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March 09, 2006



Once I saw my doctor because I needed to get scripts written for my asthma meds.
He was in the exam room with me for less than 60 seconds. GP's don't get squat for an asthma visit - uncomplicated. I forget the code, but the point is there was a financial disincentive to talk to me.
Until GPs and internists can make money providing well care it isn't going to happen.
I have no problems with NPs or PAs as physician extenders, but they still need to get paid.


This is a bit of a personal pet peeve of mine, but we do a disservice to Family Physicians when we refer to them as GP's.

GP's (in the US) are medical school graduates with 1 year of post doc training.

FP's are specialists. They have a year of internship and two years of residency -- the same requirements as applies to Peds, IM some EM's and Psychiatry. We devalue them and the profession as a whole when we can't even get it correct on a policy blog.

med student

I agree we dont need more doctors, we just need redistribution. Compared to other nations, USA is in the top 5 in terms of per capita number of doctors.

Medicare needs to pay FPs more and specialists less. We also need more programs to encourage med students to go into primary care. The most popular pathway is the NHSC health services scholarships. But those are WAY too limited. Only a select few who apply are awarded those scholarships. It needs to expand greatly.

Outcomes measures to determine reimbursement would work ONLY if there are lots of caveats and adjustments made for the patient population you are seeing. You would have to have a separate system for each specialty. The patient population that an ICU doc treats is much much sicker than the group that an FP treats so you cant judge them by the same criteria. Even within specialties, you have to be careful. For example I know the neurologist who treated Christopher Reeve. Reeve was unable to find any doctor willing to treat him because his injury was so severe that it was unlikely he would recover. If you punish doctors based on outcomes, then it would be impossible for Chris Reeve to find any medical treatment at all.

A note about NPs and PAs. They are a valuable part of the team, but they cant replace doctors. They are good for triaging and a first line contact in limited situations. But you wouldnt want an NP managing diabetes or heart failure. They can help, but they cant replace doctors.

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