Monday, March 29, 2010

Less doctors... getting more done.

The Associated Press reported today:

WASHINGTON — Primary care physicians already are in short supply in parts of the country, and the landmark health care overhaul will bring them millions more newly insured patients in the next few years.
Recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, as physicians are increasingly drawn to the better pay, better hours, and higher profile of many other specialties.
Provisions in the new law are aimed at easing the strain, including bonus payments for certain physicians and expansion of community health centers, but a growing movement to change how primary care is delivered may do more to help with the influx, advocates say.
The “medical home’’ approach would enhance access to care, with a doctor-led team of nurses, physician assistants, and disease educators working together. Such teams could see more people while giving extra attention to those who need it most.
“A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,’’ said Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.
Only 30 percent of US doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Among other steps, the new law provides a 10 percent bonus from Medicare for primary care doctors serving in those areas.
The Massachusetts Medical Society reported last fall that just over half of internists and 40 percent of family and general practitioners were not accepting new patients, an increase in recent years as the state implemented nearly universal coverage.
Nationally, the big surge for primary care will not start until 2014, when the bulk of the 32 million uninsured starts coming online.
The shortage of primary care physicians in this country has been long anticipated and the report above makes the point that millions of newly insureds will soon be gaining access to needed primary care (a good thing), thus stressing the already strained primary care system (not so good).

I'm reminded of a meeting I attended about six months ago when I was with a group discussing the possibility of developing a new large endoscopy center.  The various individuals were reviewing the need, financial impact, resource requirements and trends in endoscopy utilization.  One of the participants, a noted and highly respected physician, said that within the next few years, gastroenterologists, the physicians presently performing endoscopic procedures, would soon find themselves situated at control panels upon which there would be multiple live video feeds from several endoscopic procedures.  The GI would sit at the panel and monitor each procedure which, in this new world, would be physically conducted by "GI techs", individuals trained to handle the more routine aspects while the physician could be "extended" by allowing him or her to tend to the more cerebral and taxing aspects.  This would, said the noted MD, dramatically increase the physician's productivity, lower costs, contend with expected shortages of physician resources and maintain high levels of quality.

The medical home concept, in many ways, is no different from this scenario.  Increasing the use of "physician extenders" (I dislike that term) is also the same idea.  Ultimately, we'll need to eliminate the various factors contributing to the shortage of key primary care physicians... or quickly figure out how to extend the ones we do have.

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