Cooperating for better care.


Tag Archives

Primary-care physicians said to ‘detest’ specialists


Milton Packer, M.D., writes in Med Page Today about the deep divisions between primary-care physicians and specialists. Among his remarks:

“So I asked primary care physicians about recent advances in diabetes and heart failure. I inquired about their knowledge of clinical trials or guideline recommendations. I wondered how they interacted with physicians who had specialized knowledge.

“‘You are joking. Right?’  I was told by one primary-care physician. ‘I hate specialists, especially cardiologists. They are so arrogant. They think that they know everything. And they think that I know nothing. They don’t really want to help people. They just want to make money. I hate referring patients to them.”’

“There was more: ‘Look. I don’t do procedures. I see dozens of patients a day, and it is an impossible challenge. I don’t have the time or the staff to fill out preauthorization forms. I hardly have the time to tend to the emotional needs of my patients. Specialists certainly won’t do that.’

“‘When I call a specialist because I want their advice, all they want to know is if the patient needs a procedure. If I ask them about the use of medications, they have no time for me. Maybe I’ll get connected to one of their nurses. In any case, it’s a terrible experience.’

“Family physicians do not like specialists. Actually, they detest them.”

To read more, please hit this link.


Not too few physicians but bad distribution, not enough non-physician clinicians

It’s sort of a cliche to say that America has a  dangerous shortage of physicians. But a New York Times story challenges that.

It says, among other things:

“Some people think there’s no shortage at all — just a poor distribution of the doctors we have.”

“Adding data to this argument, the United States has fewer practicing physicians per 1,000 people than 23 of the 28 countries that reported data in 2013 (among nations in the Organization for Economic Cooperation and Development).”

“But there is strong evidence that we are thinking about this the wrong way. In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians.

“The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health.”

“And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. These are mostly in cities, especially in cities where it seems desirable to live. The problem is made worse by the ways we reimburse for care. Medicare, for instance, pays more to doctors who live in places that are more expensive. The argument for this is that the cost of living is higher, so reimbursements must be, too. But that also means that doctors can earn more in places where they already might want to live. A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others.”

“The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. …”

To read the full Times story, please hit this link.

Contact Info

(617) 230-4965

Wellesley, Mass