10 Things Your Primary-Care Physician Won't Tell You

By JIM RENDON

Filed Under: Health Insurance, Insurance

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. According to a 2007 study, it took new patients in Massachusetts an average 26 days to land an appointment with one. 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. "We're not really getting the best and brightest in primary care," says Kevin Pho, a Nashua, N.H., physician who writes the blog Kevin, MD. "And that's where they're needed."

Cherrie Brunner of Syracuse, N.Y., knows this all too well. She had such trouble finding a new doctor that she stuck with her old one despite problems -- when she had blood in her urine, for example, she had to wait a week for an appointment, and the office then tried to cancel. But find a new GP? "I want to," says Brunner. "But when friends say, 'my doctor's great,' he won't take new patients." (Brunner's doctor had no comment.)

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. "Students are not dummies," says Pho. "They graduate with $130,000 in debt; why should they go into primary care?"

The income of primary-care doctors is under such pressure these days because general practitioners are paid roughly $30 to $70 for each patient they see regardless of how long the individual visit. That scale, based on Medicare reimbursements, has changed little since 2000. "Reimbursement for primary care is lousy," says John Ford, an assistant professor at the David Geffen School of Medicine at UCLA. "They put a premium on volume, not on spending time with patients."

3. "Sorry, your 12 minutes are up."
These days it seems like a visit to the doctor involves little contact with an actual doctor. Instead, most of the time is spent explaining problems to assistants and having blood drawn by nurses. Indeed, doctors have been beefing up their support staff -- physician's assistants and nurse practitioners -- to help them squeeze in more patients. They say this assembly-line approach is necessary because they get paid about the same for each patient no matter how long it takes. It certainly has been effective; 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, says Ford. 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. Some doctors do take things to the extreme: In the Massachusetts study, 41% of patients had an appointment during which they never saw the doctor.

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. That translates into $8,000 in marketing money spent on each of the 900,000 doctors practicing in the U.S. today. "The introduction to pharmaceutical representatives starts as early as medical school, and it never really stops," says Pho.

The real amount is certainly much higher, since these figures include only journal advertising and salaries of sales reps, not their expenses. Drug reps give away pens, cups, hats and shirts, and buy office staff lunch, all in hopes of nabbing time with the doctor. But that's just the beginning -- 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. Drug companies pay these docs to give informative talks about medical conditions -- for which the company's drug gets pitched as the best remedy.

5. "Sore throat? You might be better off going to the mall."
When Mary Furman got a call from her daughter's school at 10 a.m. one day last year, she was sure it was strep throat, but her pediatrician couldn't see the girl until 4. Furman decided to try a new clinic she'd noticed at a nearby Wal-Mart; they were in and out with a prescription in under an hour.

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, says Steven Cooley, a physician and CEO of SmartCare Family Medical Centers in Denver. 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. When visiting one, says Jim King, president of the American Academy of Family Physicians, ask to have your records forwarded to your doctor, and be sure to tell him about any medication prescribed at the clinic.

Continued: 6."I Hate Technology"

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wildeowens 07:51:00 PM Dec 05 2007

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wyoed1 <I am a doctor and I must tell you, after office expences and such, I only netted $396,000 this year. Much less than most CEO's. And with medical insurance going up each year, I'll bet my net will be 30,000 dollars less next year. I'll just say " Good Luck " to the new graduate physicians.
Dr Edo>

Give me a break. Are you for real?! If you are, do you really expect anyone to empathize with you because you might only net $366,000 next year instead of the $396,000 that you netted this year? No doctor, unless he is a jack-ass, puts his name online.

bndstar 07:50:16 PM Dec 05 2007

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I agree on the 12 min., you get to tell the Dr . things, he writes them down, takes blood pressure, pulse, says a few things, you leave knowing no more than when you walked in, they made their money, you pay co-pay, and you walk to the care saying why did I even go. You didn't learn a thing.

wildeowens 07:45:00 PM Dec 05 2007

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whitebirchins <All medications kill over time. Pharmaceuticals run our country!!!>

