And this is the point

7 Jun
2009

If I start rambling, one of my best friends will challenge me with "and your point is?"  Well this is my point.

If all doctors had more time to listen

Note that these practices a variants of retainer medicine.  The patient centered medical home is a variant of retainer medicine.  They key for sucess comes in adequate payment for "coordination."  Note that coordination includes email, phone calls and time to think.  These activities are worth money, and we should pay physicians to spend their time on these activities.

And while the patient-centered movement is growing, the nation may not be able to afford to have all its primary care doctors reduce the number of patients they see. Across the country, primary care physicians are in short supply, in part because average salaries for family practitioners are the lowest of any medical specialty. According to a 2008 survey of physician salaries by the American Medical Group Association, their average annual salary is $201,555, versus $356,166 for a general surgeon and $614,536 for a neurological surgeon.

Can we afford to have our primary care physicians reduce their patient numbers?  We can as much as we can afford paying hospitalists, ER physicians, and a wide variety of subspecialists.   Why do pundits always decry primary care physicians decreasing patient volume to improve care and practice quality?  Those same pundits should complain about all the physicians who choose to do other than primary care.

I believe that if we successfully transform primary care into a better specialty (less patients and more time with each patient), then more physicians will choose that path.  The positive externality of improved practice comes when such practice becomes highly desirable.

And that, my friend, is my point.

 

Related posts:

  1. Direct primary care – an interview
  2. The barrier – echoing my mantra
  3. In which I respond to angry comments
  4. I disagree with @DrVal – retainer medicine is the answer
  5. Pulling primary care out of insurance

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2 Responses to And this is the point

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Rocky Balboa, Jr, MD

June 7th, 2009 at 5:39 pm

~50% of office visits are unnecessary. We only practice in this archaic fashion so that we can fill out a slip, submit it to a third party and maybe get paid.

The only way for primary care to survive is to refuse payment from a third-party. Let the patient submit for reimbursement.

Under these “lean” conditions our care is affordable and effective.

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solo dr

June 7th, 2009 at 7:39 pm

One of my naturalized US citizens, who originally grew up in England, was surprised when she saw me on weekend rounds. In England, physicians do not have to see their patients on weekends, outside of emergencies, and most of the care can be done by phone.

I could treat at least 30% of my daily office visits by phone, but I would not get paid and would still be liable for the care. Often doing the physical on a routine patient for allergies or a sinus infection feels wasteful, including having to make sure the bullet points are done to get paid by the insurance company. Most of the EHR systems have a generic, and often not asked, Review of Systems. Much of the time the hospital and office notes are either to cover liability or to get paid through the archaic billing methods.
I have seen charts from 20-30 years ago. A patient with a sore throat would have a short note on a 4×6 card or ongoing sheet of paper in the chart, such as strept pharygitis, penicilling given. Nowadays you have to write a 20-30 line note to cover the SOAP format and to survive any insurance company audits. This increased documentation has not improved the care . Apparently in the mid 1990s, CMS/Medicare came out with a lot of rules for ROS and H&Ps. A lot of the work feels robotic.

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