Letters to the Editor - Sept. 26, 2005

Focus on Medicare payment reform, not pay-for-performance proposal - Stop name-calling against lawyers - To make up for resident hours curb, extend length of training

Focus on Medicare payment reform, not pay-for-performance proposal

Regarding "Panel sets primary care standards for Medicare pay-for-performance" (Article, Sept. 5): Pay-for-performance versus a fix of the Medicare system (with its fatally flawed SGR conversion). Hmmmm. That one's a no-brainer.

Let's remember back to when Medicare started. Our own past president, Edward Annis, MD, sat at the table and fought nobly for all physicians. In the end, we were force-fed Medicare, which has become the government-run agency that we were promised it would not become.

Recently Medicare reimbursement has declined to the point that many physicians seek out other financial opportunities outside of the practice of medicine, leaving patients few seasoned physicians.

For the 2% swing that pay-for-performance is reporting, I place all of my chips on fixing the Medicare system and the way by which physicians are reimbursed.

Pay-for-performance should be placed behind the Medicare repairs and not supersede them. If we, as members of the AMA, allow this to happen, then we are all going to be worse off than we are now. Fight for Medicare reimbursement reform now.

--Corey L Howard, MD, Naples, Fla.

Stop name-calling against lawyers

Regarding "Finding the way back to the heart and soul of medicine" (Column, July 18): As a long-time member of the AMA and an attorney as well as a physician, I am writing to question the strange analogy noted in the body of the commentary written by the new AMA President, J. Edward Hill, MD.

Dr. Hill discusses the need for a compass when lost in the swamps of Mississippi (or in the practice of medicine) and speaks of the "spiders, rodents, alligators and snakes that too often plague medicine, such as a number of personal injury attorneys."

It is such inflammatory language that continues to deepen the gap between the two learned professions of medicine and law and, in my opinion, sets a terrible example for the members of the AMA, who will be led by Dr. Hill for the next year. We need healing, not more name-calling.

--Andrew Newman, MD, Huntingdon Valley, Pa.

To make up for resident hours curb, extend length of training

Regarding "The 80-hour experience: What happens when residents have to leave" (Article, July 25): I wish you had reported interviews with a few very old educators such as me.

The deficiency in exposure to sufficient patient-based learning, which has been caused by curtailing learning time, can, and should, soon be compensated by extending the required years of training. The failure to teach linear patient responsibility and the entrenchment of the concept that doctoring should be easy is a mortal blow to our profession.

--Bradley E. Smith, MD, Nashville, Tenn.