demonizing doctors, doctors are human too, patient satisfaction, primary care

There’s a shortage of primary care doctors. Who is responsible for solving this problem?

According to Medical Economics, in their article “How can physicians combat industry shortages and meet patient demands,” the existing primary care workforce bears sole responsibility for this.

The article doesn’t start off too badly.  It says that by 2025, there will be a shortage of 46,000 to 90,000 primary care docs. It then states that one of the reasons for the shortage is the relatively low pay that primary care docs get. This is true. Most primary care practices are consistently in the red due to low insurance payments, which is why there are very few independent practices anymore. Most are owned by hospital systems, who can absorb the loss.

That’s about where the sanity of this piece ends.  According to it, the second reason for the shortage is that we have not “embraced technological advancements.”  The article tells us that we need to deliver services via telemedicine and apps.

No matter that technology for this is still substandard.

No matter that there are serious concerns about cybersecurity and the safety of patient info.

No matter that using these technologies requires a substantial financial investments, of which no primary care doctor can afford.

No matter that there is absolutely no guarantee that insurers will actually pay for these services.
The article then goes on to give this sage advice:

Expand Office Locations: Research market trends and population changes across surrounding areas. Opening office locations in underserved areas experiencing population growth asserts your presence before other practices follow suit.”

And who the heck is going to staff these other locations? I thought they just said we’ve got a shortage of doctors! Maybe the staff of Medical Economics has discovered the secrets of cloning and can be in two places at once, but I haven’t figured it out yet.

It goes on to say:

Reevaluate office hours. Take a look at appointment patterns. Do most of your patients prefer appointments later in the day or earlier in the morning? Should you offer weekend hours? What about extending services later in the evening, when people are out of work? Instead of becoming complacent with standard office hours, test new hours and see how patients respond. Tailoring hours by office location will better serve patients while maximizing your staff’s time and resources.

See, here’s the thing.  My schedule is full during standard office hours. Do I have patients that would love evening or weekend hours? Sure. But am I supposed to work 24 hours a day, 7 days a week? It’s not like I sit around twiddling my thumbs from the hours of 9-5. I’m seeing patients for just about every minute of that time, and doing paperwork during any time I’m not seeing patients (and after hours and on weekends, too).  You can’t claim that there’s a shortage of doctors and too many patients to go around in one breath, and then claim that the doctors are the ones that need to be more accommodating in the next.  Supply and demand, people.

 

Here’s the thing, Medical Economics. The reasons for the primary care shortage are many. Low pay. Low prestige. Too much paperwork. Every-increasing government and insurance regulations and requirements. And, most important of all, not enough residency spots for training doctors.  There are only a certain amount of residency spots a year to train graduating MDs. If a doctor graduates from medical school but does not complete a residency, they can’t practice. They can’t get a license.  Their education is, in essence, wasted.  These are not bad students. There are just not enough spots.  Every year, almost 10,000 doctors do not match! Most of these doctors have gone to international schools.  All of them would do just about anything for the chance to practice medicine here.

It takes a 3 year residency to train a primary care doctor.  If those 10,000 doctors a year were able to do an internal medicine, pediatrics, or family medicine residency, our shortage would be non-existent in less than a decade.

Medicare needs to fund more residency spots.  Period. The way to solve a physician shortage is to make more physicians. It’s that simple, really.

The way to solve a physician shortage is not to place the responsiblity for it on the backs of those already bearing its brunt.

 

demonizing doctors, insurance, medicare, Washington Post

Can’t win for losing

The Washington Post recently decided to demonize doctors, with a headline trumpeting, “An effective eye drug is available for $50, but many doctors choose a $2000 alternative.”  The article tells the story of a miracle drug treatment for wet macular degeneration, which is one of the leading causes of blindness.  Avastin was approved in 2004 for treatment of colon cancer.  It targets a protein called VGEF, thereby decreasing harmful blood vessel growth in cancer.  This same protein is linked to wet macular degeneration.  The company that makes Avastin, Genentech, has created a slightly different molecule and development process to make Lucentis, which is FDA approved to treat macular degeneration.  For all intents and purposes, the drugs are the same.  Both target VGEF.  Both are effective for macular degeneration, according to several independent trials.  However, Genentech has only sought FDA approval for Lucentis to treat MD.  It does not produce Avastin in the proper size to treat MD.

Despite this, many ophthalmologists still use Avastin to treat MD.  They have to have a compounding pharmacy separate it out into the proper dose, which does introduce a risk of contamination, though the risk is slight.  However, using Avastin this way is certainly considered off-label, meaning using a medication in a way that is not FDA approved.

The newspaper clearly implies that doctors should use Avastin, and that there is no good reason not to. It implies that doctors who chose not to take the risk of using an unapproved drug are greedy, stating that the medicare reimbursement of 6% of the cost of the drug (a whopping $120) is driving their decision.

And yet, just a few months ago, The Washington Post published this article.  It decries the lack of oversight of pharmaceutical drug use in the elderly, specifically targeting the off-label use of drugs in Alzheimer’s patients.

So, which is it, Washington Post?  Am I a saint or a sinner?  Is off-label use good or bad?  Or maybe, just maybe, doctors are using their clinical judgment in individual situations to guide their decisions.

Nah.

h/t to Overlawyered.com