Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 , Nice article!! Deanna, FNP Aurora, CO Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 , Nice article!! Deanna, FNP Aurora, CO Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 Congrats! Looks like you got some positive press. Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd.info From: [mailto: ] On Behalf Of Eads Sent: Sunday, January 16, 2011 1:16 PM To: Subject: new article Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 Congrats! Looks like you got some positive press. Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd.info From: [mailto: ] On Behalf Of Eads Sent: Sunday, January 16, 2011 1:16 PM To: Subject: new article Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 Nice. ! To: Sent: Mon, January 17, 2011 11:57:00 AMSubject: Re: new article , Nice article!! Deanna, FNP Aurora, CO Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2011 Report Share Posted January 17, 2011 Nice. ! To: Sent: Mon, January 17, 2011 11:57:00 AMSubject: Re: new article , Nice article!! Deanna, FNP Aurora, CO Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 great job michelle. I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Nice. ! To: Sent: Mon, January 17, 2011 11:57:00 AM Subject: Re: new article , Nice article!! Deanna, FNP Aurora, CO Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 great job michelle. I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Nice. ! To: Sent: Mon, January 17, 2011 11:57:00 AM Subject: Re: new article , Nice article!! Deanna, FNP Aurora, CO Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 ,The comments are truly fascinating. Keep up the good work. Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 ,The comments are truly fascinating. Keep up the good work. Hi Folks, Just letting you know an article was printed today that discusses parts of my practice. http://www.gazette.com/articles/eads-111177-concierge-practice.html#slComments It ran on the front of the local Sunday paper, on the top, with the picture 8x6 inches in color even – what a nice surprise! The reporter was focusing on concierge medicine, but I tried to stress the IMP stuff. The comments have been interesting to read. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 I noted that the ethics experts made no comment on how unethical it is to put a caregiver in a system that is a prescription for burnout and is too often psychologically traumatizing. Huge private debts accumulated without hope of a sustainable career. The fault lies with the government and insurance industry policy people who have worked tirelessly the last 30+ years to marginalize and wring the last bit of profitability out of primary care.The doc is supposed to be the one who suffers emotionally and finacially so that the broken system can be propped up for a little while longer for the benefit of the entitled, the government and the insurance industry. The AMA says we should tough it out because they have just a few more coding books and seminars to sell us. My favorite comment was from the MD Vip patient that wasn't going to stay with the doctor and the new fees. Something to the effect of - It's unamerican not to accept insurance or Medicare. How about that? I guess honest work for honest pay and a reasonable family life has now become UnAmerican in the eyes of the entitled American public.Ben\ I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 I noted that the ethics experts made no comment on how unethical it is to put a caregiver in a system that is a prescription for burnout and is too often psychologically traumatizing. Huge private debts accumulated without hope of a sustainable career. The fault lies with the government and insurance industry policy people who have worked tirelessly the last 30+ years to marginalize and wring the last bit of profitability out of primary care.The doc is supposed to be the one who suffers emotionally and finacially so that the broken system can be propped up for a little while longer for the benefit of the entitled, the government and the insurance industry. The AMA says we should tough it out because they have just a few more coding books and seminars to sell us. My favorite comment was from the MD Vip patient that wasn't going to stay with the doctor and the new fees. Something to the effect of - It's unamerican not to accept insurance or Medicare. How about that? I guess honest work for honest pay and a reasonable family life has now become UnAmerican in the eyes of the entitled American public.Ben\ I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 Ben,When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?” I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives:1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you.2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day.3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis” may not be as bad as we might think. Let’s do math:a. 300,000,000 people in the USb. 936,000 doctorsc. