TH – Pirmary Care Shortage

TH – Top News Article:
“The Georgia study suggests changes to insurance reimbursements hurt primary care by rewarding the delivery of diagnostic tests and medical treatments, instead of rewarding time spent communicating with patients.

‘What has happened with the physician payment system historically is that it has given a higher value to procedures over cognitive care,’ Hubbard said.

Family medicine physicians have the lowest average salary ($185,740) of the doctors studied, compared to radiologists and orthopedic surgeons, who had an average salary of more than $400,000.

‘When a medical student chooses a specialty, potential income is becoming more and more of a factor in that decision,’ Hubbard said.

Knox fears access to care could become restricted if a primary care shortage continues.

Physician assistants and nurse practitioners can fill some of the gaps left by a dearth of primary care physicians — to a point.

‘There is a higher level of qualification required to provide some of the services that physicians provide,’ Tracy said.

Pechous said the economics of training and retaining new physicians is complex.

The debt load facing medical school graduates is one of the impediments to enlarging the pool of primary care doctors. For M.D.s, that debt is pushing $130,000, Tracy said.

‘It is like a second mortgage.'”

Another interesting statistic:

“At the University of Iowa’s Roy J. and Lucille A. Carver College of Medicine, 37 percent of the incoming class entered the family medicine field in 1996. By 2006, that number had dropped to 10 percent. In the early 1990s, Iowa graduated nearly 45 family doctors per year. By 2006, that dropped to 12.”

Thanks to Dr. Pechous for writing this. The solution, really, is obvious. Pay more for the behavior you want and less for the behavior you don’t want. Higher reimbursement for primary care services, lower for procedures. This is not “class warfare” for physicians, it is simply facing simple economics and the consequences of reimbursement rates.

Sunday Forum: Which party best manages the economy?

Sunday Forum: Which party best manages the economy?

“I call the first fact the Great Partisan Growth Divide. Simply put, the United States economy has grown faster, on average, under Democratic presidents than under Republicans.

“The stark contrast between the whiz-bang Clinton years and the dreary Bush years is familiar because it is so recent. But while it is extreme, it is not atypical. Data for the whole period from 1948 to 2007, during which Republicans occupied the White House for 34 years and Democrats for 26, show average annual growth of real gross national product of 1.64 percent per capita under Republican presidents versus 2.78 percent under Democrats.

“That 1.14-point difference, if maintained for eight years, would yield 9.33 percent more income per person, which is a lot more than almost anyone can expect from a tax cut.”

I don’t think this surprises Democrats, but Republicans will just snort in disregard, because, reality has a well known liberal bias…

Letter – Health Care Fiction – Letter – NYTimes.com

Letter – Health Care Fiction – Letter – NYTimes.com:

Too well said not to cite in its entirety…

“Re “Feeling No Pain,” by Paul Krugman (column, Aug. 29):

Mr. Krugman rightly notes that emergency room care cannot substitute for health insurance since the cost will be billed directly to the patient.

There is another reason emergency rooms cannot provide adequate health care. Emergency rooms are for emergencies. They can treat a patient in a diabetic coma, but they cannot provide continuing help in managing diabetes. They can treat a full-blown asthma attack, but they cannot provide the medications needed to manage asthma daily.

They can treat a woman who has gone into early labor, but they cannot provide prenatal care.
Emergency rooms cannot offer any help for managing Parkinson’s, Alzheimer’s or cancer. On a more basic level, they cannot provide eyeglasses, hearing aids or dentures.

Republican claims that no American is without access to health care because “you can just go to an emergency room” are openly false as well as appallingly callous.

Elizabeth Vandiver
Walla Walla, Wash., Aug. 29, 2008″

Welcome!

Hi, all!

For any of you who followed the link from MyBarackObama, welcome!

I originally set up this blog to keep track of all the information that I came across about health care in the US and other health care systems around the world, as well as some postings on “contrarian” economics (economics that contradict standard, and often wrong, commonly accepted memes).

Go over to the right and click on a topic to get started. You can find out about individual countries, our system and information about access and waiting times and so on.

I hope you learn, and, in turn, post to teach me!

Cheers,

Chris

Physicians, health, burnout | Salon

Physicians, health, burnout Salon:

“I’m tired. Really tired. I’ve been seeing patients continuously — one every 15 minutes — for five and sometimes six days a week. The pace is nothing new for me or most primary care doctors. But lately it all feels like a game of Jenga, with patients stacked on top of one another like wooden blocks, ready to come tumbling down.”

I’m posting this, not so much for the article itself (about physician burnout), but for the responses/letters. To all doctors, read the letters by clicking “Editor’s Choice” first, so you don’t get too angry or depressed. Then read all the letters.

I just found it very interesting both the animosity and admiration physicians generate among the public. And another common thread is that the public seems to understand that we, too, are entrapped in a lousy system — but also wonder, then, why we aren’t getting the AMA to finally back serious reform.

Cheers,

Texas still leads nation in rate of uninsured residents | Dallas Morning News | News for Dallas, Texas | Dallas Business News

Texas still leads nation in rate of uninsured residents Dallas Morning News News for Dallas, Texas Dallas Business News:

“But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

‘So I have a solution. And it will cost not one thin dime,’ Mr. Goodman said. ‘The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

‘So, there you have it. Voila! Problem solved.'”

Wow. Breathtaking, isn’t it?

Study: Bankruptcies soar for senior citizens – washingtonpost.com

Study: Bankruptcies soar for senior citizens – washingtonpost.com:

“It all worked fine for Noda, a widow for 23 years, until she was forced to undergo double-bypass surgery and deal with respiratory problems. She started using two credit cards more frequently for food and bills. Before long, she was $8,000 in debt and behind on car payments.

‘I’d go to bed and all I had on my mind was bankruptcy,’ she said. ‘I had nothing left.’

Noda’s car was repossessed, but her trailer home wasn’t in jeopardy because her daughter owns it. While she’s covered by Medicare and receives $968 in Social Security each month, she relied on her job for other expenses. She had no choice but to get help from Jacksonville Legal Aid and declare bankruptcy.

Most bankruptcies are still filed by people far younger than Noda, but the percentage the younger filers make up has fallen over the 16-year period, according to the Consumer Bankruptcy Project analysis, which will be published in the Harvard Law and Policy Review in January.

In 1991, the 55-plus age group accounted for about 8 percent of bankruptcy filers, according to the study, which looked at more than 6,000 cases filed in 1991, 2001 or 2007. By last year, filers 55 and over accounted for 22 percent.”