Report puts added demands on already beleaguered family physicians

LETTER — Posted May 3, 2004

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Regarding "Family physicians told to evolve so specialty can survive" (Article, April 12):

The future of family medicine certainly does look bleak. I'm referring to your article that includes many recommendations for us to "survive."

The two-year report, covered in AMNews, wants us to make our practice patient-centered with open scheduling, e-mail consults and evidence-based care, with flexible hours and an electronic medical records system for our integrated multidisciplinary team meetings. What is the cost to the average family physician? Thousands of dollars.

We already have HIPAA, CLIA, OSHA, federal and state requirements, licensure, escalating malpractice costs, expensive conferences for continuing medical education, increasing office overhead and staffing costs.

Of course, we are experiencing declining insurance reimbursements, denials, automatic Medicare cuts, continually changing codes and complex coding requirements. In addition, the erosion of our specialty to advanced registered nurse practitioners and physician assistants only magnifies the insult.

No wonder medical students are voting with their feet. Reviewing your article underscores why youths would not want to become family doctors.

It's great to see what patients want from family practitioners, but all I see are more demands on us; i.e., in-depth training for practice management, becoming more active in schools, improving relationships with academic health centers, forming multidisciplinary teams with advanced registered nurse practitioners, nutritionists and behavioral scientists, redesigned life-long learning and more complex recertifications.

For this we will receive the lowest reimbursement of any certified specialist, potentially becoming more liable with e-mail advice and compromising confidentiality of records with an EMR system.

Unless there is better reimbursement and fewer demands on the family doctors, then there will not be family medicine in less than 20 years.

Douglas Sims, MD, Venice, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/05/03/edlt0503.htm.

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