President Obama will announce that he has chosen Thomas R. Frieden, MD, the New York City health commissioner, as the next director of the Centers for Disease Control and Prevention, administration officials said. Frieden, an infectious disease specialist, has cut a high and sometimes contentious profile in his seven years as New York's health official commissioner. He led the crusade to ban smoking in restaurants and bars, pushed to make HIV testing a routine part of medical exams, and defended a program that passes out more than 35 million condoms a year. At the CDC, he will inherit a host of immediate and long-term problems.
A recent front page story in the New York Times finally made official what hospitals and the physician recruiters who work for them have known for years: America is running out of primary care physicians.
Why is the well of primary care doctors running dry? Because a growing number of medical school graduates are taking the R.O.A.D. to success—they are selecting Radiology, Ophthalmology, Anesthesiology, Dermatology and other "ologies" over family practice, internal medicine, and pediatrics. The income and the lifestyle offered by surgical and diagnostic specialties simply trump anything that primary care affords.
In a recent survey Merritt Hawkins & Associates conducted on behalf of The Physicians Foundation, some 9,000 primary care physicians were asked what they would do if they could start their careers over. Forty-one percent said they would choose a surgical or diagnostic specialty, 27% said they would choose not to be a physician, and 5% said they would choose a non-clinical role in medicine. Only 27% said they would choose primary care.
That we need to renew interest in primary care among medical students is only made more apparent by current healthcare reform plans, which emphasize prevention, EMR implementation, and standardized care. It will take a robust and willing supply of primary care doctors to achieve these measures, as the Obama administration has acknowledged.
It would be a mistake, however, to grow the supply of primary care doctors at the expense of surgical and diagnostic specialists. The medical home, and other concepts to enhance the pay and prestige of primary care physicians, will create as many problems as they solve if they are imposed on the backs of medical specialists. Paying primary care doctors more by cutting reimbursement to specialists is not the answer.
The reason is simple. Just as there is a growing shortage of primary care doctors, there is a shortage of specialists in many areas. Fifteen medical specialty organizations have published reports projecting national shortages in their disciplines, including specialties such as gastroenterology, general surgery, cardiology, medical genetics, neurosurgery, dermatology, child psychiatry, and various other pediatric subspecialties.
The number of specialists trained in the last two decades has increased only marginally, even though many medical school graduates are choosing specialty medicine over primary care. The overall number of physicians coming out of residency each year has remained virtually flat since the mid 1980s. During that time the population has grown by millions, with the highest growth rate among the elderly who drive the need for specialty care. Demographic trends and the increasing technical sophistication of medicine will accelerate the need for specialist physicians for years to come.
Cutting the income of specialists and limiting their clinical autonomy through standardized treatment protocols will significantly raise the bar of entry into fields where the bar already is set extremely high. Those with the ability to excel through four years of college, four years of medical school, and four or more years of training—and who then can go on to perform life saving procedures—should be highly rewarded.
In the effort to promote primary care we should acknowledge that there are no bad guys. We need more primary care doctors. We also need more specialists. Whatever the healthcare system looks like after reform, it should create an environment where both types of physicians can thrive.
Phillip Miller is vice president of communications for Merritt Hawkins & Associates, a national physician search and consulting firm and an AMN Healthcare company. He may be reached atpmiller@mhagroup.com.
Managed care contract negotiations tend to focus on financial and legal issues, but overlooking the effect of medical management on payer contracts could jeopardize your financial viability. To ensure that managed care contracts line up with your organization's financial goals, give one of your physicians a seat on your contracting team.
"I very much encourage doctors to participate in negotiations," says Randi Kopf, RN, MS, JD, principal of Kopf HealthLaw, LLC, in Rockville, MD.
Although practices send administrators, coders, and managed care directors for outside training in negotiating contracts, the majority of physicians don't involve themselves in contracting even though payer representatives know physicians have the final say.
In a tough economic environment, "what physicians bring to the table is the ability to look a payer in the eye and say, 'Enough is enough,' " says Reed Tinsley, CPA, CVA, CFP, principal of Reed Tinsley & Associates in Houston. Physician owners can articulate better than anyone in the practice that the organization's viability is threatened by a payer's existing reimbursement structure.
However, not everyone agrees that physicians need to participate actively in negotiations. Because they're the decision-makers, physicians are sometimes better conciliators than negotiators, says John M. Edelston, president of HealthPro Associates, Inc., in Westlake Village, CA. "You want to be able to say, 'I don't know if I agree with that. I need to go back to my physicians,' " Edelston explains. "When a physician is involved, you can undermine the group's ability to negotiate the best deal you can."
"You have to have an agreement before you go into negotiations that you have clearly defined roles," adds Susan Stone, MBA, president of Managed Care Analysis in Redwood Shores, CA. A medical director's advice on medical trends can be invaluable, "but you don't want to undermine the chief negotiator, and that's the person who talks about rates," Stone says.
This article was adapted from the May 2009 issue of The Doctor's Office, a HealthLeaders Media publication.
Physicians spend three hours per week—or 43 minutes on average per workday—interacting with health insurance plans about authorization, formulary, claims/billing, credentialing, contracting, and quality data, according to a new study in Health Affairs. That averages out to a cost of about $68,000 per physician per year, the study found.
President Barack Obama and Democratic leaders have promised to push a sweeping healthcare overhaul through Congress at top speed. "We've got to get it done this year, both in the House and Senate," Obama said. "We don't have any excuses. House Speaker Nancy Pelosi said that the full House would vote on the proposal before members leave town for their August recess.
Alarmed at Republican attacks on President Obama's healthcare proposals, Senate Democrats met with White House officials to formulate a response. Democrats said they felt an urgent need to devise a message to answer Republicans assertions that Obama's proposals could lead to a Washington takeover of healthcare.