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds)d. Divide it out and you get 1327 patients/doc.e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider.So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. From: [mailto: ] On Behalf Of Ben BrewerSent: Tuesday, January 18, 2011 12:09 AMTo: Subject: Re: new article I noted that the ethics experts made no comment on how unethical it is to put a caregiver in a system that is a prescription for burnout and is too often psychologically traumatizing. Huge private debts accumulated without hope of a sustainable career. The fault lies with the government and insurance industry policy people who have worked tirelessly the last 30+ years to marginalize and wring the last bit of profitability out of primary care. The doc is supposed to be the one who suffers emotionally and finacially so that the broken system can be propped up for a little while longer for the benefit of the entitled, the government and the insurance industry. The AMA says we should tough it out because they have just a few more coding books and seminars to sell us. My favorite comment was from the MD Vip patient that wasn't going to stay with the doctor and the new fees. Something to the effect of - It's unamerican not to accept insurance or Medicare. How about that? I guess honest work for honest pay and a reasonable family life has now become UnAmerican in the eyes of the entitled American public. Ben\ I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 Ben,When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?” I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives:1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you.2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day.3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis” may not be as bad as we might think. Let’s do math:a. 300,000,000 people in the USb. 936,000 doctorsc. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds)d. Divide it out and you get 1327 patients/doc.e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider.So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. From: [mailto: ] On Behalf Of Ben BrewerSent: Tuesday, January 18, 2011 12:09 AMTo: Subject: Re: new article I noted that the ethics experts made no comment on how unethical it is to put a caregiver in a system that is a prescription for burnout and is too often psychologically traumatizing. Huge private debts accumulated without hope of a sustainable career. The fault lies with the government and insurance industry policy people who have worked tirelessly the last 30+ years to marginalize and wring the last bit of profitability out of primary care. The doc is supposed to be the one who suffers emotionally and finacially so that the broken system can be propped up for a little while longer for the benefit of the entitled, the government and the insurance industry. The AMA says we should tough it out because they have just a few more coding books and seminars to sell us. My favorite comment was from the MD Vip patient that wasn't going to stay with the doctor and the new fees. Something to the effect of - It's unamerican not to accept insurance or Medicare. How about that? I guess honest work for honest pay and a reasonable family life has now become UnAmerican in the eyes of the entitled American public. Ben\ I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 Great points and Ben. I also get upset by all of these discussions. The powers that be have made the healthcare system into a business. If we look at it as a business, then why can't we compare it to other service related businesses like lawyers, plumbers, automechanics, restaurants, etc. Why are we expected to give more charity care or undergo more regulations?? I loved the essay posted here a couple of years ago where you go into a restaurant, eat your meal, and then tell the owner to wait until the insurance EOB to see what they they the meal is worth, what they will pay for the meal, and then what my responsibibility for the meal. I have added a little travel medicine to my practice. I had a young man the other day who had been in Europe and got most of his travel-related vaccines there. He is here now and needed a couple of more before heading down to the Amazon. He made a comment about how much cheaper the vaccines were in Europe. I pointed out to him that it cost me over $200,000 for my degree and I don't believe the doctors over there had to spend that much for theirs. I get upset when I hear about requiring us to take Medicare/insurance to maintain our licenses for that fact- they need to pay for our education then too! Of course we are all altruistic and that is why most of us do take these plans or some of the plans but why should we??? Sorry to rant but I just did my year end financials and I took home $30K less last year, despite billing out $11K more!!! WOrking more for less seems to be our motto these days! Margaret Coughlan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2011 Report Share Posted January 18, 2011 Great points and Ben. I also get upset by all of these discussions. The powers that be have made the healthcare system into a business. If we look at it as a business, then why can't we compare it to other service related businesses like lawyers, plumbers, automechanics, restaurants, etc. Why are we expected to give more charity care or undergo more regulations?? I loved the essay posted here a couple of years ago where you go into a restaurant, eat your meal, and then tell the owner to wait until the insurance EOB to see what they they the meal is worth, what they will pay for the meal, and then what my responsibibility for the meal. I have added a little travel medicine to my practice. I had a young man the other day who had been in Europe and got most of his travel-related vaccines there. He is here now and needed a couple of more before heading down to the Amazon. He made a comment about how much cheaper the vaccines were in Europe. I pointed out to him that it cost me over $200,000 for my degree and I don't believe the doctors over there had to spend that much for theirs. I get upset when I hear about requiring us to take Medicare/insurance to maintain our licenses for that fact- they need to pay for our education then too! Of course we are all altruistic and that is why most of us do take these plans or some of the plans but why should we??? Sorry to rant but I just did my year end financials and I took home $30K less last year, despite billing out $11K more!!! WOrking more for less seems to be our motto these days! Margaret Coughlan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Thanks for the post , I will be talking to the 3rd