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Money Isn’t Everything In Primary Care

Much has been recently made about the bureaucratic obstacles that primary care doctors face. With good reason. The impetus was a recent New England Journal of Medicine paper from Richard J. Baron that I mentioned recently.

The New York Times’ Pauline Chen interviewed Dr. Baron, who shared some interesting insights on what needs to be done. He contrasts the inertia in primary care to drug manufacturing.

If you took the resources that went into drug development, for instance, “and put them into a program like this that achieves meaningful levels of behavior change, a lot more patients could be better off.” In other words, research into new primary care models isn’t taking off because the money isn’t there.

But Dr. Baron also notes that money isn’t everything, since “primary care practitioners have been saying that we either already do or would do certain things if you paid us more. It’s true that you can’t do things consistently, reliably and across scales without additional payment. But payment is not enough. People have to change what they are thinking about when they go to work.” Read more »

*This blog post was originally published at KevinMD.com*

From “Winnie The Pooh”: Edward Bear And Primary Care

Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it. 

– From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”

Internists, I expect, will identify with Edward Bear.

Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.

Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

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I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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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

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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