What can PAs learn from this physicians article?

[surgblumm]

Rest in peace, primary care

Dr. Alexis Gopal | Physician | January 18, 2021

 

The corporatization of medicine has destroyed primary care as a specialty. The primary care physician is supposed to be your go-to doctor, your advocate, the coordinator of your health care. Now that corporations buy out hospitals and private practices in an almost predatory fashion, the priority is turning a profit for the corporation at the expense of not only patient health but also the health and well-being of the primary care physician. Who do you think bears the brunt of patient frustration and public misconception? The PCP.

Patients actually accuse salaried primary care physicians of being greedy, “that’s why you don’t spend enough time” during those seven-minute visits. The reality is that in corporatized medicine, the physicians don’t make the rules. More often than not, hospital administrators with no clinical background or experience dictate how these practices are run. They decide how many patients you need to see in a day to turn a profit, to maintain the salaries of superfluous middle managers.

 

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Primary care has become an unsustainable specialty. The average internal medicine patient, especially the older demographic, has numerous chronic medical issues. How does a primary care physician address their concerns in such a short visit, much less develop a relationship, which is just as important to patient health?

At the beginning of my career, I took great joy in learning about each patient, their family and home dynamic, having two minutes to chat about “how’s the family?” Now, it’s a challenge to make eye contact, as the pressure to document on the electronic medical record to maximize reimbursement and prevent litigation is the priority.

 

 

The nail in the coffin? There are several. In one of the wealthiest nations in the world, why are our patients so chronically ill? Rates of obesity, autoimmune disorders, cancer, cardiovascular disease are increasing. Assembly line medicine has led to “band-aid” medicine, relying heavily on pharmaceuticals to put out fires, because who has the time to focus on prevention and lifestyle counseling?  Oh, and those greedy, millionaire PCPs, as the public perceives them? Their salaries actually go down every year, and they have to make up the difference by seeing more patients, in these poorly constructed RVU systems. Physician burnout is at a record high, understandably so. Primary care physicians are leaving medicine in droves. An already existing shortage will reach devastating levels in the very near future. Corporations like Walmart are opening clinics staffed mostly by nurse practitioners.

 

 

Who will care for the complicated patients, who may have rare illnesses in addition to the common fare like diabetes?

I fear for the future of health care in this country. Until the day physicians become as well organized and as strong a lobby as nurses, pharmaceutical companies, and health insurance companies, primary care is doomed as a specialty. Rest in peace, primary care.

Alexis Gopal is an internal medicine physician and can be reached at Vitality Medicine of New York. She can also be reached on Instagram, Facebook, YouTube, and Pinterest.

[Cideous]

1 hour ago, surgblumm said:

Rest in peace, primary care

Dr. Alexis Gopal | Physician | January 18, 2021

 

The corporatization of medicine has destroyed primary care as a specialty. The primary care physician is supposed to be your go-to doctor, your advocate, the coordinator of your health care. Now that corporations buy out hospitals and private practices in an almost predatory fashion, the priority is turning a profit for the corporation at the expense of not only patient health but also the health and well-being of the primary care physician. Who do you think bears the brunt of patient frustration and public misconception? The PCP.

Patients actually accuse salaried primary care physicians of being greedy, “that’s why you don’t spend enough time” during those seven-minute visits. The reality is that in corporatized medicine, the physicians don’t make the rules. More often than not, hospital administrators with no clinical background or experience dictate how these practices are run. They decide how many patients you need to see in a day to turn a profit, to maintain the salaries of superfluous middle managers.

 

ADVERTISEMENT

 

 

Primary care has become an unsustainable specialty. The average internal medicine patient, especially the older demographic, has numerous chronic medical issues. How does a primary care physician address their concerns in such a short visit, much less develop a relationship, which is just as important to patient health?

At the beginning of my career, I took great joy in learning about each patient, their family and home dynamic, having two minutes to chat about “how’s the family?” Now, it’s a challenge to make eye contact, as the pressure to document on the electronic medical record to maximize reimbursement and prevent litigation is the priority.

 

 

The nail in the coffin? There are several. In one of the wealthiest nations in the world, why are our patients so chronically ill? Rates of obesity, autoimmune disorders, cancer, cardiovascular disease are increasing. Assembly line medicine has led to “band-aid” medicine, relying heavily on pharmaceuticals to put out fires, because who has the time to focus on prevention and lifestyle counseling?  Oh, and those greedy, millionaire PCPs, as the public perceives them? Their salaries actually go down every year, and they have to make up the difference by seeing more patients, in these poorly constructed RVU systems. Physician burnout is at a record high, understandably so. Primary care physicians are leaving medicine in droves. An already existing shortage will reach devastating levels in the very near future. Corporations like Walmart are opening clinics staffed mostly by nurse practitioners.

 

 

Who will care for the complicated patients, who may have rare illnesses in addition to the common fare like diabetes?

I fear for the future of health care in this country. Until the day physicians become as well organized and as strong a lobby as nurses, pharmaceutical companies, and health insurance companies, primary care is doomed as a specialty. Rest in peace, primary care.

Alexis Gopal is an internal medicine physician and can be reached at Vitality Medicine of New York. She can also be reached on Instagram, Facebook, YouTube, and Pinterest.

