The challenge and importance of being a generalist

this topic links directly with the
can primary care survive? rant.

you exactly describe the problem with the practice of general medicine. Under the current “climate” of manage care, primary care providers have a few minutes to listen, examine, consider, and treat a patient.

I would not trust an electrician or mechanic to work on my home or car if he/she was forced to do a rush job.

physicians by training offer a wealth of information and value. Each can translate that information to patients according to her/his own style and pace. Too many physician’s are cornered by circumstance into practicing in a way that makes sense for managed care and not for themselves professionally.

Chenry is right… we work much too hard on managed care issues AND caring for the patient. We should not allow the business of managed care to become our business.

Is dropping managed care possible? Yes, if you structure your practice in a way that allows independence from managed care.

examples
1. http://www.simplecare.com
2. http://www.aafp.org/fpm/20020300/25goin.html
3. NRMP website…data shows that med
avoid the hassles of primary/ general
medical practice by avoiding primary
care. (novel idea)

Some might say that practicing in the above styles restricts access to care,but given the loss of several thousand MD’s and DO’s training in primary or general medicine since 1997 the loss of access is already here.

Med students will choose primary care if they can see examples of doc’s practicing in styles that create satisfaction among patients and physicians. as a result more students will choose primary care and the access problems should lessen.

reform of general/primary care practice is occurring …not by relishing the good old days, pleading for fixes from legislative bodies, or begging profit motivated MCO’s to reimburse more.

Reform is occurring because their are thousands less physcians doing primary care
and those that remain are now acutely aware that we can do well without being dependent on MCO’s.

Even if we had all day to see one patient, it would be impractical to address each and every issue that must be addressed in one visit. At some point, it just becomes too much information for the patient to handle.

If someone comes in to see me because they’re miserable from diarrhea, or because they want their blood pressure medicine refilled, or they want their pap smear, they have an idea in their mind why they’re there and what they want. They begin to lose interest when the conversation turns away from their agenda to mine.

The reality of dealing with people is much different than the ideal. And unfortunately, those in academia who perform these sorts of studies have no experience with reality.

nurse practitioners?

I saw a manpower study dated 2001, it is expected that 50,000 NP’s will be out practicing by 2005. of course many are going into subspecialty care, but it would be probably a good guess to estimate 10,000 NP’s will be doing primary care by 2005.