken straight off the AAFP website. http://www.aafp.org/online/en/home/...rnment-medicine/20090520schwartz-pc-bill.html

The delusion is continuing to believe this isn't happening despite evidence to the contrary. Dr. King makes a very reasonable argument but as I said above, when people in control make demands guided by fear/greed they make very UNREASONABLE decisions.

From my perspective, it's an over-simplification that students aren't going into FM based on income. I think students may actually be viewing income as a surrogate for job stability. Many think FM is a dying specialty. I realize there's currently a huge number of jobs for FMs, but students also seem to believe DNPs/NPs will take those jobs up as they become outpatient simple complaint/health maintenance/well-child/counseling visits.

The continually narrowing scope (decreasing OB, decreasing ER, decreasing surgery) of practice doesn't help. If the utility of FM is breadth of practice, then isn't it reasonable to think the narrowing of that breadth signals a decreased utility? The growing momentum of hospitalist peds/IM is also viewed as pushing FMs into straight outpatient practice which is not the sole domain of physicians.

I also believe students aren't going into it based on the mountains of paperwork/phone calls as I alluded to in a former post above.

 

[andwhat]

Denial, stage 1. It makes me wonder if you've even worked at a hospital clinic.....

Primary care is important. But it's not as simple as throwing more PCPs into the mix as you would suggest.

Scubadoc brings up excellent points: "Did those studies define what the PCPs did? Did they practice outpatient and inpatient medicine? Were they strictly in outpatient doing well-child exams, health maintenance and counseling people on cancer prevention/smoking cessation/diet?"

Because if it's the latter (the preventative medicine counseling that you seem to preach so strongly), guess what, NPs/DNPs/and other midlevels can deliver that too. After all, it's just access to that kind of counseling that will make the difference right?

oh my goodness.... you are in denial. DNPs, NPs, P.A.s, whatever, will NEVER be able to provide the level of healthcare that a Physician can deliver. That is absurdity, and it is you that has zero clinical experience. Reality is that Physicians can only deliver quality health care. Denial is a strong thing though please do not be so hard on yourself.

Dude you are too clueless. Preventive Medicine counseling is only a fraction of the entire package. Absurd argument. Sestamibi is very entertaining though.

 

[sestamibi]

Role of Nurse Practitioners


The legislation also would allow nurse-practitioner-managed practices to serve as medical homes, as long as they meet the same standards applied to physician practices. Not surprisingly, this has prompted concern from the AAFP.

"We have some concerns with the way that the legislation includes nonphysician providers in a role similar to that of physicians, especially in the implementation of the patient-centered medical home," King said. "Without data showing the comparability of nonphysician providers to primary care physicians -- whose training and experience are much more intense and extensive -- it is a risk to allow these providers to deliver these services without the standard level of supervision."

The above is a quote from AAFP Board Chair Jim King and was taken straight off the AAFP website. http://www.aafp.org/online/en/home/...rnment-medicine/20090520schwartz-pc-bill.html

The delusion is continuing to believe this isn't happening despite evidence to the contrary. Dr. King makes a very reasonable argument but as I said above, when people in control make demands guided by fear/greed they make very UNREASONABLE decisions.

From my perspective, it's an over-simplification that students aren't going into FM based on income. I think students may actually be viewing income as a surrogate for job stability. Many think FM is a dying specialty. I realize there's currently a huge number of jobs for FMs, but students also seem to believe DNPs/NPs will take those jobs up as they become outpatient simple complaint/health maintenance/well-child/counseling visits.

The continually narrowing scope (decreasing OB, decreasing ER, decreasing surgery) of practice doesn't help. If the utility of FM is breadth of practice, then isn't it reasonable to think the narrowing of that breadth signals a decreased utility? The growing momentum of hospitalist peds/IM is also viewed as pushing FMs into straight outpatient practice which is not the sole domain of physicians.

I also believe students aren't going into it based on the mountains of paperwork/phone calls as I alluded to in a former post above.

