Sunday, June 28, 2009

Primary Care and Extra Services

Anyone who follows medical economics or medical blogs knows that primary care physicians are becoming few and far between. The number of young doctors who chose any specialty OTHER than primary care (family medicine or general internal medicine) continues to rise. So it is no surprise that I just read an article about adding "Ancillary Services in Primary Care".

It is kind of sad that taking care of the whole patient and serving as a well trained comprehensive doctor is at the bottom of the desirability food chain of medicine. Hospitals and multi-specialty medical groups see primary care physicians as "lost leaders". We have become the "oil change" of medicine, so the big ticket "engine overhaul" can be captured by the high dollar procedures.

So now there is advice being offered for how primary care physicians should add new services to the "core" practice of patient care. Believe me, the "core" is challenging and time-consuming enough but patients and payers don't seem to see it that way. Here is what is recommended:
  • Diagnostic tests on site such as Holter monitor, labs, imaging, treadmill testing. (most of these require significant up front capital and the only way to justify it is to order lots and lots of tests....rising health care costs anyone?)
  • Cosmetic procedures such as Botox, injectable fillers, laser hair removal, laser skin resurfacing and vein treatments. (it worked for the dermatologists. Have you tried to find one to look at a mole or a rash lately?)
  • Behavioral health like weight management, nutritional counseling, smoking-cessation. (most of us do this for free. Hey maybe that's part of the problem?)
  • Alternative and holistic treatments like acupuncture, massage. ( I see $$ for additional staff and space with little additional revenue)
  • Products like drugs, skin care products and nutritional supplements. (lots of doctors do this already. Does it put undue pressure on patients and represent a conflict of interest?)
I find it sad that primary care doctors are advised to get into these extra services in order to survive as a specialty. I certainly understand the economics. The average fee for laser hair removal is $503. It takes about 45 minutes to do and it costs $1100 for a two day training course. It sure beats doing physical exams.

What do you readers think? Should your doctor get into these ancillary services?


Linda Leighton said...

Although I understand the economics, I find this very sad as well. Of my former students and friends' children who will be finishing medical school in the next year or just finished this year, not one that I know of is going in to family medicine or internal medicine. This is a very timely topic, Toni, and a crisis in the future!

Linda Leighton said...

And no, I do not think my primary care doctor should offer these services. There is so much for her to focus on already!

Anonymous said...

I really feel for the primary care doctors and understand why they might need to sell other services but I agree with Linda. There is so much to do and anything that takes their focus away from my health cannot be good. I think they are worth their weight in gold.

Anonymous said...

Who is recommending this expanded core practice? No, I do not believe that practitioners should get involved in any of these and should be able to determine their limits within their scope of practice. Yes, how cynical, would make more in the quick--get rich schemes. No, drs. should not practice counseling or other expanded practices. But, I do believe that they should be fully informed of ancillary services that the public is seeking.

KM said...

I can see how this could cause problems for making it take alot longer to get an appointment to see a primary care doctor if his or her time is spent doing all these other things and delay getting help for real medical problems that are urgent. I agree most of the good primary care physicians I know discuss stopping smokiong, losing weight, or nutrition for people who have it affecting their health causing other problems like high chol. high BP or diabetes.

There are already professionals to see for thses other things and does nnot seem like what a Family Practice Physician or Internist really went to medical school to do and their trainging is more extensive and beyond this and should be reserved for dealing with tougher more critical medical challanges.

Anonymous said...

Lab and diagnostics on-site... 'rising health care costs'? False! In fact, in-house labs and diagnostics significantly reduce health care costs.

Primary care's main source of income is reimbursements from E&M (cognitive services). Primary care is a dying breed because "there is no money in it". Primary care providers simply do not understand evidence based medicine.

Evidence based practices have (lab & diagnostics) which enable providers the ability to detect and treat illnesses in their early stages... more importantly asymptomatic stages which prevents catastrophic costs to the overall system and saves lives.

Instead, primary care providers operate "waived" labs to avoid quality assurance headaches... they attempt to see as many patients as possible in efforts to survive (which reduces the quality of care they provide even further). Is this how they want to practice medicine? I dont think so.

It is no longer possible to survive on revenues from evaluation and management, especially in primary care. The once viable option of seeing more patients can not be sustained, as new clinical guidelines and incentives reward improved patient outcomes.

Physicians must change the way they deliver care with a focus on prevention, wellness, and the management or treatment of chronic disease to bring in new streams of revenue.

Anonymous said...

Whether or not anyone wants to admit it medicine must be considered a business. Sadly enough history is litered with companies that maintained business as usual in spite of market change and declining revenue. This is what is happening in the primary care area.
Working harder and longer will only result in physician and staff burn-out.
The simple answer is to find additional services that can multiply the physician's time instead of adding to it. There are a number of ancillary services that can be added into the practice mix, add addtional revenue, provide great patient care & service, and take very little of the staff's time. Win - win for all. All you need to do is look outside the envelope!

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