Re: NYTimes: Doctor Shortage Likely to Worsen With Health Law

[Guest guest]

I have to wonder how true this looming crisis is. The last statistic I saw, there were about 310,000,000 people in the US. There are around 220,000 internists, FPs and pediatricians (in fact, last year, the AAFP had it largest membership ever). There are another 110,000 NPs and PAs doing primary care. By my calculation, that means there are about 910 patients/provider (of course, this does not take into consideration coming retirement of a number of our colleagues). What it seems like we really have is a couple of big issues:1) A crisis of supply and demand driven by the arbitrary barrier of insurance. Currently many doctor’s offices (like mine) might be taking new patients with insurance X or Y and not taking new patients with insurance Z. There are many reasons for this. Unfortunately, if they have insurance at all, the poor and the marginalized tend to have insurance Z. I believe if we equalize payment and administrative responsibilities between insurances (or eliminate insurance contracting with primary care altogether), there would be plenty of providers to see the patients. 2) There are a lot of trained primary care providers no longer doing primary care. That is because the system is toxic and docs burn out and do something else. We need to change the system to encourage a sense of autonomy, mastery and purpose (read Drive by Pink).I am not arguing with the experts who predict we are going to be 100,000 docs short (thought the math doesn’t seem to add up for me). However, if we are going to be that short of physicians, don’t we want to make sure all potential barriers to access, including those caused by insurances, are removed? From: [mailto: ] On Behalf Of Frederick ElliottSent: Saturday, July 28, 2012 9:49 PMTo: Subject: NYTimes: Doctor Shortage Likely to Worsen With Health Law From The New York Times:Doctor Shortage Likely to Worsen With Health LawEven as the new health care law expands insurance coverage, another problem faces many areas of the country: a lack of physicians, particularly primary care ones.http://nyti.ms/OuslY2Frederick Elliott MDBuffalo, NY

[Guest guest]

Read this in the Seattle Times this am also. What I am wondering, is with the shortage, but no real improvement in pay from the government payors, and likely the insurance companies either, is will Concierge or direct pay practices pick up steam? If you have to wait 2 months to get 10 min with your doctor, because he/she is busy seeing 30/day of mostly new medicaid, would you as a middle income person, be more likely to spend on a blended practice, where you might pay 300-500/y fee to belong to a practice that would still bill your insurance, but yet not overbook? I know some of you are doing now, but seems to me the market will drive this more. What do others think?

CCote

To: Sent: Saturday, July 28, 2012 8:48:35 PMSubject: NYTimes: Doctor Shortage Likely to Worsen With Health Law

From The New York Times:Doctor Shortage Likely to Worsen With Health LawEven as the new health care law expands insurance coverage, another problem faces many areas of the country: a lack of physicians, particularly primary care ones.http://nyti.ms/OuslY2Frederick Elliott MDBuffalo, NY

[Guest guest]

Follow the money. Increase PCP reimbursements and the gap will close quicker.

________________________________________

From:

[ ] On Behalf Of Dr. Brady

[drbrady@...]

Sent: Sunday, July 29, 2012 9:17 AM

To:

Subject: RE: NYTimes: Doctor Shortage Likely to Worsen

With Health Law

I have to wonder how true this looming crisis is. The last statistic I saw,

there were about 310,000,000 people in the US. There are around 220,000

internists, FPs and pediatricians (in fact, last year, the AAFP had it largest

membership ever). There are another 110,000 NPs and PAs doing primary care. By

my calculation, that means there are about 910 patients/provider (of course,

this does not take into consideration coming retirement of a number of our

colleagues). What it seems like we really have is a couple of big issues:

1) A crisis of supply and demand driven by the arbitrary barrier of

insurance. Currently many doctor’s offices (like mine) might be taking new

patients with insurance X or Y and not taking new patients with insurance Z.

There are many reasons for this. Unfortunately, if they have insurance at all,

the poor and the marginalized tend to have insurance Z. I believe if we equalize

payment and administrative responsibilities between insurances (or eliminate

insurance contracting with primary care altogether), there would be plenty of

providers to see the patients.

2) There are a lot of trained primary care providers no longer doing

primary care. That is because the system is toxic and docs burn out and do

something else. We need to change the system to encourage a sense of autonomy,

mastery and purpose (read Drive by Pink).

I am not arguing with the experts who predict we are going to be 100,000 docs

short (thought the math doesn’t seem to add up for me). However, if we are going

to be that short of physicians, don’t we want to make sure all potential

barriers to access, including those caused by insurances, are removed?

From:

[mailto: ] On Behalf Of Frederick

Elliott

Sent: Saturday, July 28, 2012 9:49 PM

To:

Subject: NYTimes: Doctor Shortage Likely to Worsen With

Health Law

From The New York Times:

Doctor Shortage Likely to Worsen With Health Law

Even as the new health care law expands insurance coverage, another problem

faces many areas of the country: a lack of physicians, particularly primary care

ones.

http://nyti.ms/OuslY2

Frederick Elliott MD

Buffalo, NY

[Guest guest]

it  is not just the money It is the jobI need more tools to  do my complex work without so much difficulty I need less prior auths true but I need interoperability and  specialists who will let me schedule patietn easily and I need far better tools for communication , I need to get what money I do get with far less hassleand I need to get it consistently for the care not varying with  payor

  No one SHOULD take this job, to be honestReimbursement is a silly word as is payors I need t o go to work and have tools to do a good job without patching  together systems on my  and begging for varied amnts of money   depending on who doles it out.

You can;t make this stuff up

Follow the money. Increase PCP reimbursements and the gap will close quicker.

________________________________________

From: [ ] On Behalf Of Dr. Brady [drbrady@...]

Sent: Sunday, July 29, 2012 9:17 AM

To:

Subject: RE: NYTimes: Doctor Shortage Likely to Worsen With Health Law

I have to wonder how true this looming crisis is. The last statistic I saw, there were about 310,000,000 people in the US. There are around 220,000 internists, FPs and pediatricians (in fact, last year, the AAFP had it largest membership ever).  There are another 110,000 NPs and PAs doing primary care. By my calculation, that means there are about 910 patients/provider (of course, this does not take into consideration coming retirement of a number of our colleagues). What it seems like we really have is a couple of big issues:

1)      A crisis of supply and demand driven by the arbitrary barrier of insurance. Currently many doctor’s offices (like mine) might be taking new patients with insurance X or Y and not taking new patients with insurance Z. There are many reasons for this. Unfortunately, if they have insurance at all, the poor and the marginalized tend to have insurance Z. I believe if we equalize payment and administrative responsibilities between insurances (or eliminate insurance contracting with primary care altogether), there would be plenty of providers to see the patients.

2)      There are a lot of trained primary care providers no longer doing primary care. That is because the system is toxic and docs burn out and do something else. We need to change the system to encourage a sense of autonomy, mastery and purpose (read Drive by Pink).

I am not arguing with the experts who predict we are going to be 100,000 docs short (thought the math doesn’t seem to add up for me). However, if we are going to be that short of physicians, don’t we want to make sure all potential barriers to access, including those caused by insurances, are removed?

From: [mailto: ] On Behalf Of Frederick Elliott

Sent: Saturday, July 28, 2012 9:49 PM

To:

Subject: NYTimes: Doctor Shortage Likely to Worsen With Health Law

From The New York Times:

Doctor Shortage Likely to Worsen With Health Law

Even as the new health care law expands insurance coverage, another problem faces many areas of the country: a lack of physicians, particularly primary care ones.

http://nyti.ms/OuslY2

Frederick Elliott MD

Buffalo, NY

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