Precisely. Some people/dunces feel that merely repeating that midlevels cannot provide the same level of care as physicians will somehow be enough.

Anyone who has been through 4 years of medical school (not to mention a rigorous residency) knows physicians will pick up items that midlevels don't

The key is conveying that to patients. And most of all, the legislators. Until that happens, students will continue to forego FM even with mild increases in reimbursement to PCPs. Oh and by the way, the new Medicare proposal also has NPs slated for a 6% wage increase.

 

[scubadoc78]

oh my goodness.... you are in denial. DNPs, NPs, P.A.s, whatever, will NEVER be able to provide the level of healthcare that a Physician can deliver. That is absurdity, and it is you that has zero clinical experience. Reality is that Physicians can only deliver quality health care. Denial is a strong thing though please do not be so hard on yourself.

Dude you are too clueless. Preventive Medicine counseling is only a fraction of the entire package. Absurd argument. Sestamibi is very entertaining though.

it's a little disheartening to see people in the field answer honest questions/points with sarcasm and dismissive phrasing. if the leaders of the aafp feel this is a concern, why shouldn't you?

 

[sestamibi]

it's a little disheartening to see people in the field answer honest questions/points with sarcasm and dismissive phrasing. if the leaders of the aafp feel this is a concern, why shouldn't you?

It's a defense mechanism. Looking back at his posts, it's likely been an issue since childhood.

 

[andwhat]

It's a defense mechanism. Looking back at his posts, it's likely been an issue since childhood.

I strongly urge you to stick to the point. There will be pay increases in Primary Care, coming soon. DNPs, NPs, are not even close to providers that can 'fill gaps' where Physicians are lacking. Sestamibi started this 'mudslinging' that is clearly evident, even upon scrolling up this page. Get a life dude.
NPs and PAs are excellent resources, and "midlevel" providers, but overall they cannot, and should not, be thought of as "substitutes" to real health care.

 

[scubadoc78]

i'm not interested in mudslinging. i'm just trying to get genuine answers to concerns i have as i'm applying to residency and putting all the work and sacrifice of my wife, daughter and myself on the line.

if the aafp puts out a position statement on the issue that doesn't mean that's how it will go. as i understand it, the reality is that NPs will be in direct competition with FPs under Obamas policies. same scope, same reimbursement. nobody is debating that an NP = physician.

these concerns can summarily be dismissed as "trolling" or "being naive" but it doesn't make the concerns go away. if people are worried medical students aren't going into primary care doesn't it make sense to listen to the medical students concerned? when i see the leaders of the field opposing legislation going through then i think to myself "wow, NPs really are going to be treated as FPs." this even includes NPs hiring PAs to work under them! unless the aafp can show the obama administration that medical students view primary care as being given to NPs, then i don't see the problem going away.

 

[sestamibi]

DNPs, NPs, are not even close to providers that can 'fill gaps' where Physicians are lacking. NPs and PAs are excellent resources, and "midlevel" providers, but overall they cannot, and should not, be thought of as "substitutes" to real health care.

Excellent strategy. Keep saying it over and over, maybe your president will believe it.

i'm not interested in mudslinging. i'm just trying to get genuine answers to concerns i have as i'm applying to residency and putting all the work and sacrifice of my wife, daughter and myself on the line.

if the aafp puts out a position statement on the issue that doesn't mean that's how it will go. as i understand it, the reality is that NPs will be in direct competition with FPs under Obamas policies. same scope, same reimbursement. nobody is debating that an NP = physician.

these concerns can summarily be dismissed as "trolling" or "being naive" but it doesn't make the concerns go away. if people are worried medical students aren't going into primary care doesn't it make sense to listen to the medical students concerned? when i see the leaders of the field opposing legislation going through then i think to myself "wow, NPs really are going to be treated as FPs." this even includes NPs hiring PAs to work under them! unless the aafp can show the obama administration that medical students view primary care as being given to NPs, then i don't see the problem going away.

