Letters to the Editor - May 3, 2004

Report puts added demands on already beleaguered family physicians - Want to ensure family practice's future? Cut the hours, up the pay - Bariatric surgery is only recourse for some patients and it must be covered - ACGME: "Credible evidence" will drive any changes to work-hour limits

Report puts added demands on already beleaguered family physicians

Regarding "Family physicians told to evolve so specialty can survive" (Article, April 12):

The future of family medicine certainly does look bleak. I'm referring to your article that includes many recommendations for us to "survive."

The two-year report, covered in AMNews, wants us to make our practice patient-centered with open scheduling, e-mail consults and evidence-based care, with flexible hours and an electronic medical records system for our integrated multidisciplinary team meetings. What is the cost to the average family physician? Thousands of dollars.

We already have HIPAA, CLIA, OSHA, federal and state requirements, licensure, escalating malpractice costs, expensive conferences for continuing medical education, increasing office overhead and staffing costs.

Of course, we are experiencing declining insurance reimbursements, denials, automatic Medicare cuts, continually changing codes and complex coding requirements. In addition, the erosion of our specialty to advanced registered nurse practitioners and physician assistants only magnifies the insult.

No wonder medical students are voting with their feet. Reviewing your article underscores why youths would not want to become family doctors.

It's great to see what patients want from family practitioners, but all I see are more demands on us; i.e., in-depth training for practice management, becoming more active in schools, improving relationships with academic health centers, forming multidisciplinary teams with advanced registered nurse practitioners, nutritionists and behavioral scientists, redesigned life-long learning and more complex recertifications.

For this we will receive the lowest reimbursement of any certified specialist, potentially becoming more liable with e-mail advice and compromising confidentiality of records with an EMR system.

Unless there is better reimbursement and fewer demands on the family doctors, then there will not be family medicine in less than 20 years.

--Douglas Sims, MD, Venice, Fla.

Want to ensure family practice's future? Cut the hours, up the pay

Regarding "Family physicians told to evolve so specialty can survive" (Article, April 12):

This opinion is rated "NPC" -- not politically correct.

Medical students are not entering family practice and the specialty's future is threatened. Why? They do not like the long hours and poor pay offered by family practice.

The "New Vision" for family practice suggests electronic medical records, evidence-based medicine, etc. None of these changes address long hours or poor pay. Indeed, some admittedly place an increased burden on the physician.

--Jeffrey R. Waggoner, MD, Denver

Bariatric surgery is only recourse for some patients and it must be covered

Regarding "Insurers trim bariatric surgery coverage" (Article, April 5):

Insurers' attempts to block coverage of bariatric surgery is loathsome and a blatant disregard for the health of those they have contracted to care for -- all done under the fatuous guise of concern for the "safety" of such surgery. Nonsense.

Bariatric surgery is the only recourse for many patients who have chronically battled with their obesity. No one takes it lightly.

Doctors and patients fully appreciate the risks of such an intervention, but they also fear the long-term complications of obesity. The postoperative course is not a picnic. No patient uses it as "an easy way out."

Yet, once again, obese patients are judged as weak and lacking in character, and their illness is lumped together with "lifestyle" health issues. The result is blatant money-grubbing by insurers and overt discrimination of obese patients. Any entry-level bookkeeper should be able to realize that the cost of the surgery is far outweighed by the long-term improvements of the patient's health.

As much as I hate to say it, we are forced to work with legislators for state-level laws to prevent such coverage blocking. Obesity is a true medical illness and must be covered.

--Andrew Pavlatos, MD, Chicago

ACGME: "Credible evidence" will drive any changes to work-hour limits

Regarding "Some work-hour limits could change" (Article, April 12):

Your article reported that the Accreditation Council for Graduate Medical Education announced, at its educational conference in March, it is considering modifying duty-hour standards for residents in response to feedback from program directors.

The ACGME common duty-hour standards have been in effect since July 1, 2003.

In keeping with its commitment to promote quality in graduate medical education, the ACGME is collecting information on challenges related to the implementation of the common duty-hour standards from its Residency Review Committees and the education community, including residents.

Any future refinements to the standards will be based on credible evidence that they would further promote, and not harm, resident education, patient safety and resident well-being. Benefits of potential changes will be weighed against their drawbacks.

--Ingrid Philibert, staff, ACGME Subcommittee on Duty Hours, Chicago