[lit-ideas] health care in the US

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Primary care about to collapse, physicians warn 
 
 
 
By Maggie Fox, Health and Science CorrespondentMon Jan 30, 1:44 PM ET  


Primary care -- the basic medical care that people get when they visit their  
doctors for routine physicals and minor problems -- could fall apart in the  
United States without immediate reforms, the American College of Physicians 
said  on Monday. 
"Primary care is on the verge of collapse," said the organization, a  
professional group which certifies internists, in a statement. "Very few young  
physicians are going into primary care and those already in practice are under  
such stress that they are looking for an exit strategy." 
Dropping incomes coupled with difficulties in juggling patients, soaring  
bills and policies from insurers that encourage rushed office visits all mean  
that more primary care doctors are retiring than are graduating from medical  
school, the ACP said in its report. 
The group has proposed a solution -- calling on federal policymakers to  
approve new ways of paying doctors that would put primary care doctors in 
charge  
of organizing a patient's care and giving patients more responsibility for  
monitoring their own health and scheduling regular visits. 
U.S. doctors have long complained that reimbursement policies of both  
Medicare and private insurers reward a "just-in-time" approach, instead of  
preventive care that would save money and keep patients healthier. 
"Medicare will pay tens of thousands of dollars ... for a limb amputation on  
a diabetic patient, but virtually nothing to the primary care physician for  
keeping the patient's diabetes under control," said Bob Doherty, senior vice  
president for the 
ACP. 
The ACP plan called for innovations such as using e-mail to consult on minor  
and routine matters, freeing up expensive office visit time for when it is  
needed. Doctors would be compensated for an e-mail consultation. 
The proposals include incentives for doctors to work more efficiently and to  
provide better care, ACP President Dr. C. Anderson Hedberg told a news  
conference. "ACP proposals would provide patients with access to care that is  
coordinated by their own personal physician," Hedberg said. 
YOUNG DOCTORS AVOIDING PRIMARY CARE 
The ACP cited an American Medical Association survey that found 35 percent of 
 all physicians nationwide are over the age of 55 and will soon retire. 
In 2003, only 27 percent of third year internal medicine residents actually  
planned to practice internal medicine, the group said, with others planning to 
 go into more lucrative specialty jobs. 
"Primary care physicians -- the bedrock of medical care for today and the  
future -- are at the bottom of the list of all medical specialties in median  
income compensation," the ACP said. 
The group, which represents 119,000 doctors and medical students in general  
internal medicine and subspecialties, joins others that warn the U.S. health  
care system is untenable. 
"If these reforms do not take place, within a few years there will not be  
enough primary care physicians to take care of an aging population with  
increasing incidences of chronic diseases," said Dr. Vineet Arora, chair of the 
 
College's Council of Associates. 
Dr. Sara Walker, a Missouri physician, said she believed doctors were leaving 
 general practice because of drops in Medicare reimbursement to doctors. 
"A drop in Medicare payments will not only force me to stop taking Medicare  
patients but could force me out of business," agreed Dr. Kevin Lutz, a solo  
practitioner in Denver.  






 
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