This is exactly the issue. While physicians know that NPs do not equal FPs, the people who are calling the shots aren't exactly viewing it this way. They're sitting back and saying, "Can't midlevels do well-child exams? Can't they counsel people on health maintenance? Cancer prevention? Smoking cessation? Diet? Aren't these the things that cause people to be admitted for hospitalizations and in turn, driving up our health care costs?"

If you feel that flooding the market with PCPs is going to fix the healthcare system while lowering costs, then by the same logic, unleashing a horde of midlevels will have a similar effect at even lower costs.

 

[andwhat]

Excellent strategy. Keep saying it over and over, maybe your president will believe it.



This is exactly the issue. While physicians know that NPs do not equal FPs, the people who are calling the shots aren't exactly viewing it this way. They're sitting back and saying, "Can't midlevels do well-child exams? Can't they counsel people on health maintenance? Cancer prevention? Smoking cessation? Diet? Aren't these the things that cause people to be admitted for hospitalizations and in turn, driving up our health care costs?"

If you feel that flooding the market with PCPs is going to fix the healthcare system while lowering costs, then by the same logic, unleashing a horde of midlevels will have a similar effect at even lower costs.

wrongggggggggggg we will see.

 

[andwhat]

i'm not interested in mudslinging. i'm just trying to get genuine answers to concerns i have as i'm applying to residency and putting all the work and sacrifice of my wife, daughter and myself on the line.

if the aafp puts out a position statement on the issue that doesn't mean that's how it will go. as i understand it, the reality is that NPs will be in direct competition with FPs under Obamas policies. same scope, same reimbursement. nobody is debating that an NP = physician.

these concerns can summarily be dismissed as "trolling" or "being naive" but it doesn't make the concerns go away. if people are worried medical students aren't going into primary care doesn't it make sense to listen to the medical students concerned? when i see the leaders of the field opposing legislation going through then i think to myself "wow, NPs really are going to be treated as FPs." this even includes NPs hiring PAs to work under them! unless the aafp can show the obama administration that medical students view primary care as being given to NPs, then i don't see the problem going away.

no no not you, sestamibi only. My apologies if the sentiments were misconstrued.
Your concerns are very valid, and understandable scuba, my apologies for reacting to Sestamibi's poor behavior.

I do not think that it will get to that level, NPs vs M.D.s, as far as Primary Care goes. The lawmakers understand this. It is a matter of restructuring the whole system, which will not happen overnight.
The N.P.s are merely 'stopgaps' in order to recalibrate the structure of Health Care, and improve the state of Primary Care. Point being, something has to be done.
It is a very very valid and legitimate concern Scuba. However I think that it is somewhat 'exaggerated' with media hype.
Again, these N.P.s are excellent help, and 'midlevel' providers, but will never have the abilities to practice independently, as Practitioners. This plan, if implemented, of providing Nurse Practitioners to compete with Physicians, will fail miserably.
In the meantime, more money into Primary Care is coming. Obviously, this will not have an immediate fix. It will significantly enhance the state of the future, which means boosting Primary Care enrollment.
Unleashing a hoarde of N.P.s to do a Physician's job, would be a disaster. It is not about payment, or compensation, it is about the safety and well being of patients. Liability would skyrocket, and who is going to be responsible for all of these nurses on a supervising basis?
It would be an insane idea.
The N.P. idea, is more of a 'stopgap' idea, kind of like a rest area, on the way to a destination. What is the destination? To improve the state of health care, by boosting Primary Care enrollment. This will require more money into Primary Care, which is the logical thing to do, and is finally happening.
It will be interesting to sit back, and watch how it unveils.
I can inform you what is going on from the Hospitalist perspective. The movement is to weed more N.P.s out of the system, hire more Physicians, and limit current N.P.s scope of practice. I find this a bit unfortunate, as I would love to have more help esp. on nights at times.