year medical students at the Univ. of Illinois College of Medicine in Rockford, IL. in May. They asked me to speak about my experiences running a private FP practice and about my EMR. I would like to give them some framework around the idea that they could possibly have a satisfying career in primary care. I remember listening to such things 17 years ago when I was a medical student. Much of it turned out to be well intentioned hope and too much BS. They predicted primary care was the way of the future for medicine and would be compensated better down the line. Hasn't happened yet, and probably won't unless we change the business model away from what's historically been done. Hurray for and others brave enough to try something different. Ben Subject: RE: new articleTo: Date: Tuesday, January 18, 2011, 6:59 AM Ben, When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?†I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives: 1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you. 2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day. 3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis†may not be as bad as we might think. Let’s do math: a. 300,000,000 people in the US b. 936,000 doctors c. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds) d. Divide it out and you get 1327 patients/doc. e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider. So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Ben this is way cool I have been talking to the 3 rd yr residents at thelocal fp prgoram for 3 or 4 yrs Several come to see my practice and those largley go into the same imp or imp like direction This week's resident actually is going on to tto a VA Quality Scholar program first. What we do is what fps want to do To give young people starting out the tools to successfully do it is fabulous yay michelle .Of course EAds has been a star for along time. I have begun to get Medical Economics free lately,( who knows) and Joe Scherga( sp?) in S cal is an academic yes- I have heard several of you mention him I was browsing through the Dec 2010 edition of Medical Economics and Dr Scherga had written an article about the future practice models of fp He said that in Health Affairs, the MAY issue of Health Affairs, in which there were 47 articles devoted to the theme of reinventing priamrycare he saw 2 general models emerging - not mutually exclusive many shared features in any one p ractice -and these two are- the optimized team, per Dr t Bodenheimer's work and- relationship cneterd care. the relationship centered model AT which point he goes on t o describe the work of l Gordon and IMPS ! he also mentions Groups Health adn Greenfiled Health( WA and r OR) respectively, doing similar work with better access continity and lowered panel sizes I cannot share the medical economics issue and one cannot see health affairs onlinebut good stuff.We expect he says that patients are expected to change and we, he syas should change if we want to improve our practices and optimize primary c are - major changes he says are needed to improve primary care This group is already way out in fornt Thanks for the post , I will be talking to the 3rd year medical students at the Univ. of Illinois College of Medicine in Rockford, IL. in May. They asked me to speak about my experiences running a private FP practice and about my EMR. I would like to give them some framework around the idea that they could possibly have a satisfying career in primary care. I remember listening to such things 17 years ago when I was a medical student. Much of it turned out to be well intentioned hope and too much BS. They predicted primary care was the way of the future for medicine and would be compensated better down the line. Hasn't happened yet, and probably won't unless we change the business model away from what's historically been done. Hurray for and others brave enough to try something different. Ben Subject: RE: new article To: Date: Tuesday, January 18, 2011, 6:59 AM Ben, When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?” I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives: 1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you. 2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day. 3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis” may not be as bad as we might think. Let’s do math: a. 300,000,000 people in the US b. 936,000 doctors c. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds) d. Divide it out and you get 1327 patients/doc. e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider. So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. -- MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Ben this is way cool I have been talking to the 3 rd yr residents at thelocal fp prgoram for 3 or 4 yrs Several come to see my practice and those largley go into the same imp or imp like direction This week's resident actually is going on to tto a VA Quality Scholar program first. What we do is what fps want to do To give young people starting out the tools to successfully do it is fabulous yay michelle .Of course EAds has been a star for along time. I have begun to get Medical Economics free lately,( who knows) and Joe Scherga( sp?) in S cal is an academic yes- I have heard several of you mention him I was browsing through the Dec 2010 edition of Medical Economics and Dr Scherga had written an article about the future practice models of fp He said that in Health Affairs, the MAY issue of Health Affairs, in which there were 47 articles devoted to the theme of reinventing priamrycare he saw 2 general models emerging - not mutually exclusive many shared features in any one p ractice -and these two are- the optimized team, per Dr t Bodenheimer's work and- relationship cneterd care. the relationship centered model AT which point he goes on t o describe the work of l