Primary Care in Transition

Abstract

It is generally agreed that too few physicians have chosen careers in primary care. The advent of managed care as a popular method of health care provision is now affecting primary care physicians in ways that may further discourage enthusiasm for the practice of primary care and have an unintended negative effect on the primary care physician supply. In addition, the early implementation of the resource-based relative value scale by Medicare and some insurance carriers has been less beneficial to primary care physicians than expected and may even have been harmful to general internists. Efforts to improve the position of primary care physicians in relation to payers and among peers are hindered by the fact that, as a group, primary care physicians are less affluent, less influential, and greatly outnumbered by their more specialized colleagues. Consequently, some of the support currently directed toward primary care may be more apparent than real. My proposals, which aim both to protect and to enhance primary care practice, are the creation of separate primary care fee schedules and separate primary care budgets within health plans, changes in consumer protection rules that intrude on primary care practice, and the development of statewide primary care associations for mutual support and greater bargaining power. Some aspects of contracting and gatekeeping require further study.

Improving primary care residents’ proficiency in the diagnosis of skin cancer

“…Successful triaging involves screening, making correct initial diagnosis and evaluation planning decisions, and appropriately referring to specialists. Because many of these managed care organizations use financial incentives and administrative mechanisms to encourage generalists to limit referrals to specialists, 1 we must ensure that primary care physicians can screen, diagnose, and evaluate effectively with reduced access to specialists. In dermatology, primary care physicians may not need to be as skilled as dermatologists at diagnosing and planning treatment for the approximately 2,000 named skin diseases, 2 but, at a minimum, they need to proficiently screen, diagnose, and evaluate lesions indicative of skin cancer.…”

Nurse Practitioners and Physicians: Patients' Perceived Health and Satisfaction with Care

“…The use of NPs to meet the need for community-oriented primary care has been proposed as a possible solution to an overextended medical system (Callan, 1992;Wilkinson-Faulk, 1994;Wright, 1993). Since medical schools cannot produce enough generalist graduates to fill the void in primary care until after the turn of the century, some physicians agree that there is a need to alter the health care system by placing NPs to provide primary care (Alpert, 1994;Prescott, & Driscoll, 1980;Weiner, 1994).…”

Effects of a self-administered previsit questionnaire to enhance awareness of patient’s concerns in primary care

“…§ p Ͻ .05. ʈ In items 1-4, physicians were asked "to rate some things about the clinic visit in terms of whether they were Poor (1), Fair (2), Good (3), Very Good (4), or Excellent (5)." In items 5 and 6, physicians were asked whether they "Strongly disagree (1), Somewhat disagree (2), Are uncertain (3), Somewhat agree (4), or Strongly agree (5)." JGIM achieve.…”