Comments on: First-stop docs could get a pay raise http://whyy.org/cms/news/health-science/2009/08/24/first-stop-docs-could-get-a-pay-raise/15621 News and Information from WHYY in Philadelphia Mon, 19 Dec 2011 23:50:34 -0500 hourly 1 http://wordpress.org/?v=3.0.4 By: Healthcare reform | WHYY News and Information | WHYY http://whyy.org/cms/news/health-science/2009/08/24/first-stop-docs-could-get-a-pay-raise/15621/comment-page-1#comment-655 Healthcare reform | WHYY News and Information | WHYY Fri, 11 Sep 2009 16:06:38 +0000 http://whyy.org/cms/news/?p=15621#comment-655 [...] First-stop docs could get a pay raise Taunya English – August 24, 2009 [...] [...] First-stop docs could get a pay raise Taunya English – August 24, 2009 [...]

]]> By: William Johns, MD http://whyy.org/cms/news/health-science/2009/08/24/first-stop-docs-could-get-a-pay-raise/15621/comment-page-1#comment-551 William Johns, MD Wed, 26 Aug 2009 15:32:04 +0000 http://whyy.org/cms/news/?p=15621#comment-551 I wanted to comment on two points that Dr. Smith mentioned. 1. "primary care physicians are pretty commonly available". This may be true in Pennsylvania, but is certainly not true in other parts of the country. Most primary care physicians are at capacity for their practice, and have difficulty recruiting new physicians. If healthcare reform passes and we have to serve as doctors for another 50 million people, there will be a severe shortage. This is what happened in MA when they passed reform. 2. "[primary care physicians] don't do much when they see you." This is precisely the current pay problem with Medicare. My job is to counsel and guide patients toward healthy lifestyle habits, to screen for disease risk factors, and to treat risk factors appropriately...not to perform procedures. Unfortunately, Medicare pays perverse rewards to doctors who physically "do" things to patients. Monitoring and counselling are not among those tasks. I screen patients for cancers and cardiovascular risk factors, and while not dramatic, I save lives. I think that is a valuable service. I wanted to comment on two points that Dr. Smith mentioned.
1. "primary care physicians are pretty commonly available". This may be true in Pennsylvania, but is certainly not true in other parts of the country. Most primary care physicians are at capacity for their practice, and have difficulty recruiting new physicians. If healthcare reform passes and we have to serve as doctors for another 50 million people, there will be a severe shortage. This is what happened in MA when they passed reform.
2. "[primary care physicians] don't do much when they see you." This is precisely the current pay problem with Medicare. My job is to counsel and guide patients toward healthy lifestyle habits, to screen for disease risk factors, and to treat risk factors appropriately…not to perform procedures. Unfortunately, Medicare pays perverse rewards to doctors who physically "do" things to patients. Monitoring and counselling are not among those tasks. I screen patients for cancers and cardiovascular risk factors, and while not dramatic, I save lives. I think that is a valuable service.

]]> By: Cheryl BryantBruce, M.D. http://whyy.org/cms/news/health-science/2009/08/24/first-stop-docs-could-get-a-pay-raise/15621/comment-page-1#comment-542 Cheryl BryantBruce, M.D. Mon, 24 Aug 2009 20:40:12 +0000 http://whyy.org/cms/news/?p=15621#comment-542 Perhaps Dr. Smith's experience with primary care physicians has been less than favorable, because he is seeing them under a model that doesn't allow them to do too much more than say hello. Perhaps he is having difficulty getting what he needs from his PCP, because the current paradigm punishes primary care physicians who delve too far into specialty areas if they are practicing in cities where specialists are available, even if their schedules make them inaccessible to the patients. All of these are reasons that the current system needs to be revised to better reward and empower primary care physicians to do well what we really are trained well to do. Concierge physicians are pushing the ball that is now rolling more rapidly toward massive healthcare reforms that will be better for all. Cheryl BryantBruce, M.D. http://www.elitepersonalphysician.com Perhaps Dr. Smith's experience with primary care physicians has been less than favorable, because he is seeing them under a model that doesn't allow them to do too much more than say hello. Perhaps he is having difficulty getting what he needs from his PCP, because the current paradigm punishes primary care physicians who delve too far into specialty areas if they are practicing in cities where specialists are available, even if their schedules make them inaccessible to the patients. All of these are reasons that the current system needs to be revised to better reward and empower primary care physicians to do well what we really are trained well to do. Concierge physicians are pushing the ball that is now rolling more rapidly toward massive healthcare reforms that will be better for all.

