99203 - Why You Doctor Only Has 5 Minutes to Cure Your Rare Disease.

The following story deals with the looming shortage of internists and family practice doctors which I have made a recurring theme in my blog and feel everyone should be aware of when making political and economic judgements of the future of their lives and our nation. More stories about why your doctor only spends 5 minutes with you on your visit and your for profit insurance company may be to blame.

Fewer US med students choosing primary care

By CARLA K. JOHNSON, Associated Press Writer Tue Sep 9, 7:33 PM ET

CHICAGO - Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.

The results of a new survey being published Wednesday suggest more medical students, many of them saddled with debt, are opting for more lucrative specialties.

Just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary care internal medicine, according to results published in the Journal of the American Medical Association. In a similar survey in 1990, the figure was 9 percent.

Paperwork, the demands of the chronically sick and the need to bring work home are among the factors pushing young doctors away from careers in primary care, the survey found.

"I didn't want to fight the insurance companies," said Dr. Jason Shipman, 36, a radiology resident at Vanderbilt University Medical Center in Nashville, Tenn., who is carrying $150,000 in student debt.

Primary care doctors he met as a student had to "speed to see enough patients to make a reasonable living," Shipman said.

Dr. Karen Hauer of the University of California, San Francisco, the study's lead author, said it's hard work taking care of the chronically ill, the elderly and people with complex diseases — "especially when you're doing it with time pressures and inadequate resources."

The salary gap may be another reason. More pay in a particular specialty tends to mean more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a separate study.

Family medicine had the lowest average salary last year, $186,000, and the lowest share of residency slots filled by U.S. students, 42 percent. Orthopedic surgery paid $436,000, and 94 percent of residency slots were filled by U.S students.

Meanwhile, medical school is getting more expensive. The average graduate last year had $140,000 in student debt, up nearly 8 percent from the previous year, according to the Association of American Medical Colleges.

Another likely factor: Medicare's fee schedule pays less for office visits than for simple procedures, according to the American College of Physicians, which reported in 2006 that the nation's primary care system is "at grave risk of collapse."

Lower salaries in primary care did not deter Dr. Alexis Dunne of Chicago, who is 31 and carrying $250,000 in student debt.

Last year, a parade of specialists couldn't solve the mystery of her mother's weight loss, fevers and severe anemia. Finally, an internist diagnosed a rare kidney infection. The kidney was removed, and Dunne's mother has felt fine since.

Watching her mother go through the health crisis affirmed her decision to go into primary care. She also enjoys being "the point person" for her patients.

"You become so close to them you're almost like a family friend," said Dunne, who completed her residency at Chicago's Northwestern Memorial Hospital in July.

She also found inspiration from the doctors she met during training: "They were the ones who would sit at a patient's bedside and spend more time with them rather than running off to surgery."

A separate study in JAMA suggests graduates from international medical schools are filling the primary care gap.

About 2,600 fewer U.S. doctors were training in primary care specialties — including pediatrics, family medicine and internal medicine — in 2007 compared with 2002. In the same span, the number of foreign graduates pursuing those careers rose by nearly 3,300.

"Primary care is holding steady but only because of international medical school graduates," said Edward Salsberg of the Association of American Medical Colleges, a co-author of the study. "And holding steady in numbers is probably not sufficient when the population is growing and aging."

And as American students lose interest, teaching hospitals will probably become less interested in offering primary care programs, said Dr. David Goodman, associate director of the Center for Health Policy Research at Dartmouth Medical School.

In a JAMA editorial, Goodman called on Congress to create a permanent regulatory commission to encourage training for needed specialties. U.S. teaching hospitals now receive $10 billion a year from the government to train doctors "with virtually no accountability," he said.

The coordinated care provided by primary care doctors can keep costs down by preventing harmful drug interactions, unneeded medical procedures and fragmented specialty care, Goodman said.

The Web-based survey was done at 11 medical schools with demographics and training choices similar to all U.S. medical students.

Why Medical Insurance Is Only A Discount And Not Insurance

Medical Insurance Is Becoming a Discount Plan And Not An Insurance Plan

(There is supposed to be a difference. Please see the Federal Trade Commission consumer alert for their warning and advice by clicking this link: FTC Consumer Alert)

I have been saying this for years now. The list of medical insurance woes is a very long interweaving laundry list with historical nuances and beyond a short blog post. It is the story of multiple books since its complex and compound details simply cannot be confined to just a few. Bearing this in mind, however, lets just take a quick jaunt through some salient and some recent developments that have come to the battlefront and stirred considerable political debate. Lets pull back the curtain and let me give you a bit of the benefit of my 21 years of industry exposure from a Podiatrists perspective, from an admittedly anecdotal view, and via the application of simple deductive analysis, i.e. common sense.