Gordon and IMPS ! he also mentions Groups Health adn Greenfiled Health( WA and r OR) respectively, doing similar work with better access continity and lowered panel sizes I cannot share the medical economics issue and one cannot see health affairs onlinebut good stuff.We expect he says that patients are expected to change and we, he syas should change if we want to improve our practices and optimize primary c are - major changes he says are needed to improve primary care This group is already way out in fornt Thanks for the post , I will be talking to the 3rd year medical students at the Univ. of Illinois College of Medicine in Rockford, IL. in May. They asked me to speak about my experiences running a private FP practice and about my EMR. I would like to give them some framework around the idea that they could possibly have a satisfying career in primary care. I remember listening to such things 17 years ago when I was a medical student. Much of it turned out to be well intentioned hope and too much BS. They predicted primary care was the way of the future for medicine and would be compensated better down the line. Hasn't happened yet, and probably won't unless we change the business model away from what's historically been done. Hurray for and others brave enough to try something different. Ben Subject: RE: new article To: Date: Tuesday, January 18, 2011, 6:59 AM Ben, When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?” I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives: 1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you. 2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day. 3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis” may not be as bad as we might think. Let’s do math: a. 300,000,000 people in the US b. 936,000 doctors c. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds) d. Divide it out and you get 1327 patients/doc. e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider. So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. -- MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Ben this is way cool I have been talking to the 3 rd yr residents at thelocal fp prgoram for 3 or 4 yrs Several come to see my practice and those largley go into the same imp or imp like direction This week's resident actually is going on to tto a VA Quality Scholar program first. What we do is what fps want to do To give young people starting out the tools to successfully do it is fabulous yay michelle .Of course EAds has been a star for along time. I have begun to get Medical Economics free lately,( who knows) and Joe Scherga( sp?) in S cal is an academic yes- I have heard several of you mention him I was browsing through the Dec 2010 edition of Medical Economics and Dr Scherga had written an article about the future practice models of fp He said that in Health Affairs, the MAY issue of Health Affairs, in which there were 47 articles devoted to the theme of reinventing priamrycare he saw 2 general models emerging - not mutually exclusive many shared features in any one p ractice -and these two are- the optimized team, per Dr t Bodenheimer's work and- relationship cneterd care. the relationship centered model AT which point he goes on t o describe the work of l Gordon and IMPS ! he also mentions Groups Health adn Greenfiled Health( WA and r OR) respectively, doing similar work with better access continity and lowered panel sizes I cannot share the medical economics issue and one cannot see health affairs onlinebut good stuff.We expect he says that patients are expected to change and we, he syas should change if we want to improve our practices and optimize primary c are - major changes he says are needed to improve primary care This group is already way out in fornt Thanks for the post , I will be talking to the 3rd year medical students at the Univ. of Illinois College of Medicine in Rockford, IL. in May. They asked me to speak about my experiences running a private FP practice and about my EMR. I would like to give them some framework around the idea that they could possibly have a satisfying career in primary care. I remember listening to such things 17 years ago when I was a medical student. Much of it turned out to be well intentioned hope and too much BS. They predicted primary care was the way of the future for medicine and would be compensated better down the line. Hasn't happened yet, and probably won't unless we change the business model away from what's historically been done. Hurray for and others brave enough to try something different. Ben Subject: RE: new article To: Date: Tuesday, January 18, 2011, 6:59 AM Ben, When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?” I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives: 1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you. 2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day. 3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis” may not be as bad as we might think. Let’s do math: a. 300,000,000 people in the US b. 936,000 doctors c. