Sunday, May 18, 2008

More on the Primary Care Shortage

Medical Economics magazine reports that graduating primary care doctors are getting more job offers than previously. This is in a large part due to the decreasing number of physicians going into primary care.
So why the continuing shortage in primary care? In a word, money, despite a boost in financial incentives for new recruits beginning last year. Even today, medical graduates shouldering huge debts survey the practice landscape and see a real disconnect between the hours PCPs put in and their incomes, at least compared with specialists and surgeons. Compounding the problem is graduates' perception that, as PCPs, they'll occupy a lower rank in the medical pecking order. No wonder, then, that primary care practice still isn't a big draw, at least not for US medical residents.


Over the last several months, much has been written on the medical blogosphere and on medical websites about "never events":
In August 2007, Medicare announced that, starting October 2008, it will no longer reimburse the treatment hospitals must provide to redress eight medical errors, a list likely to lengthen in the future. In fact, CMS has already announced its plan to add ventilator-associated pneumonia and deep vein thrombosis to its list in fiscal year 2009.
Some of the events on the list are expected complications of treatment rather than true medical mistakes.
For now, the Medicare decision affects only hospitals. So why should physicians worry?
Although under the never-event rule physicians may still bill for their services when a mistake on Medicare’s list occurs in the hospital, Gosfield says those days are numbered. “I think at some point that will change,” she says. “There’s going to be more and more emphasis on shared clinical responsibility for patients — that you should pay attention to where you are referring to and who you’re taking referrals from.

Saturday, May 17, 2008

Medical Ethics

The current issue of Medical Economics magazine has an interesting article about medical ethics:
A consequence of fewer physicians accepting Medicare and Medicaid recipients, of course, is that those who continue to treat these patients will be forced to see a disproportionate share of them, and suffer the economic consequences.
FP Patricia Roy of Muskegon, MI, proposes a middle ground. "Nobody can make a living caring for these folks exclusively," she says. "But I think ethically, and in the interest of fairness, we all have to takesome." Turton agrees. "Physicians work within a system," he says, "and, ethically speaking, the burden of caring for uninsured and underinsured patients must be distributed evenly throughout the physician population."

Medicare and Medicaid reimbursement will continue to decline in inflation-adjusted dollars, and possibly also in nominal dollars as well. As a sleep specialist, I will continue to see most patients referred to me by my primary care colleagues, including patients with Medicare and Medicaid.
I disagree that primary care patients have an obligation to work within a broken system and take Medicare and Medicaid. Until PCP's show some backbone, Medicare reimbursement will continue to decline.

Wednesday, May 07, 2008

Doctor Etiquette

I'm too lazy to summarize the WSJ Health Blog post on doctor etiquette, my comment on the matter is #3. I also entered a comment around #24 (which may not be up yet if you reading this around 12:30 am May 8).

Tuesday, May 06, 2008

medical blog rankings

Medical blog rankings for the month of April are up. This blog is # 340, right behind "A Chance to Cut is a Chance to Cure," which has no new posts this year. Doing somewhat better is my other blog, "sleepdoctor," at #236.

Monday, May 05, 2008

CON Opposition in the South

David Rosenfeld at Medical News, Inc reports on the controversy regarding Certificate of Need laws:

Florida Governor Charlie Crist is mounting an aggressive campaign this year against the state’s certification process for new hospitals, commonly known as Certificate of Need (CON). And he’s not alone.
CON laws face a battery of opposition in states across the South. Yet few believe that the laws will change.
Although most CON laws are slightly different, each represents the efforts of individual states to limit growth and ensure that healthcare facilities are constructed only where they’re needed.

Existing hospitals, in an attempt to decrease competition, tend to support these laws.

Sunday, May 04, 2008

My Predictions for the US Dollar

Although the long-term trend of the US dollar has been to weaken, especially against the Euro, for the last 2 weeks the US dollar has strengthened.

Warren Buffett predicts further weakening of the US Dollar (

The U.S. dollar will keep weakening and Buffett feels ``no need to hedge'' against currency risk when buying large companies outside the U.S., he said.

Who am I to disagree with the legendary Buffett? He takes a long-term view on investments, and I agree with him that in the long-term the US dollar will continue to weaken. However, I believe that the US dollar will (mildly) strengthen against the Euro over the next 4 to 6 months. The Fed rate cuts are over, and there will probably be a rise in the Federal Funds rate this summer, which will have a strengthening effect on the dollar. The economic slow-down will also tend to strenghten the dollar. On the other hand, current inflationary pressures will have a weakening effect. I expect the dollar to resume its long-term trend of weakening late in 2008, as increasing inflation and economic expansion will cause the US dollar to fall to new lows against the Euro.

Saturday, May 03, 2008

American Psychiatric Association caves in to gay activists

Bob Unruh reports in WorldNetDaily:

A discussion on religion, homosexuality and therapy that had been scheduled during the American Psychiatric Association's annual meeting in Washington has been shut down following an attack by a "gay" publication on some of the people planning to participate.

But the event, scheduled Monday, has been yanked from the schedule, according to the APA, because of the "misinformation and rhetoric" that was circulating about the issue.

My Solution for the Primary Care Shortage

In an attempt to alleviate the coming physician (particularly primary care) shortage, states are increasing the size of their medical school classes, and a few are even building new medical schools. As pointed out by the WSJ Health Blog, this will make little difference in the total number of licensed, practicing physicians since the number of practicing physicians is determined by the number of residency slots. The primary effect of increasing the number of US medical students will be to increase the proportion of US graduates to foreign medical graduates in residency programs, and ultimately the proportion of US grads to foreign grads in the ranks of practicing physicians.

Many states, including Mississippi, are foolishly increasing the size of their medical school classes in an attempt to increase the number of primary care doctors in their state. If the goal is to increase the number of primary care doctors within a particular state, a better way to accomplish this goal would be to increase the number of primary care residency slots in that state. Since CMS (Medicare) is not adding new subsidized residency slots (approximately 100,00 dollars per year), states should subsidize these slots themselves. If the goal is to increase primary care docs in a state, subsidizing primary care residency slots is a much better investment than increasing the number of medical students, many of whom will end up leaving the state or practicing a subspecialty. Since many internists go on to subspecialize, the best investment value would be to increase the number of family practice and pediatric slots.