Primary Care

The future for medical students with large educational debts is not as bleak as "Med Students Seek Cure for Debt" [Nov. 27] portrayed, especially for those future doctors interested in working with the underserved. It is true that the practice of medicine is becoming much more difficult with many bureaucratic hurdles that interfere with patient care and reimbursement. Further, many young specialist physicians will have trouble finding positions locally as a surplus of many types of specialists exists.

SACRAMENTO -- A series of bills to expand the roles of nurse practitioners and other healthcare professionals has set off a turf war with doctors over what non-physicians can and can't do in medical practices. Citing a doctor shortage in California, state Sen. Ed Hernandez (D-West Covina) has proposed legislation that would redefine professional boundaries for nurse practitioners, pharmacists and optometrists to help treat what is expected to be a crush of newly insured Californians seeking care next year under the federal healthcare law. But physicians are pushing back, arguing that the proposed “scope of practice” changes would radically alter longstanding medical standards and jeopardize patient safety.

Until now, doctors have pretty much called the shots in the doctor-patient relationship. But change is on the way. Patients, say ahhhhh - it's about to be all about you. The new approach is called patient-centered care, and it's a very good thing, according to Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics in Bedford, Ind. "It will mean better outcomes, more satisfied patients and lower costs," he...

SACRAMENTO -- Facing a doctor shortage in California, state lawmakers want to fill the gap by redefining who can provide healthcare in the Golden State. As detailed in Sunday's Los Angeles Times , they are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high- blood pressure . The effort is being led by state Sen. Ed Hernandez (D-West Covina)

The Senate and House are inching closer to extending health insurance to millions of Americans. Access to insurance, however, does not necessarily mean access to healthcare. What is also needed is a sufficient supply of primary-care doctors. As an internal-medicine physician who works in multiple clinical settings, I repeatedly witness the consequences of patients not having that access. When I was working in an emergency room a few months ago, for example, a middle-aged man with hypertension came in with a paralyzing stroke.

The average adult fills about a dozen prescriptions and refills every year; after age 65, they fill more than 30 prescriptions annually. For many people, their local pharmacist may be as familiar as their doctor ? and often a lot easier to get time with. Some pharmacists are building on that position, expanding their role from drug dispenser to drug educator and chronic disease coach. By doing so, they may fill a void created by the shortage of primary-care physicians while boosting their business.

"That's where the money is," Willie Sutton famously quipped when asked why he robbed banks. There's a similar rationale for employers who hope to improve employee health and contain costs with workplace health clinics: That's where the people are. Day in and day out, workers troop into the office, spending the better part of their waking hours there. What better place to have medical staff on hand, not only to treat sore throats and cut fingers but also to help employees stay healthy by offering on-site preventive tests and screenings, and health coaching to encourage healthful habits?

Antidepressants, now the third-most commonly prescribed class of drugs in the United States, are routinely offered to patients with vague complaints of fatigue, pain and malaise but who are not classified as suffering from a mental disorder by the physician who recommends the treatment, says a new study. And among primary care provider as well as specialists who are not psychiatrists, the practice of prescribing these medications without diagnosing depression is rising steeply, the study finds.

The United States will need an additional 52,000 primary care doctors to cope with population growth, newly insured people and an aging population, a group of researchers has forecast. The researchers -- from several institutions including Georgetown University and the Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington, D.C. - looked at several factors to come up with their total. Others have projected different numbers but agree that there will be a shortage of doctors.

Re "Why the doctor won't see you now," Column One, Dec. 15 This is a timely article, as healthcare reform becomes more likely with the incoming Obama administration. However, any comprehensive effort to change our fragmented healthcare system will run aground if our primary care crisis is not dealt with. The American College of Physicians reports that from 1997 to 2005, the number of U.S. medical graduates entering family medicine residencies dropped by 50%. That is likely to continue as medical school debt increases well beyond $100,000 per graduate and primary care physicians continue to receive low payment rates from Medicare and other insurers.

For all of our sophisticated medical care, Americans can expect shorter lives and more health troubles than the people of other well-off nations, according to a new report. And that's not just true of infants and poor people, the groups usually pinpointed as particularly vulnerable to health issues; it is also the case for the affluent, teenagers and middle-aged people. Some of this can be traced to a lack of preventive and primary care, some to car accidents and violence, some to obesity and poor health habits.

This might be tough for parents who want to swoop in and fix their children's every problem, but a study found that half of the teenagers who screened positive for depression got better in six weeks without treatment. Two aspects of the teenagers' conditions seemed to predict whether the depression would ease without treatment: the severity of the symptoms and whether the symptoms persisted for six weeks, the researchers, led by Dr. Laura Richardson of Seattle Children's Research Institute, said in an article published this week in the journal Pediatrics.

The United States will need an additional 52,000 primary care doctors to cope with population growth, newly insured people and an aging population, a group of researchers has forecast. The researchers -- from several institutions including Georgetown University and the Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington, D.C. - looked at several factors to come up with their total. Others have projected different numbers but agree that there will be a shortage of doctors.

Until now, doctors have pretty much called the shots in the doctor-patient relationship. But change is on the way. Patients, say ahhhhh - it's about to be all about you. The new approach is called patient-centered care, and it's a very good thing, according to Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics in Bedford, Ind. "It will mean better outcomes, more satisfied patients and lower costs," he...

Women who were screened for partner violence and given a list of resources to help didn't have better health or less partner violence a year later than women who were not screened, researchers found. The research follows a call from numerous public health agencies, including the Institute of Medicine, for such screening, the researchers wrote in Tuesday's issue of the Journal of the American Medical Assn. They note that several other agencies including the U.S. Preventive Services Task Force have concluded there's not enough evidence to support the screening.

Like all modern healthcare systems, the National Health Service -- Britain 's centralized, universal healthcare system -- has room for improvement. But there's much more to the story than that presented by Dr. Theodore Dalrymple in his Aug. 8 Op-Ed article, " Britain's cherished, lousy National Health Service . " The NHS' widely known strength is primary care. And time and again it has been shown that a strong primary-care system is at the heart of a healthy population. In part because of Britain's focus on primary care, the country has lower age-adjusted rates of diabetes (about half our rate)

Healthcare should be a top item of our national agenda, particularly universal healthcare ("Healthcare reform calls get louder," Feb. 8). Unfortunately, the primary-care workforce -- general internists and family physicians -- is not big enough to handle the current needs of the insured, let alone the projected load of the 47 million uninsured. Part of the problem is that for decades medical schools have discouraged students from entering primary care, steering them into specialties instead.

Re "Paying for more of your doctor's time," July 29 I recently changed a limited portion of my practice to a "concierge model," in which patients pay an annual fee for better access. Although the financial incentive is certainly appealing to physicians, patients benefit as well. Most longtime primary-care doctors treasured the time they could spend with each patient. But given the constraints of the present era, providing this level of attention has become almost impossible.

Pharmacy giant CVS Caremark Corp. and UCLA Health System are teaming up to treat patients in 11 in-store clinics in Los Angeles County as one remedy to a growing shortage of primary care physicians. Under this arrangement, UCLA physicians will serve as medical directors overseeing 11 CVS MinuteClinics and the two entities will share electronic medical records. CVS runs nearly 600 MinuteClinics nationwide inside its stores where nurse practitioners treat routine illnesses and provide physicals and vaccinations with no appointment necessary seven days a week.