Medical insurance is quickly becoming a discount plan and not real insurance in the sense that we have all grown accustomed too. A recent article in the AP news wire service quotes a recent study that forecasts deductibles, co-payments, and out of pocket expenses will rise again next year. That means you the patient pay more of the share of the cost and the insurance company pays less. However your insurance bill will not go down. I don't know how the insurance companies continue to get away with increasing the cost on both sides of the balance sheet while reducing what they pay doctors and hospitals to the point where many hospitals, emergency rooms, and doctors are going out of business. In the face of this the insurance companies have reported record profits until this year! ("WellPoint Boosts Premiums to Bolster Profits") It seems that bleeding your clients dry in the face of decreasing job market, increased energy costs, and increasingly undertreated epidemic chronic diseases is not a good strategy. You just don't kill the cow if you want to get any milk.

While some relief of suspect health insurance company reimbursement practices is finally coming to California from Sacramento lawmakers it is certainly too little and certainly too late for many.

"The Legislature's major healthcare accomplishments involved several high-profile, though relatively uncommon, practices that afflict consumers and patients. Lawmakers agreed to stop insurers from retroactively canceling policies of sick customers..."

"Legislators also voted to require insurers to spend at least 85% of the premiums they collect on medical care rather than overhead and profits. If signed by Schwarzenegger, that measure could turn out to be the nation's most stringent, although there are doubts that it will lead to lower premiums. In addition, lawmakers decided that insurers must pay for maternity care, orthodontics cleft palate treatment and the purchase of medical equipment such as wheelchairs."

These changes appear to this observer as hardly earth shattering. If anything they are common sense changes that should have been enacted long ago. Good God I think that my health insurance should spend more than a mere 85% of what they get to take care of the sick. If anything why is there a limit at all. Ah yes, of course profit. And the almighty profit is worth more that the health of your mother, or sister, or daughter. Sure that makes sense. (cyniscism and snarkiness borrowed from Republic National Convention) Pay for a wheelchair! I'll bet you thought that was a given. Surprise, its not! (Limp or crawl home if you can't afford one or beat up that week retard down the street and take his wheelchair. Great.)

All of the measures await action by the governor, who has until Sept. 30 to sign or veto bills from this session.

It is not unusual for a patient to visit my office, have a bill sent to their insurance company for the $65 office visit, the insurance pays me, the doctor, $9.00, and the patient is liable for the remaining $45, with an $11 negotiated discount for seeing a participating provider in your insurance plan. It is also common for a patient to present to my office and pay a $35 or $45 co-payment at the time of visit and after sending the bill to the insurance company for $65 they, the insurance company, pay $ 1-10 (Or even less. I have seen checks in the amounts of 0.40 cents. Don't believe me? Ask your doctor. E-mail Dr Sanjay Gupta if you please. Click here for Dr. Gupta's Blog) This means you pay $45 they pay $5 or $10 dollars for a visit to the doctor that costs $65. All this, while you send them $500 to $800 a month for what they call health insurance. That's not insurance my friends that's a medical discount card.

The average income of a family practice doctor is around $180,000 a year. No joke. Although that seems like a decent wage in comparison to other jobs, the years of study and the average student loan debt of over $150, 000 (mine was closer to $200,000 and the average Podiatrist income in Los Angeles is placed at some at around $ 150,000) incurred by doctors it may not be so attractive. I have met sales reps making the same amount and never had to endure the long years of study and student loan debt. Article after article has been written about and by doctors sharing their discontent but more importantly students are being deterred from studying medicine, especially family care, as a result of these dissincentives. Why should they toil taking difficult pre-med courses in college, struggle through difficult medical school programs, suffer long hours in residency and internships, and incur great debt only to struggle to make ends meet and under the pressure of mountains of debt for years? It is much shorter and easier for the these intelletuals in our society to pursue some other mor profitable venture. The result doctor shortages while an increase in patients due to the aging baby boomer population will create medical care crisis already being felt in parts of Canada and discussed with respect to Medicare costs.

"American health care is now largely delivered via a government-subsidized private health insurance industry operating parallel to and within Medicare. A recent nationwide poll of physicians published in the Annals of Internal Medicine utilizing the AMA physician database demonstrated that 60 percent of doctors support a single-payer national health plan based on the most efficient and effective Medicare system.

This national health plan currently before Congress (HR 676) would provide medical care and low-cost prescription drugs to all Americans - including the 47 million uninsured and 50 million underinsured citizens - while maintaining the private-practice quality of physicians, hospitals, clinics and therapists.

The lower overhead costs of the most efficient Medicare insurance plan, which already treats more than 40 million people, would provide substantial cost savings to all Americans and businesses while maintaining quality private physician practices and hospitals. A majority of physicians in this country can't be wrong in their support of a single-payer national health insurance plan such as HR 676. - HOWARD A. GREEN, M.D."

Watch actual persons tell their story of medical insurance woes in person in an AARP TV Ad Campaign which hits the nail on the head by clicking on this link. Unless you are a human with a reptile nervous center you will be moved by these true stories (requires flash palyer)

(Blue and underlined words indicate a link to a source article or video, double click to view these. Quotes are in italics.)