Primary Care

Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

The medical home requires building a better team

Fred N. Pelzman, MD

Health Policy

August 25, 2013

How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?

Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists … the list goes on and on.

As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to …

Do the name and ethnicity of your doctor matter?

Qing Meng Zhang, MD

Physician

August 25, 2013

I would like to begin this article with a question: Do the name and ethnicity of a doctor affect your decision when choosing a physician?

America has always been a melting pot with diverse cultures and ethnicity. The medical field is a melting pot in its own right with its own politics, conflicts, racial disparities and the like.

When I was starting medical school, my mother suggested that I should change my Chinese …

It’s a miracle: The connection between saints and doctors

Rajeev Kurapati, MD

Physician

August 25, 2013

saints

To approve sainthood to a pope, the Vatican only needs one miracle. And there we have it, a new saint.

Pope John Paul was named a saint by Francis after a Costa Rican woman is said to have been cured from a brain aneurysm after praying to John Paul in 2011. His first miracle, curing a French nun of Parkinson’s disease, was also …

The beauty of direct pay physicians

Bryan J. Treacy, MD

Physician

August 24, 2013

A recent review by CNN shows that the percentage of physicians who have gone to a direct pay practice has doubled in the past year. Currently, 6% of physicians are in this mode of health care delivery and the numbers are expected to rise as health care reform takes hold.

The beauty of direct pay physicians is that they are working for the patient, not an insurance company or government entity. …

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The beauty of direct pay physicians

I am an orphan: A medical school without a family medicine department

Seth Rosenblatt, MD

Medical Education

August 24, 2013

I am a fourth year medical student that attends an institution that does not have a department of family medicine.

Currently there are only 10 such allopathic institutions in the country. When I tell colleagues and friends that I intend to enter family medicine they say, “oh primary care?” While yes, it is true that family physicians obviously practice primary care, I am disheartened that my colleagues do not know or …

How will primary care handle the influx of patients in 2014?

Edward Pullen, MD

Health Policy

August 23, 2013

As a family physician I look forward to the next few years in practice with a sense of uncertainty. One of biggest of these uncertainties is how to help meet the anticipated demand for primary care I expect. A number of changes are coming that will alter the supply and demand equation for patients and primary care providers. These include significant projected population demographics, and others that are due to …

Foreign medical graduates are not the primary care solution

Shirie Leng, MD

Physician

August 23, 2013

With immigration reform under hot debate, it’s important to remember that all of us except the Native Americans are foreigners. It’s what has made our culture so diverse. People from foreign countries ideally bring the best of their cultures to the US and enrich us all with the diversity of life. This advantage lessens considerably when those visitors want to enter fields in which understanding of endemic American culture is …

Doctors are conflicted about sharing discharge summaries with patients

Ishani Ganguli, MD

Physician

August 22, 2013

Whether it lasted hours or months, every hospital stay is chronicled in that one final document: the proverbial baton passed from a patient’s hospital doctor to his primary care provider better known as a discharge summary.

This report has always been available to patients after they fill out a decent amount of paperwork. In mid-July, Massachusetts General Hospital began sharing discharge summaries with all patients through an online portal. The move …

The physicians to solve the doctor shortage are already here

Karan Chhabra

Health Policy

August 21, 2013

Catherine Rampell recently wrote up an often-overlooked aspect to the doctor shortage debate:

Thousands of foreign-trained immigrant physicians are living in the United States with lifesaving skills that are going unused because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here.

The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most …

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The physicians to solve the doctor shortage are already here

AAFP: What does it mean to be a family physician?

Reid Blackwelder, MD

Physician

August 21, 2013

Paul Simmons’s recent post highlights the challenges family physicians face, both in practicing the full scope of family medicine and how we communicate about our profession. I couldn’t agree more that we must raise awareness about what it means to be a family physician and fight to ensure we can practice to the fullest extent of our credentials. Family physicians care for both genders and all ages. Our …

Why does Ezekiel Emanuel have such a low opinion of physicians?

