The Struggle to Recruit Family Doctors

Will the Plan to Change Compensation Help Recruit Doctors to be Generalists?

(CBS)  Like all good primary care doctors, Joseph Mambu is part specialist. An Orthopedist one minute, a cardiologist the next, reports CBS News correspondent Wyatt Andrews.

But Dr. Mambu does not get paid like a specialist. On average specialists make twice as much as primary physicians. A starting cardiologist, with three to five years more training makes up to $350,000 a year. A starting family doctor makes $149,000, mostly because they aren't paid for the extra time spent counseling patients.

"The only way doctors get compensated is by doing something to the patient," Mambu said.

"To the patient meaning some procedure?" Andrews asked.

"Exactly," Mambu said. "Nobody values what primary cares do - that's why we're in the crisis situation we're in."

Dr. Mambu is part of national experiment called Medical Home, which increases the pay and power of family doctors. His practice gets a 10 per cent bonus, and has hired extra nurses who stay in close touch with patients, handling the details of care.

It frees him up to spend more time with each patient, better manage chronic diseases like diabetes, and avoid any extra trips to specialists.

"If we pay primary docs more how does that save the system money?"

"Well, unnecessary and unwanted care no longer occurs," Mambu said. "I can't tell you how many people get referred, wind up getting worked up and really didn't need it."

But as the system begins to pay primary care doctors more, the pressure is on to pay specialists less.

Medicare just proposed a pay cut of up 40 per cent for specialists, like radiologists and cardiologists, and pay increases of up to 8 percent for family doctors.

Specialists complain the cuts will reduce their service in rural areas, and still not raise enough money to recruit more family physicians.

Jack Lewis doesn’t think the changes will result in more primary care doctors.

"The cuts to cardiologists are devastating to them," Lewis said. "It's not even close to helping primary care in the way they need to be helped."

Without more help for family doctors - health care reform could make the crisis worse. If you think it's hard to see your family doctor now - imagine what happens when 45 million uninsured American start to enter the system.

[peggyeren]

Once again, CBS news dropped the ball and gave a very incomplete view of primary care in this country. There are more than 100,000 nurse practitioners in this country, most of whom are educated in primary care. Further, NPs are ready, willing and able to provide high quality care. This does not mean we don't need physicians in primary care. We should remove barriers to NP practice to make sure Americans have access to high quality health care.

[peggyeren]

Once again, CBS news dropped the ball and gave a very incomplete view of primary care in this country. There are more than 100,000 nurse practitioners in this country, most of whom are educated in primary care. Further, NPs are ready, willing and able to provide high quality care. This does not mean we don't need physicians in primary care. We should remove barriers to NP practice to make sure Americans have access to high quality health care.

[erasmus111]

by rightaboutit July 29, 2009 8:50 AM EDT
You don't think they have bills like every body else? I just had one that lived behind me move to a more practical home.


Gee, that's tough, ain't it?

If he was getting paid what he should have been getting paid, instead of getting a ridiculous amount of money, he wouldn't have had to move. He would already be in a "practical" home.

You like them sucking you dry of your hard earned money?

You're being ripped off! You like them getting away with that?

[chinadoc]

i was a chinese doctor before i came to US. i wanted join family medicine training program but unfortunatly no any program responded to me yet. i am wondering if any program interested in me since we are short of family doc @ any where. I hope it's true, i saw the number on the news.

[lawyertom1]

General practitioners are underpaid in a major way. We need many more to help with the preventative aspect of health reform. We are also short of neurologists, another endangered species. Reform needs to address such shortages.

[cynthiah777]

We know the value of a Family Physician. I am glad to see the recognition in this article. Currently we are looking to recruit an FP for our practice. If interested, please visit :
http://www.siteskins.net/cflhealthcarecareers...
or contact me directly at [e-mail]

Cynthia Hernandez,
Practice Manager

[iam4honesty]

Wow, that's an interesting way to recruit a physician. Good luck competing with the hundreds of 'large' headhunting companies out there. My wife gets calls every day.