GREAT ARTICLE BOB!  EVERYONE SHOULD READ THIS.

[ventana]

• strongly agree!!!!!

 

We have got to reverse the trend of everyone seeing and self referring to specialists

 

If I could move I would go somewhere remote with no one else around, just so I could actually practice full spectrum medicine......

 

 

 

This has been pinned 

[CAdamsPAC]

1 hour ago, ventana said:

• strongly agree!!!!!

 

We have got to reverse the trend of everyone seeing and self referring to specialists

 

If I could move I would go somewhere remote with no one else around, just so I could actually practice full spectrum medicine......

 

 

 

This has been pinned 

Patients have "the right" to decide what care they seek or receive. Who are we to have the temerity to attempt to inflict our opinions upon them? The "Suits" understand that making patients happy is the primary focus of medicine!!

 

[ventana]

13 minutes ago, CAdamsPAC said:

Patients have "the right" to decide what care they seek or receive. Who are we to have the temerity to attempt to inflict our opinions upon them? The "Suits" understand that making patients happy is the primary focus of medicine!!

 

I don't disagree with you

BUT

if you don't know what is wrong and go to a specialist you have already eliminated 90% of the Ddx as you (the patient) self selected to a specialist......  the PCP is truly the hub of the wheel.  I have also seen the specialist hiring more and more (NP in my area) who really are not clinically strong.  I recently got into a disagreement on a nuclear stress test on a patient that was clearly worse then the same test 3 years ago on same patient and was read as a non-negative test(just under 1mm ST and sig diminish exercise tolerance but no chest pain).  She stated "the patient is not complaining of chest pain so we do not recommend a cath"   At my insistence he was evaluated at a different out of area hospital by a CARDS MD and got cath's soon after showing restenosis (the NP hung her hat on a 3 yr old stent) of a 3 yr old stent - LAD - widowmaker in a 63 yr old.....

 

My point is two fold

1) someone needs to look at patients with a blank Ddx - and burn brain cells and then (only if needed) refer to a specialist.

2) with everything being driven by $$$ the specialists are hiring lots of inexperienced providers (in my local area seemingly NP by my unofficial count) whom are not on a level that they should be practicing independently in a subspeciality.

 

So the point it is  - let the PCP drive the bus.........

[CAdamsPAC]

12 minutes ago, ventana said:

I don't disagree with you

BUT

if you don't know what is wrong and go to a specialist you have already eliminated 90% of the Ddx as you (the patient) self selected to a specialist......  the PCP is truly the hub of the wheel.  I have also seen the specialist hiring more and more (NP in my area) who really are not clinically strong.  I recently got into a disagreement on a nuclear stress test on a patient that was clearly worse then the same test 3 years ago on same patient and was read as a non-negative test(just under 1mm ST and sig diminish exercise tolerance but no chest pain).  She stated "the patient is not complaining of chest pain so we do not recommend a cath"   At my insistence he was evaluated at a different out of area hospital by a CARDS MD and got cath's soon after showing restenosis (the NP hung her hat on a 3 yr old stent) of a 3 yr old stent - LAD - widowmaker in a 63 yr old.....

 

My point is two fold

1) someone needs to look at patients with a blank Ddx - and burn brain cells and then (only if needed) refer to a specialist.

2) with everything being driven by $$$ the specialists are hiring lots of inexperienced providers (in my local area seemingly NP by my unofficial count) whom are not on a level that they should be practicing independently in a subspeciality.

 

So the point it is  - let the PCP drive the bus.........

My SARCASM font wasn't activated during my post. I do not support the blanket self referral to specialist  that is rampant in this country. The wheel needs a center for the axle to work effectively, the PCP  fills that role.

[sas5814]

On 1/23/2021 at 7:50 PM, CAdamsPAC said:

My SARCASM font wasn't activated during my post. I do not support the blanket self referral to specialist  that is rampant in this country. The wheel needs a center for the axle to work effectively, the PCP  fills that role.

This^^. I have worked in some kind of primary care most of my career. We have had a fairly large cadre of people who wanted us to just be referral mills and got really hot when I wouldn't.

I think part of our responsibility is good stewardship of resources so everyone gets the most bang for the buck. Now that I work for the VA there simply aren't enough resources so managing them well is critical.

[Sherijane]

An interesting side note to this, last year I was at a used bookstore in Minneapolis and came across a book called "Inventing Disease and Pushing Pills."  I didn't read it, but I  flipped through and the gist was similar, we made medicine a business and patient care suffered, and is still suffering.  I agree with this article.

 I work for a major health system and the guys running the show have NO experience with patient care or clinical medicine.  They make the rules and sidestep them by being "important" in the system that provides their care.

Worse the system buys the small practices and then tries to drive those who don't sell out of practice by ordering people not to refer to independent specialists and refusing to give them OR time, etcetera. 

We need to go backwards to a time when we knew more about our patients, looked them in the eye, and recognized them at the grocery store.  That's why we went to school, right?

Edited June 23, 2021 by Sherijane

[CAdamsPAC]

 A good read;https://www.kevinmd.com/2019/07/im-sorry-why-i-lost-my-love-for-medicine.html?fbclid=IwAR0vLrEsaKR7XlEuvZTBo-ZtDuedFPwSMXXBvXyMZ3xbhFee5SdyCZkg0aw