[lit-ideas] Re: health care in the US

This sure is right.  All my physicians are specialists.  My internist is the 
primary care person.  I go into the office every three months, talk about how I 
feel and doc listens to my heart and lungs, renews medications.  When I am 
really sick, I describe symptoms to receptionist and they call in a 
prescription to the local pharmacy.  (this is only for non-chronic conditions.) 
 If it sounds serious, one is directed to the emergency room, which is over 
loaded with people who have no insurance and it's a thousand dollars to step 
through the door.  And we have the best coverage.  The whole system is nuts.  
Why go to a doctor if one does not feel sick and the chronic condition is 
controlled but not eliminated?  To keep to a good schedule for a doctor I guess.

Veronica Caley
Milford, MI


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Subject: [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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