• Reflex: October 13, 2011

    It’s not just that we have a shortage of primary care physicians, it’s also how they’re distributed, reports the RWJF“The maldistribution of primary care providers appears to be a larger problem than an overall shortage. Primary care providers tend to aggregate in suburban and urban areas at a higher rate than the overall population leaving rural and some poor, inner-city areas without an adequate supply of primary care providers.” Aaron’s comment: I’ve written a number of times on how we have too few doctors in the US. This makes things even worse. One suggestion is to use more mid-level providers. Another is to train more primary care docs.

    Insurers suggest big savings if they manage the care for Medicare-Medicaid dual enrollees, reports Alex Wayne (Bloomberg). “America’s Health Insurance Plans, or AHIP, the Washington- based trade group for insurers, is lobbying the congressional supercommittee studying debt reduction to allow states to hire health plans such as UnitedHealth Group Inc. (UNH) to direct care for the indigent elderly and disabled.” The claim is that care management by private plans for this population will save $125 billion over 10 years. Austin’s comment: One question I have is the extent to which claimed savings would be driven by management and coordination or by the nature of private plans. In other words, if Medicare and Medicaid developed a public program that included the suggested care management, would that save more or less than the $125 billion insurers claim they will save? Other things to keep in mind: There is scant evidence that private plans control spending better than public programs. Also, a recent study found that Medicaid managed care didn’t lower spending, on average, though there is variation by state.

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    • Ditching the RBRVS and moving away from third-party payment for routine medical care would also help immensely.*

      The kind of people that get admitted to medical school generally don’t want to live in the country (ask yourself what percentage of them prefer hunt and/or fish in the country vs sampling high-end Pinots and artisanal cheeses out there ), and and any altruistic motives they might have for doing so quickly wilt under the pressure of the compensation differentials, low status, uninteresting and tedious duties, and great masses of uncompensated time at the end of each working day. It’s possible that they’d be willing to move to Walmartland if they could make enough money to offset the negative intangibles, but that isn’t going to happen anytime soon.

      .Observing the number of people that actually went onto careers in primary care after graduating from a school that was consistently ranked number one in the nation for training primary care docs and which supposedly takes that into consideration when selecting students was eye-opening. Pretend you want to be a primary care doc in a rural setting and then gun for Optho or Derm like your life depends on it.

      PA’s are a different story. Many more pass the hunting, fishing tests, or at least don’t get nauseated when listening to more than 5 seconds of Garth Brooks), a primary care setting isn’t a waste of their training, and they don’t have vastly more lucrative options available to them under the current compensation structure. They’re the only hope in the current environment, I’m afraid.

      *One doctor’s testimonial.
      http://www.thestranger.com/seattle/lessons-from-the-abyss/Content?oid=999924