[xlib]

Oh sure, bright young people will just run to enter med school to be a family practitioner. Why, with a thug in charge who just bad mouthed doctor's yep, they sure will want to work for this thug.
Say, don't know if that was covered in your state run media. Perhaps I should fill you lemmings in. See, I believe it may have been on Monday but the thug was droning on and on with teleprompter at hand and he made the statement that you could take your child to the Pediatrician for frequent sore throats and the the Pediatrician would perform a tonsillectomy to "fill his pockets". Yea, that was another one of his bright, show the populace who I really am statement.
I really don't know the last time a Pediatrician performed tonsillectomies. I thought an ENT doc did that. Could be wrong.
But yea, saying things like that will really want someone to get into medicine.
I'm sure there may be some bright members of ACORN that would enter for him.\
I just posted that to get some of you lemmings PO'd.

[helloall34]

In the US, primary care is going to happen mostly at Walmart and CVS (like it or not), it has already started. Specialization will happen more and more via live web links (that too has already started). The knowledge that once allowed doctors to make lots of money is not as scarce as it once was, making it less valuable. Cheap health care is not only possible but very likely, the only barrier is the status quo. It is just a matter of time before these changes are common place. Will quality go down ? Maybe, but likely not. It's already generally not too good in the US. People will be able to be seen more often and therefore more preventative steps can be taken, this will improve health care.

[erasmus111]

"The cuts to cardiologists are devastating to them,"

I bet it will be. They have been getting paid zillions of dollars more than they are worth. It's about time they are brought down off their high horses.

[hamiltongrad]

why not pay them like lawyers, talk to them on the phone= 150, type a ltter =350, ask how they are =54 $.


THE REFORM WE NEED FIRST IS LEGAL . IT IS KILLING ALL OF US. THAT WOULD BRING DOWN THE COST OF MEDICINE PRONTO. DON'T HOLD YOUR BREATH.

[rhs648]

correction

So much exaggeration on all sides. Not all uninsureds are down and out people who can't afford medical care or don't receive health care if they need it. Some people are uninsured by choice for a number of reasons. There are people wealthy enough to take care of their needs without insurance. There are people who are healthy and don't see the need to have insurance. There are people who would rather spend their money on vacations, cell phones, big screem TVS, cable television, and fancy cars. Many uninsured people go to expensive emergency rooms rather than free or less expensive clinics. We keep throwning numbers out such as 40,000,000 people without insurance. The number of people who don't have health insurance because they can't afford it is probably less than half that number. Recently, my neice and her husband dropped their health insurance so their children would qualify for free health insurance provided by the state. This is another example of people gaming the system to get something for nothing by shirking their obligation to provide for themselves. Yet, my neice can afford a second home, a vacation summer home.

[rhs648]

So much exaggeration on all sides. Not all uninsureds are down and out people who can't afford medical care or don't receive health care if they need it. Some people are uninsured by choice for a number of reasons. There are people wealthy enough to take care of their needs without insurance. There are people who are healthy and don't see the need to have insurance. There are people who would rather spend their money on vacations, cell phones, big screem TBS, cable teleision, and fancy cars. Many uninsured people go to expensive emergency rooms rather than free or less expensive clinics. We keep throwning numbers out such as 40,000,000 people without insurance. The number of people who don't have health insurance because they can't afford it is probably less than half that number. Recently, my neice and her husband dropped their health insurance so their children would qualify for free health insurance provided by the state. This is another example of people gaming the system to get something for nothing by shirking their obligation to provide for themselves. Yet, my neice can afford a second home, a vacation summer home.

