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The Primary Care Shortage: Killing The Golden Egg-Laying Goose?

This past Monday, I was drawn to an article in the Wall Street Journal: “Medical Schools Can’t Keep Up.” The article detailed the growing shortage of primary care doctors in our country and reminded me that we in the U.S. may have something called “insurance reform” now, but without physicians to translate insurance access into healthcare, the state of our healthcare system will continue to beg additional attention and reform.

Although new medical schools are opening and some schools have increased enrollment numbers, there are a limited number of residency positions in this country. The government has always funded these residency positions and our new reform law tries to address the primary care shortage with “slot redistribution,” whereby money from unused residency positions will be deferred to primary care or general surgery residency programs.  Read more »

Health Insurance Goes Up For Doctors, Too

Physicians aren’t exempt from the struggles with personal health insurance coverage, affordability, denied coverage, etc.  

When I finished my medical training and opened my practice 20 years ago, I had to buy individual coverage. All options included a rider that excluded coverage on my uterus and ovaries due to fibroid surgery during my training, so when I had my TAH & BSO a few years later, the entire cost came out of my pocket. Fortunately I knew how to ask for cost reductions, but still.

My husband and I are both small business individuals. I have always carried our health insurance under my name (office). Over the years we have gone to a health savings account with a high deductible to keep the cost reasonable. Fortunately, we have been mostly healthy. Last month we received a letter from Assurant Health. Read more »

*This blog post was originally published at Suture for a Living*

Physicians Need To Lead Cost Control Efforts In Health Reform

Boy if that statement doesn’t hit the nail on the head.

Talking to Cortese this week, I heard two themes that cut to the heart of the debate. First, he thinks Obama has made a mistake in moving toward the narrower goal of “health insurance reform” when what the country truly needs is health system reform. Imposing a mandate for universal insurance will only make things worse if we don’t change the process so that it becomes more efficient and less costly. The system we have is gradually bankrupting the country; expanding that system without changing the internal dynamics is folly.

Let me give you the truth of our current reality. We as a nation are headed for a devastating bankruptcy at the hands of our current health insurance model. A model that pays for everything (of substance) and passes on those costs to current and future generations.

Obama’s push for health insurance reform will do nothing to save America’s model that pays for everything (of substance) and passes on those costs to current and future generations.

The argument, as I see it, is not that a lack of insurance is bankrupting our country, but rather the model of insurance itself. Getting more of the same won’t make health care less expensive, it will make it more expensive. And ultimately, if we keep paying for things the way we pay for things now, there won’t be any money left for anyone.

Some people argue that spending money now with universal access will create a healthier and cheaper to insure America. To that, all I have to say is look to the history of the last 50 years. Medicare did not make health care cheaper. It has, for the last 50 years lead to a devastating economic death spiral. FREE=MORE is bankrupting our country. The model of insurance is bankrupting our country. The storm on the horizon will be the death of America, unless something changes, and soon.

I think the whole current nonsense debate is a travesty both from the Republicans and the Democrats. Opponents and proponents are both focusing on the wrong issues at hand. The issue is cost. If you can’t control costs, nothing else matters.

Doctors every where should embrace a system of delivery that encourages value and quality. The ones that will fight you tooth and nail are the ones that are ripping off America with their pretend care. The bad ones will suffer as will.

The physicians most expensive procedure is the pen. If doctors can’t lead the way toward cost effective care, then they should get out of the way while others do. Because if we as physicians don’t do something, we will have spent all the Treasury’s money for all future generations. And we will have no one to blame but ourselves.

Thanks again to Are You A Doctor for pointing me to this article.

*This blog post was originally published at A Happy Hospitalist*

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Latest Book Reviews

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

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