“Nationwide physician shortages are expected to balloon to 62,900 doctors in five years and 91,500 by 2020, according to the Association of American Medical Colleges work force projections," American Medical News reports. "That's up more than 50% from previous estimates. AAMC officials attribute the widening gap to increased demands from the aging baby boomer generation and expansion of coverage by 2019 to 32 million uninsured Americans under the health system reform law. … To counter shortages, the AAMC is urging federal officials to lift limits on Medicare funding for residency positions, which have been capped at 100,000 slots since 1997" (Krupa, 10/11). http://www.kaiserhealthnews.org/daily-reports/2010/october/11/doctors-issues.aspx
Thursday, November 17, 2011 #hchlitss tweetchat featured Kevin Bernstein, MD @BernieMD31. He had just published a post called “Should we occupy medical schools to effectively occupy healthcare?” at http://occupyhealthcare.net/2011/11/should-we-occupy-medical-schools-to-effectively-occupy-healthcare/ . Kevin is presently doing his Family Medicine residency. The tweetchat was based on information provided in this blogpost. @BernieMD invited Mark Ryan, MD, @RichmondDoc, a faculty member in Family Medicine at the Medical College of Virginia at Virginia Commonwealth University.
Physicians in other specialties are said to denigrate those who choose family medicine. Is this something that you have experienced?
Both @BernieMD31 and @RichmondDoc shared having had this experience.
· Those who want to enter primary care go through “a hazing process” during medical school .
· Entering primary care is called a “waste of talent.”
· Many specialists denigrate Family Medicine.
· Those interested in Family Medicine hear “if [they] want to be a "real doctor" …should be [fill in the blank]”
· There is a perception that becoming a specialist means that you are smarter
Both physicians refute the belittling of their profession.
· Family Medicine is not a bunch of algorithms – it’s an art.
· “I can see anyone, and at least start evaluation on anyone... and I can often complete the evaluation and treatment plan. Without a specialist.”
· I went into Family Medicine because I want to be able to care for any patient in my office. It is valuable in rural and international settings.
· “Why go to school and residency for so long only to focus on one body system” when you can treat the whole person.
· It's those on the fence about primary care that follow the money. For those who are undecided, money and lifestyle equals prestige.
How do we get the rest of medicine to value patient-centered preventive care so that more medical school graduates go into Family Medicine?
· Change the way Family Medicine and Specialities are paid.
· In the military, a family doctor and orthopedic doctor with same number of years experience, same rank, same number of family members have only a $30,000 difference in pay. This is in contrast to the civilian setting where there is a difference of $300,000.
· Set up “medical homes” for primary care. “Medical homes is not about physicians making “house calls” as the name may imply. It is about revising the health care experience by making it patient-centered, integrating care, reducing cost, having more “accessible” care, having electronic medical records (EMR) and improving outcomes.
· The American Medical Association established a committee called the Resource Based Relative Value Scale Update Committee, known as RUC, in the early 1990s. Unfortunately, this committee has had the ear of those who make the decisions on Medicare and Medicaid pay for physicians.
· The RUC is predominantly made up of Specialists. Those in Family Medicine believe that this group has kept the pay differential in place between Specialists and Primary Care Physicians
· Family Medicine is not asking for a pay raise. They are interested in having physicians paid less for procedures that don’t benefit morbidity or mortality.
· Enhancing Family Medicine interest is occurring in different medical schools like VCU. http://t.co/XrOoAN6g #fmSTAT
Would increasing the length of family medicine/primary medicine residencies increase prestige within the medical setting?
Neither @RichmondDoc nor @BernieMD31 believed that this would be an effective way to change the problem.
· Since specialists predominate the hospital settings and medical staff for schools, students see the specialist as the “measure of success.” Interestingly in Canada, residency is only two years.
· A change in the gap in pay between primary care physicians and specialist will do the most to change the prestige situation. Reference was made to the COGME 20th Report. This report indicates that the relative difference in pay between these specialists and primary care needs to be changed, not by increasing the pay of primary care physicians but by paying the specialists less.
The Canadian system single payer system was touted as an example of reducing the administrative burden on US physicians. Canadian administrative costs average 1/4 of the US. “US Physician Practices versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers” http://t.co/7yLP3upC
· Family medicine physicians are treated with more respect
· Have a much lower pay gap
· In the US recent experience, when there was less financial disparity between primary care and specialists, more students when into primary care. Altarum and COGME
Can you tell us about the occupy medical school movement? Why is it important? How to get involved?
Medical schools are advertising that they are producing primary care physicians but they are not. Even US News and World Reports are giving high ranking for schools lowest at production true primary care physicians.
· Yet they are getting federal funding for producing primary care physicians
· Occupy Medical School asks where is all the tuition money going. Why are medical students having $200,000 to $300,000 debt burden
· Medical school is so expensive that many of the disadvantaged cannot afford to go to school
· There is a suggestion that medical school conduct research on only 1% of our population
· Nurses and physicians don’t stay in primary care because of lifestyle and money.
At one point in the tweetchat, the discussion diverged to include the role of nursing, especially Advanced Practice Registered Nurse Practitioners. The Institutes of Medicine’s recommendation to expand the Medicare and Medicaid programs to include coverage of advanced practice registered nurse services that are within the scope of practice under applicable state law, just as physician services are now covered.
What is the difference between primary care physician and nurse practitioners educations?
According to family medicine physician, nurse practitioners are key team members, but their training differs markedly. Robert Bowman's http://t.co/jczLdykm research clearly shows primary care years for Family Medicine MD far exceeds that of Nurse Practioners. There is a table which shows the number of standard primary care years by various training paths http://t.co/i1qYmtU1.
What do you foresee as the future of primary medical care? How can we help? How can we help Nurse Practioners to be respected, Primary Care Physician numbers increase and help change the system?
· We are at a tipping point. Medical students that are not going into Primary Care now are making big mistake.
· Keep up with the Occupy healthcare blog and sign up for google plus Occupy healthcare group http://t.co/MvbrbQGq
· Follow #FMRevolution, future of family medicine blog and @drmikesevilla for nonstop family med fun!