[NorenforSenate]

I am running for US Senate in NY and am a health care provider. I agree with much of this article..I am a dental specialist and think that on the one hand, cutting specialty pay for Medicare and Medicaid is unwise and not for the obvious reason that we want to be recompensed fairly. It will become a worse access problem if you push away specialists. It is already a poorly reimbursed situation. In dentistry, it invites fraud to under-reimburse. I get paid MAYBE 60% of my usual and customary fees which are already below the national averages.
On the other hand, medical tuition and expenses to go to medical school influence students to go into specialty areas in greater numbers. Why punish surgical specialties; instead, pay primary care docs more. Personal responsibility in areas of obesity and smoking must be emphasized by politicians (system won't work at this rate..see today's USA Today on obesity); the insurance industry must be mandatorily regulated at the Fed level, not the state level. Lower premiums, halve the deductibles at the minimum, no waiting periods, etc.
The two top insurance lobby money takers in the entire US Senate are:
Schumer and Gillibrand...see Opensecrets.org
for more info go to my web site...norenforsenate.com
Dr. Noren

[HiTor15]

HEALTH CARE REFORM IS IMPERATIVE FOR THE EVOLUTION OF THE MIDDLE CLASS. WITHOUT IT, THE MIDDLE CLASS WILL FIND ITSELF WORKING FOR PEANUTS MUCH LIKE CIRCUS ANIMALS THEY WILL WORK FOR LITTLE MORE THAN A CHEAP BENEFITS PACKAGE AND MINIMUM WAGE.

[whymayiask]

With the premiums you will be paying for a Gov't health plan, your paycheck may show more, but your bank statement will show a row of peanuts.. 000000

[TrickynWV]

The answer to this shortage of primary care providers is Physician Assistants. They are highly trained with a similar medical school to doctors. They can diagnose and treat, and their skills are superb. The military and the Veterans Affairs have used PAs effectively for years for combat and non-combat care.

The problem is, there are no standard Federal guidelines for utilizing them and therefore states are allowed to regulate PAs as they see fit. There are 50 different states and 50 different sets of regulations, depending on what state you are in. Doctors embrace PAs as great providers to over-burdened clinics.

Physician Assistants always work under the supervision of a physician, and each physician can supervise several PAs in various locations. Their knowledge and safety is pristine. The PA salary is not nearly as much as a primary care physician, so they really deliver affordable health care. Physicians win, patients win, and insurance companies can win. However some (Blue Cross) refuse to pay for PA services. Kind of makes you wonder why. That certainly drives up health care costs.

The care a PA delivers is excellent and cost effective. Chances are you have been treated by one, or know of someone who has.

[rhs648]

In theory you are correct. Doctors with physician assistants charge the same fee when their physician assistants and nuse practitioners see patients. This is great for the doctors. It is very profitable for doctors to employ less expensive help than to employ other doctors. Why pay another doctor $300,000 per year when you can pay a physician's assistant or nurse practitioner $100,000 per year. Even the malpractice insurace is often lower. This is not an argument against the abilities of physicians assistants and nurse practitioners. It is an argument that their is little or no savings to the patient, the insurance companies, or the government.

[iam4honesty]

My wife is an NP, and you are correct, Physicians often use NP's and PA's to pad their wallets, charging full rates when these people see patients. The trend, though is to allow NP's to operate their own practice. This is a great way to bring cost of primary care down. These professionals are fully qualified to offer primary care and refer patients to specialists if needed. That is what General Practice Physicians do anyway.

[TrickynWV]

Dear iam4honesty: I would beg to differ about the "trend" to use NPs as independent practitioners. The American Medical Association is strongly opposing NPs working independently as a matter of safety for patients. I agree with the AMA. All midlevel providers SHOULD work under supervision as a matter of pure safety. But again, we are mixing apples and oranges. This topic isn't about granting midlevel providers independence (that would require research, and jumping lots of legal hurdles). Personally, since neither NP or PA went to full medical school, I like the safety of having a supervisor, and most patients do too. I'm sure the NPs have reasons for not wanting to be supervised. Nor is it about saving medical costs. (that would be a specific topic about malpractice and lawyers). Hospitals and clinics all across America use PAs and NPs to provide excellent care at salary cost savings to them. Canada is starting to consider PAs more for their national health care, which is in trouble, mainly due to lack of providers.

