Letters to the Editor - June 20, 2005

Fewer hassles, lower overhead would attract more doctors to primary care - Low pay, high expenses, 4th-class status plague primary care

Fewer hassles, lower overhead would attract more doctors to primary care

Regarding "Subspecialties flourish as IM residents shun primary care," (Article, May 16): Your article reports that the reasons residents are not choosing primary care are low prestige, low reimbursement and low-end personal lifestyle.

But after 30 years in primary care, I can say that the biggest deterrent for me, if I had to do it all over again, would be the excessive and onerous administrative hassles imposed by HMOs.

If the administrative hassle could be eliminated, not only would primary care doctors be relieved of unnecessary emotional strain, but the money saved by needing less office staff would immediately increase their incomes.

For most physicians, these two factors -- less hassle and less office overhead -- would make up for any differential in reimbursement and prestige compared with other specialties.

Also, if primary care physicians use hospitalists, they can manage a more controlled lifestyle. Although there is a trade-off in loss of income when delegating hospital patients to hospitalists, many primary care docs feel that the increase in personal time is worth it.

This is the best way of "re-igniting" interest in primary care.

--Edward J. Volpintesta, MD, Bethel, Conn.

Low pay, high expenses, 4th-class status plague primary care

Regarding "Subspecialties flourish as IM residents shun primary care" (Article, May 16): As a general internist, I can tell you why the numbers are decreasing for primary care.

First: Declining reimbursement. When physician assistants, nurse practitioners, CT scan technicians and nuclear medicine technicians make more money than those in primary care, there is something wrong with the system.

Second: We are treated like fourth-class citizens by the specialists, insurance companies and the patients we try to help.

Third: Increasing costs of doing business, particularly the increase in liability premiums. (It's great. We testify against each other, and for what -- money.)

Fourth: Endless paperwork, most of which is unreimbursable.

Fix all this and they will come.

--Brent Layton, MD, Claypool, Ariz.