FROM THE BLOGOSPHERE
YES CASSIE, THERE IS A
FUTURE IN PRIMARY CARE
Kathy Nieder, MD
M
y daughter recently introduced me to a friend of hers via
email. She is a newly minted fourth-year medical student,
named Cassie, who asked me:
“I would love to hear your thoughts about the future of primary
care and what it is like to work as a family medicine doctor in
Louisville.”
To start, I’d encourage you to read the recently published New
York Times review of the state of primary care. If you began in
practice today, you would quickly find yourself with more patients
than you can adequately care for, having just left residency and not
expecting to see 25-30 patients daily. In Louisville, you will probably
be employed by one of three healthcare systems. All of them have
compensation based on patient volume and RVUs--I hope someone has showed you what RVUs are but I bet they haven’t. Relative
Value Units are supposed to measure the “time, skill, training and
intensity”[1] of patient care and compensate accordingly. Unfortunately they are heavily skewed toward proceduralists. As Dr.
John Mandrola, a Louisville interventional cardiologist, observes
in his excellent post “Thirty Dollars...Really?” a doctor is paid a lot
more to do a coronary catheterization than to talk about the causes
behind coronary artery disease. To understand H] H[ܙH