Sunday, May 28, 2006

Doctors for Adults

This catchy little slogan from the American College of Physicians (ACP) reminds you that you just have to love internists. Perhaps you didn't ever give that a thought. Consider then:

"They are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time." Direct from doctorsforadults, this stirring language confirms that primary care providers such as myself, trained in internal medicine, are 'whole picture' kind of docs, diagnosticians who take the extra time to consider your entire health situation.

So now how good is that? Well, unfortunately, general internists are leaving the field in droves, and the proportion of third-year internal medicine residents choosing internal medicine careers has dropped to 1 in 4.

Dr. Donna Sweet of the ACP Board of Regents warns, "Unless steps are taken now, there will not be enough general internists to take care of an aging population with growing incidences of chronic diseases." Perhaps Dr. Sweet is a weensy bit biased from her chair position on the ACP Board of Regents, but she's got more to say: "Without general internal medicine, the health care system can become and will become increasingly fragmented, overspecialized, and inefficient, leading to poorer quality care at even higher costs than we have today."

On the heels of all this bad news from the ACP, the Centers for Medicare and Medicaid Serices are considering moves to make primary care for aging adults an even less attractive practice choice than ever. They are proposing a 4.6% pay cut for 2007. Dr. Larry Fields of the American Academy of Family Physicians is blunter than Dr. Sweet when he notes that many more physicians may stop taking new Medicare patients or may even close their practices. In short, says Dr. Field, "When the overhead is greater than the payment there won't be any access."

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