Cheryl BryantBruce, M.D.
http://www.elitepersonalphysician.com

]]> By: Allen Smith, Ph.D. http://whyy.org/cms/news/health-science/2009/08/24/first-stop-docs-could-get-a-pay-raise/15621/comment-page-1#comment-540 Allen Smith, Ph.D. Mon, 24 Aug 2009 18:51:39 +0000 http://whyy.org/cms/news/?p=15621#comment-540 I have to say that the experience of my wife and myself is that care physicians are pretty commonly available... but don't do very much when they see you. About the only thing we wind up using a primary care physician for is routine lab work and a few prescriptions - but there are a lot of prescriptions they won't write. I have wound up having to search out psychiatrists for some of my medication (despite that it's been constant for years now), with massive problems getting in to see one (the more well-recommended ones have several months of wait time, which doesn't work when one is on Schedule II meds that can't be prescribed for more than a month...). Similarly, my spouse has had major problems getting in to see a decent GYN in any reasonable amount of time. (This may partially be due to Pennsylvania's statute of limitations for lawsuits vs OBs - 18 years. This is ridiculous; any mistake the OB makes when doing a dellivery is almost always immediately apparent, or will be apparent within a month or so.) My father was a primary care physician - a pediatrician - for 25 years in private practice (and prior to that in the military and Indian Health Service); my uncle is practicing as a family practitioner right now. I don't disparage primary care doctors. But for people who have some background in biology (I have a Ph.D. in it) and medicine, most of them aren't knowledgeable enough to be that much use except for things that doctors have a monopoly on (prescriptions plus lab tests that insurance will pay for and aren't overly regulated by states like California). I've been known to go in and simply tell a primary care physician what statins won't interact with my other medicines. The good ones cooperate with knowledgeable patients. Incidentally, on concierge medicine - umm... we live in a capitalist society. That means that a basic incentive for people to work is to make money that they can use to buy things/services that are better than those without money can get. My family doesn't currently have the money for concierge medicine, but we'd certainly be interested in it - provided that the primary care and other services provided were of distinctly better quality (not just time-wise, but competency-wise) than the average otherwise available. I have to say that the experience of my wife and myself is that
care physicians are pretty commonly available… but don't do
very much when they see you. About the only thing we wind up using a
primary care physician for is routine lab work and a few prescriptions

- but there are a lot of prescriptions they won't write. I have wound
up having to search out psychiatrists for some of my medication
(despite that it's been constant for years now), with massive problems

getting in to see one (the more well-recommended ones have several
months of wait time, which doesn't work when one is on Schedule II
meds that can't be prescribed for more than a month…). Similarly, my

spouse has had major problems getting in to see a decent GYN in any
reasonable amount of time. (This may partially be due to
Pennsylvania's statute of limitations for lawsuits vs OBs – 18 years.
This is ridiculous; any mistake the OB makes when doing a dellivery is

almost always immediately apparent, or will be apparent within a month or so.)

My father was a primary care physician – a pediatrician – for 25 years in private practice (and prior to that in the military and Indian Health Service); my uncle is practicing as a family practitioner right

now. I don't disparage primary care doctors. But for people who have
some background in biology (I have a Ph.D. in it) and medicine, most
of them aren't knowledgeable enough to be that much use except for
things that doctors have a monopoly on (prescriptions plus lab tests
that insurance will pay for and aren't overly regulated by states like

California). I've been known to go in and simply tell a primary care
physician what statins won't interact with my other medicines. The
good ones cooperate with knowledgeable patients.

Incidentally, on concierge medicine – umm… we live in a capitalist
society. That means that a basic incentive for people to work is to
make money that they can use to buy things/services that are better
than those without money can get. My family doesn't currently have the money for concierge medicine, but we'd certainly be interested in it -

provided that the primary care and other services provided were of
distinctly better quality (not just time-wise, but competency-wise)
than the average otherwise available.

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