Jordan Grumet, MD

Health Policy

August 20, 2013

A study in JAMA suggested that physicians feel that other players (lawyers, insurance companies, hospitals, etc.) are more responsible than doctors for reducing healthcare costs. Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system.

Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye. Before I get …

A comprehensive locum tenens guide for physicians

Val Jones, MD

Physician

August 19, 2013

I’ve been traveling around the United States working as a locum tenens (in Latin, “place holder” – a more elegant name than “temp”) physician. We’ve all heard of traveling nurses, but more and more physicians are also “living la vida locums,” as it were. There are actually over 100 agencies who find/provide temporary physician coverage for hospitals who need to fill gaps in their full timers’ schedules. You can find out more about …

The disturbing link between high fructose corn syrup and honey

Dr. Charles

Physician

August 19, 2013

High fructose corn syrup, that sweet over-produced commodity of agribusinesses everywhere, has been linked in two miserable ways to bees and honey. The first discovery was made almost two years ago, and the second only 2 months ago. First, most of the “honey” available for purchase in supermarkets is not really honey, but instead an ultra-filtered impostor often produced in China, and …

Primary care versus specialists: Sophie’s Choice in health care

Wes Fisher, MD

Health Policy

August 19, 2013

Sophie’s Choice is a novel by American author William Styron, whose plot ultimately centers around a tragic decision Sophie was forced to make upon entering the Nazi concentration camp: on the night that she arrived at Auschwitz, a sadistic doctor made her choose which of her two children would die immediately by gassing and which would continue to live, albeit in the camp.

While not of the same gravity, I have seen the discussion by policy wonks about physician payment reform …

Patient satisfaction: What restaurants can teach doctors

Neil Baum, MD

Physician

August 18, 2013

Americans are notoriously generous and good tippers. However, there are some servers who get “over the top” gratuities. How do they do it?

1. They make a concerted effort to reach out and touch someone. How many physicians enter a room and never touch a patient? They are touching more keyboards than hearts. I have learned from complementary healthcare providers that there’s a medicinal value of touching the patient. Every chiropractor, …

5 questions ACOs need to ask themselves

David B. Nash, MD, MBA

Health Policy

August 18, 2013

ACO — for accountable care organization — is by now a familiar acronym within the healthcare industry and among all Americans who have followed the steady implementation of the Affordable Care Act.

Easily described but very challenging to operationalize, ACOs rely on effective partnering among healthcare providers of all shapes and sizes — health systems, hospitals, clinics, physician practices, urgent care centers — to collectively share responsibility for the health of …

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5 questions ACOs need to ask themselves

The key to medical home success: Bringing the stakeholders together

Fred N. Pelzman, MD

Health Policy

August 18, 2013

One of the greatest challenges when it comes time to affect major change in any system is figuring out who the stakeholders are, who has a vested interest in seeing a project rise or fall.

Without knowing who all the players are from the word go, there is almost no way to move things forward. But recognizing that we can’t keep everyone happy is also a big part of this process.

So …

Direct pay is the solution to real world cost transparency

Kim Byars, ARNP

Health Policy

August 18, 2013

In an environment of increasing regulation, government mandated red tape, and shrinking reimbursement, health care practitioners find themselves caught between a rock and a hard place. They are being forced to see more patients to make ends meet and both parties are poorer for the process. Not necessarily in just a monetary way. Patients are beginning to feel frustrated and disengaged from their mutually frustrated and disengaged providers. Both parties …

Why the Accuracy In Medicare Physician Payment Act should pass

Brian Klepper, PhD and Paul Fischer, MD

Health Policy

August 18, 2013

With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association’s (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the light of public scrutiny. “Special Deal,” Haley Sweetland Edwards’ piece in the Monthly, provides by far the more detailed and lucid explanation of the mechanics of the RUC’s arrangement with …

Primary Care

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