Letters to the Editor - July 17, 2006

Good care flows from maintaining medicine as a desirable career - Report on better pay in primary care doesn't jibe with practice realities - Protect patient privacy by using a waiting room number system

Good care flows from maintaining medicine as a desirable career

Regarding "Primary care doctors in demand; signing bonuses and higher pay for some" (Article, June 19): As a case example, your article speaks to the benefits of low supply -- the physician "was able to negotiate a package tailored to the way he wanted to practice."

I have read with interest the many articles projecting a physician shortage and the subsequent belief that we need to increase the number of physicians. I must admit that I do not see that such steps would benefit our profession or ultimately our patients.

Historically, we have seen that markets dynamically correct themselves for supply and demand. In the near term, when a service is in short supply, the providers of that service enjoy better working conditions and compensation.

Others then decide to train and provide that service as well. Over time, supply and demand reach a dynamic equilibrium. (Keeping in mind that alternative and substitute supplies may exist, e.g., foreign-trained physicians, PAs, NPs, prescribing pharmacists, etc.)

In the same issue as an article on medical schools expanding enrollment to increase physician supply, the cover article was "Practice climate shows a decade of decline" (Article, May 15), citing an [index based] on "everything from managed care hassles to rising real estate costs."

If the marketplace set by legislators, regulators, insurers and/or consumer demands once again makes medicine a highly attractive profession, the best and the brightest will seek it out, entering an environment where forces allow physicians to provide patients with compassionate, high-quality, efficient medical care.

--Gregory Hess, MD, Plymouth Meeting, Pa.

Report on better pay in primary care doesn't jibe with practice realities

Regarding "Primary care doctors in demand; signing bonuses and higher pay for some" (Article, June 19): Your report indicated predictions for rising physician salaries in primary care. How pray tell, are we in private practice to experience salary increases when we are being told annually to expect reimbursement for physician services to go down? Am I to suddenly get some kind of free bonus from some unforeseen lottery for primary care physicians?

The current physician reimbursement fee schedule guarantees the ongoing and worsening shortage of primary care physicians in the United States.

I am in private practice and cannot work faster or longer to bring about this pie-in-the-sky rosy future of improved salary for my already under-compensated services.

I won't be hiring any new primary care physicians until or unless significant improvement in reimbursement occurs.

Please don't publish such nonsense about improved physician salaries without explaining where this money is going to come from.

--Raymond W. Kordonowy, MD, Fort Myers , Fla.

Protect patient privacy by using a waiting room number system

Regarding "HIPAA compliance is seldom total" (Column, June 5): Patients are frequently called aloud, by name, in physician waiting rooms. This practice does not protect their privacy.

My wife suggests that the patient be given a number to be used for that visit at the time of registration. The number can then be called when the patient is to be seen. The patient's name is used thereafter in the privacy of the examining room. I think this is a simple, cost-effective and positive strategy that the HIPAA folks would like.

--Joseph A.C. Girone, MD, Telford, Pa.