[iam4honesty]

by TrickynWV July 29, 2009 9:44 AM EDT
Dear iam4honesty: I would beg to differ about the "trend" to use NPs as independent practitioners. The American Medical Association is strongly opposing NPs working independently as a matter of safety for patients.




Actually, a number of states have already expanded the parameters for mid-level practitioners. And there is a serious groundswell that is probably less noticeable to those not directly involved. My wife attended a phone/web conference on Monday with Dr. Howard Dean and thousands of mid-level health professionals concerning this very issue. Also, primary care physicians use and refer to specialists with almost every patient they see, as do NP's. There are no safety issues.

Further, this topic is about the shortage of 'Family Practice' medical providers. Although you apparently do not realize it, the idea of expanding responsibilities of mid-level practitioners is very much a part of the conversation on a national level.

[iam4honesty]

I think it is also important to note that the AMA is a lobbying group for physicians. Just as the NRA is a lobby for gun enthusiasts. Although the AMA is a powerful lobby, of late it has started to see some ****** in it's armor. The last thing we should be doing now is allowing the lobbyists to control the debate on health care reform. If we do there will be no reform. We are already seeing the effect that their bribes have on some of our less than honest representatives. We hear senators telling outright lies such as, "America has the best health care on earth". Insurance lobbyists, the AMA, pharmaceutical lobbyists and others are at war with the American people over health care reform. They do not want things to change.

[nonplusedinnewyork]

"...health care reform could make the crisis worse. If you think it's hard to see your family doctor now - imagine what happens when 45 million uninsured American start to enter the system."

Nice shot, Wyatt. 45 million Americans can't afford to see a doctor, and you think the "crisis" is what happens if they can.

[debinok1]

The Democrats and the Republicans are to blame for the mess this country is in, no more blame the other side, no more trying to be bi-partisan, they are BOTH CROOKED, they are BOTH TO BLAME.

The system we have is ruined, and they have ruined this country in the process. They say whatever they have to say to get elected time and time again and every time they turn their backs on the american people who put them there.

These are PUBLIC SERVANTS, elected by US, to work for US. They can only govern US as long as we agree to LET them.

It is time to take back control of our government.
http://www.thepetitionsite.com/1/are-we-confident-our-government-is-working-for-us

[hungry1968-16]

by hawksprings July 28, 2009 8:53 PM EDT
....Flipping burgers or doing a lousy job of being President.







Obama's the second best president we've had since Kennedy, behind only Clinton.

The Bush's, Reagan, Ford, and Nixon were more like Al Qaeda than presidents, with the damage they wreaked on this country.

[theMEDIAisWRONG]

check out his approval ratings they're droppin like flies baby! you must want socialism. this sad excuse for a president is just a socialist pieces of crap.
i wonder why people come to America from countries with socialized medicine to get care? maybe because they'd die if they waited to see their doctors in their country.

[whymayiask]

Taebok do you not understand that the "numbers" can be translated just like any other set of statistics? If theynever "treat" you you cannot be deemed a negative statistic. Look at it this way. If you are treated and live (+1). If you are denied treatment or have to wait too long and DIE before treatment you are a (0) not a (-1). Only IF they actually TREAT you for an ailement and FAIL are you ever a (-1). Well, the bill already has in place the ability to deny tratment based on age or medical history. That is a whole lot of negatives that will never be counted. They are now zeros. Get it??

[jwesel1]

I know someone who got out of family practice for a 3 years fellowship in cardiology, thinking his pay was low in family practice. I am sure he will be banging his head against the wall now.

[legacyabq]

Gee theres a good idea. Lets fix the health care system by paying these people EVEN MORE.

Doctors already think they are gods among men. They are not so smart, rather, they are well-trained.

WHO CAN AFFORD MEDICAL SCHOOL??!!!??!??


The filthy rich upper eschelons who bid their kids to become doctors for the money and the prestige.

Doctors are an exclusive club: they come from the rich.