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds) d. Divide it out and you get 1327 patients/doc. e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider. So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. -- MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Thanks for pointing out Joe Scherger's article (I hadn't noticed it despite years of receiving Medical Economics in the mail for free, again despite sending cards in multiple times asking to be removed from the mailing list). It's a good article though. Can cut and paste link:http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Its-time-to-optimize-primary-care-for-a-healthier-/ArticleStandard/Article/detail/699150 I like the relationship centered model name (that's what I like to call my practice) and the concept of the organized team model as a non-competing but rather complementary way to provide care to larger groups. Joe lurks on this listserve, I believe. If so, good job!SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617 PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 Thanks for pointing out Joe Scherger's article (I hadn't noticed it despite years of receiving Medical Economics in the mail for free, again despite sending cards in multiple times asking to be removed from the mailing list). It's a good article though. Can cut and paste link:http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Its-time-to-optimize-primary-care-for-a-healthier-/ArticleStandard/Article/detail/699150 I like the relationship centered model name (that's what I like to call my practice) and the concept of the organized team model as a non-competing but rather complementary way to provide care to larger groups. Joe lurks on this listserve, I believe. If so, good job!SharonSharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617 PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2011 Report Share Posted January 19, 2011 , I get this question a great deal, especially at the medical school. My responce is usually, " why is this my problem? I have worked for 40 years, in various public an private practices, and I signed up to take great care of my patients. This is great care, seeing 25 patients a day, is not. If the medical establishment, and educators have spent the last 40 years ignoring and underpaying primary care, the problem lies elsewhere. " Jim From: [ ] On Behalf Of Dr. Brady [drbrady@...] Sent: Tuesday, January 18, 2011 5:59 AM To: Subject: RE: new article Ben, When I was giving a lecture once, I had the question posed to me: “We are facing a primary care crisis. If we all went to an IMP kind of practice, then we could never meet the needs of the population. How can you justify this?” I went into a similar discussion as you just posted. After thinking about it a while, I decided the best answer lies in looking at the problem from 3 different perspectives: 1) From the perspective of the patient: How many other patients do you want your doctor to see in a day? This gets to an intrinsic understanding of processes and burnout and the feeling of relationship with your doctor. Patients know (generally) the more patients you see in a day, the less effective you will be when they need you. 2) From the perspective of the provider: How many patients would you see a day if you were independently wealthy? This gets to physician satisfaction and burnout. Unfortunately, 60% or more of us would retire based on the latest studies I have seen. I don’t know of anyone who would say they want to see 40-50 patients a day. 3) From the perspective of society: How many providers do we need to take care of the population? This gets back to your legitimate concerns below, but the “looming crisis” may not be as bad as we might think. Let’s do math: a. 300,000,000 people in the US b. 936,000 doctors c. 226,000 primary care docs (112,000 FP, 50,000 IM, 58,000 Peds) d. Divide it out and you get 1327 patients/doc. e. Add 100,000 NPs and 16,000 PAs and you get 877 patients/provider. So it seems there is really plenty of providers to go around, we simply have a mismatch of supply and demand. Now, you can fix this mismatch through legislation mandating certain things (take medicare or you will no longer have a license) or by offering incentives and making primary care more attractive. I think the latter is a better option because the former has obviously not worked in the past. From: [mailto: ] On Behalf Of Ben Brewer Sent: Tuesday, January 18, 2011 12:09 AM To: Subject: Re: new article I noted that the ethics experts made no comment on how unethical it is to put a caregiver in a system that is a prescription for burnout and is too often psychologically traumatizing. Huge private debts accumulated without hope of a sustainable career. The fault lies with the government and insurance industry policy people who have worked tirelessly the last 30+ years to marginalize and wring the last bit of profitability out of primary care. The doc is supposed to be the one who suffers emotionally and finacially so that the broken system can be propped up for a little while longer for the benefit of the entitled, the government and the insurance industry. The AMA says we should tough it out because they have just a few more coding books and seminars to sell us. My favorite comment was from the MD Vip patient that wasn't going to stay with the doctor and the new fees. Something to the effect of - It's unamerican not to accept insurance or Medicare. How about that? I guess honest work for honest pay and a reasonable family life has now become UnAmerican in the eyes of the entitled American public. Ben \ I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2011 Report Share Posted January 20, 2011 Jim & , Also relevant is recruitment and retention into primary care. If docs are burned out victims they are poor role models essentially deterring the next generation of primary care docs. (JAMA article 2% go into gen int. medicine) Vs. " Happy docs beget happy docs. " I've had several patients decide to go to med school after seeing me as a role model. And as far as retention: I had 6 jobs in 10 years prior to my IMP (now nearly 6 years in 1 job! - a record). I had quit and decided to go back to waitressing prior to IMP. Last employed position 4 female docs left in mid-career for more meaningful work (teacher, homemaker). . . ~ Pamela Pamela Wible, MD 3575 St. #220 Eugene, OR 97405 www.idealmedicalcare.org > > \ I find it interesting that it's always the academic folks that don't see patients who make the arguments about low-volume practices being unfair because there aren't enough primary care docs then. > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.