I understand your sentiment about the big drug companies whose primary agenda is profit and doctors who over-prescribe, but the fact is is that drugs do save lives. That is the trade-off, unfortunately: Sometimes one has to take a drug that has unpleasant side effects or is even toxic/cytotoxic (chemo/corticosteroids) because there simply is no other alternative to stop the course of a disease. Drugs are life-saving. You just have to weigh the benefits against the risks. I, too, believe that diet is very important--research proves that--but sometimes eating healthy and exercising is not enougt to prevent one from getting sick or to get one better when they are already sick.

wildeowens 07:29:00 PM Dec 05 2007

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mvo0221 <And then you'll have to buy private insurance because universal systems will not see you or get you in for non-life threatening ailments for months or years. You'll wait. Until the issue is far worse.>

Although I have talked to others from England and Canada who have said there is sometimes a wait, especially for specialized/expensive tests and consults, all agree that this is better than having no insurance at all--obviously.

<So, remember - nothing is free; the thought of free only invites abuse and lack of service offerings.>

You're right that nothing is for free, but our taxes should be going towards this and not unjust and unnecessary trillion-dollar wars. And why would there be any more abuse of the system/fraud/unnecessary tests prescribed by a physician just because one's health insurance is under the auspice of the federal government?

wildeowens 07:23:00 PM Dec 05 2007

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mvo0221 <While this article points out the issues with the future of Family Practitioners, universal healthcare would be the biggest mistake polititions could adopt since prohibition. People think 'wow, free healthcare for all. How nice is that?' What it translates to is anywhere from 15 -25% of your gross income going to health related taxes.>

That is a gross over-estimation. That would be more than most people pay now for their premiums. Besides, some of us now pay 25% of our income for the yearly premium, anyway--for instance, those with preexisting conditions. America is a wealthy country and can afford this (w/o an income tax hike) just as other industrialized countries can and do; we're the only exception. Think of the trillions this war cost. I wonder how many years of health coverage those trillions would have provided for each and every American. We need to get the neocons out of the White House so money is used for constructive instead of destructive purposes.

wildeowens 07:05:00 PM Dec 05 2007

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shokkers <If you ate right, exercised and took care of your teeth, you'd never NEED a doctor.-K.K. (rockherworld.net)>

Nice sentiment but unfortunately not true.

LChunkiebutt 06:06:30 PM Dec 05 2007

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It's amazing the number of articles written on healthcare and the healthcare providers, i.e nurses, doctors etc.. What's never mentioned is the management behind these decisions and the dictatorship of the insurance companies. Medical professionals have lives and bills just like patients. What patients need to do is demand that CEO'S and insurance companies stop dictating what's cost effective and necessary to ensure a person is healthy. GP's may like what they do however who is going to starve so Blue Cross Blue Shield can stay rich? There are alot of dynamics going on behind the scenes that patients are not aware of.

mvo0221 03:31:33 PM Dec 05 2007

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While this article points out the issues with the future of Family Practitioners, universal healthcare would be the biggest mistake polititions could adopt since prohibition. People think 'wow, free healthcare for all. How nice is that?' What it translates to is anywhere from 15 -25% of your gross income going to health related taxes. And then you'll have to buy private insurance because universal systems will not see you or get you in for non-life threatening ailments for months or years. You'll wait. Until the issue is far worse. So, remember - nothing is free; the thought of free only invites abuse and lack of service offerings.

bluebonbon22 03:31:00 PM Dec 05 2007

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There actually is a sterile type of medical grade 'super glue" I know because when I worked for a vet, he would use it. Not harmful and it is medical grade, not just super glue.

virtualeman 09:36:39 AM Dec 05 2007

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Got AOL'd.

Our health care system is bad now...hours of waiting in ERs, escalating costs of health insurance/care, but you ain't seen nothin' yet. Wait til "Hillarycare" goes into effect.

Ask any vet what the VA healthcare system is like, and you'll get an idea.

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