10 Things Your PC Physician Won’t Tell You
I have to agree that there is a lot of pressure to specialize.
1. “They should put me on the endangered-species list.” A good primary-care doctor (someone to coordinate your health care, help choose your specialists and be the first to diagnose just about any problem) is the key to good medical treatment. But they’re getting harder to come by. Why? Fewer med students are going into primary care: Interest is so low that the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade.
2. “I’m the pauper of my profession.” One big reason fewer medical students are specializing in primary care is pure and simple economics. In 2006 primary-care doctors earned an average of $171,519. That might sound like a lot to most working people, but it’s less than half of what dermatologists made that same year. And the call of more-lucrative specialities is only likely to get louder for today’s residents: According to one study, the income of primary-care doctors, adjusted for inflation, actually fell by 10% between 1995 and 2003.
3. “Sorry, your 12 minutes are up.” Some doctors are able to see 40 patients a day. That’s one every 12 minutes. And it doesn’t show signs of slowing: According to one survey the average number of patients doctors saw grew by 7.5% from 2004 to 2005. While this system isn’t inherently bad, it can be abused. Assistants may have a different philosophy from the doctor, leading them to treat problems differently as well. Communication can break down, causing confusion about medications, and a misdiagnosis by an assistant is always possible.
4. “I hawk for Big Pharma in my spare time.” Your physician relies on his best judgment when deciding what drugs to prescribe. And influencing that judgment is big business. Market-research firm IMS has found that the pharmaceutical industry spends $7.2 billion a year targeting doctors with ads and sales representatives. Drug companies know doctors are more likely to take their cues from other doctors, so they sponsor weekend seminars at expensive resorts featuring presentations by physicians.
5. “Sore throat? You might be better off going to the mall.” Walk-in clinics are springing up across the country. They’re run by nurse practitioners, who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice or referrals if the problem is beyond their scope. These clinics have caught on in part because they’re fast and don’t require an appointment. They’re also cheap — $40 to $60 a visit, versus $150 for a doctor or $300 for an ER visit — and many take insurance. Today there are about 460 such clinics, but analysts expect the number to jump to 4,000 by 2009.
6. “I hate technology.” Primary-care physicians have been slow to adopt the technology: A recent study found that only 28% use these systems. Why? They can cost up to $70,000, and cash-strapped GPs see little payoff. For most patients the benefits of the technology are huge. It eliminates prescription errors due to illegible handwriting. It ensures that patients get the right dosage. Records won’t get lost. It reminds doctors when they need to monitor their patients. And specialists and others can easily forward electronic records to your GP.
7. “Your insurance company is calling the shots.” These days doctors have more freedom to send you to a specialist or order expensive tests than they once did under managed care. But that doesn’t mean the system is fixed. With increased deductibles, it’s often the patient who foots the bill for a referral or an expensive test. Insurers also still wield the power when it comes to hospital stays.
8. “My legal history is none of your business.” Today’s insurance plans give patients a wider range of doctors to choose from, but patients don’t have any more information to help them decide. The best information about doctors is off-limits to patients. It’s the National Practitioner Data Bank, which state medical boards and hospitals use to do background checks, and it includes information on disciplinary actions and malpractice payments. The best publicly available information is tracked by state medical boards, many of which publish this information on their Web pages. If yours doesn’t, you can pay $9.95 for a report from DocInfo.org, a site run by the Federation of State Medical Boards.
9. “If you’re over 65, don’t bother me…” Doctors who specialize in geriatrics are increasingly rare. Right now there is just one geriatrician in the U.S. for every 5,000 seniors, about half of what we should have, according to the American Geriatrics Society. Treating older patients who have multiple, often complex problems is about the worst way a doctor can make a living. Medicare doesn’t compensate much more for a 45-minute appointment with a patient with dementia, hearing loss and a half-dozen other maladies than it does for seeing someone for a simple checkup.
10. “…unless, of course, you’re willing to pay extra.” Unfortunately, the shortage of geriatricians is worsening. The American Geriatrics Society estimates that by 2030, there will be a shortage of about 36,000 geriatricians in the U.S., up from 7,000 today. Though the situation seems dire, there are ways to guarantee qualified care. One approach is to see a good primary-care doctor who is also a geriatrician long before you need one. Other approaches can be costly. In Sarasota, Fla., many doctors provide “concierge” service: Patients pay an annual retainer of about $4,000 in exchange for their doctor’s cell number and upgraded access. These pricey options aren’t what most people have in mind when they think of health care reform, but they may be the only way to maintain ready access to a good doctor.
