Doctors Face Image Problems; Patients Deal With Shortages, Are Urged To Question Care

Doctors must not only face the fading image of primary care providers, but also physician shortage issues. Meanwhile, some experts suggest patients consider saying "no" to their doctor to control health care costs.

The New York Times has a story from Pauline Chen, MD, who reports that many medical students who choose to follow the "ROAD (radiology, ophthalmology, anesthesia and dermatology)" instead of primary care when choosing their specialties. "While 50 years ago half of all physicians were in primary care, almost three-quarters are now specialists." Even though nurses and physicians assistant are helping out, much of reform could be in danger if there aren't enough primary care doctors — who are increasingly drawn away from primary care by over-burdening debt, increasing income and plusher lifestyles, The Times reports (Chen, 11/12).

Meanwhile, Bloomberg reports that the doctor shortage may create even more delays and crowded emergency rooms in America if health care reform is enacted. "Underserved areas in the U.S. currently need 16,679 more primary-care physicians to reach a 'medically appropriate' target of 1 for every 2,000 residents, U.S. data shows. The health-care overhaul bills before Congress would raise pay for family doctors, increase residency training and forgive school debt to help meet that deficit." But those things would likely take years to make a difference (Wechsler, 11/13).

Finally, Forbes has a story on when patients should say "no" to extra tests or care in order to reduce health care costs. "Health policy researchers furiously debate how much is wasted on treatments sometimes that don't make people better. … Elliott Fisher and his colleagues at Dartmouth Medical School have shown that medical spending fluctuates wildly from town to town and hospital to hospital, with no measurable improvement in health in the pricey places. They calculate that 20 percent or more of all costs could be eliminated without harming anyone." Americans share the blame for equating "fancy tests with high-quality care," Forbes reports, and some tests and treatments that Congress could look at curbing to save money include high-tech imaging, certain mental health treatments and back pain treatments (Langreth, 11/12).

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