- Primary care -- the basic medical care that people get
when they visit their doctors for routine physicals and minor problems
-- could fall apart in the United States without immediate reforms, the
American College of Physicians said on Monday.
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- "Primary care is on the verge of collapse,"
said the organization, a professional group which certifies internists,
in a statement. "Very few young physicians are going into primary
care and those already in practice are under such stress that they are
looking for an exit strategy."
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- Dropping incomes coupled with difficulties in juggling
patients, soaring bills and policies from insurers that encourage rushed
office visits all mean that more primary care doctors are retiring than
are graduating from medical school, the ACP said in its report.
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- The group has proposed a solution -- calling on federal
policymakers to approve new ways of paying doctors that would put primary
care doctors in charge of organizing a patient's care and giving patients
more responsibility for monitoring their own health and scheduling regular
visits.
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- U.S. doctors have long complained that reimbursement
policies of both Medicare and private insurers reward a "just-in-time"
approach, instead of preventive care that would save money and keep patients
healthier.
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- "Medicare will pay tens of thousands of dollars
... for a limb amputation on a diabetic patient, but virtually nothing
to the primary care physician for keeping the patient's diabetes under
control," said Bob Doherty, senior vice president for the ACP.
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- The ACP plan called for innovations such as using e-mail
to consult on minor and routine matters, freeing up expensive office visit
time for when it is needed. Doctors would be compensated for an e-mail
consultation.
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- The proposals include incentives for doctors to work
more efficiently and to provide better care, ACP President Dr. C. Anderson
Hedberg told a news conference. "ACP proposals would provide patients
with access to care that is coordinated by their own personal physician,"
Hedberg said.
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- YOUNG DOCTORS AVOIDING PRIMARY CARE
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- The ACP cited an American Medical Association survey
that found 35 percent of all physicians nationwide are over the age of
55 and will soon retire.
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- In 2003, only 27 percent of third year internal medicine
residents actually planned to practice internal medicine, the group said,
with others planning to go into more lucrative specialty jobs.
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- "Primary care physicians -- the bedrock of medical
care for today and the future -- are at the bottom of the list of all medical
specialties in median income compensation," the ACP said.
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- The group, which represents 119,000 doctors and medical
students in general internal medicine and subspecialties, joins others
that warn the U.S. health care system is untenable.
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- "If these reforms do not take place, within a few
years there will not be enough primary care physicians to take care of
an aging population with increasing incidences of chronic diseases,"
said Dr. Vineet Arora, chair of the College's Council of Associates.
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- Dr. Sara Walker, a Missouri physician, said she believed
doctors were leaving general practice because of drops in Medicare reimbursement
to doctors.
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- "A drop in Medicare payments will not only force
me to stop taking Medicare patients but could force me out of business,"
agreed Dr. Kevin Lutz, a solo practitioner in Denver.
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- Copyright © 2006 Reuters Limited.
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