Letters to the Editor - Nov. 20, 2006

Medicare not rewarding physicians for keeping the service growth rate down - In-store clinics' edge: Less waiting - Competition's outcome

Medicare not rewarding physicians for keeping the service growth rate down

Regarding "Physician service growth rate slows, easing Medicare premium increase" (Article, Oct. 9): The physician service growth rate was less than expected. Instead of rewarding physicians for this success, Medicare beneficiaries receive the largesse -- they will pay a lower premium than previously estimated. Once again, doctors get the short shrift. In 2007, hospitals, HMOs and skilled nursing facilities will receive payment increases; only physicians receive a cut in reimbursement. When we will be rewarded fairly? Why are we always asked to swallow the bitter pill?

--Alan C. Weinberg, MD, Fullerton, Calif.

In-store clinics' edge: Less waiting

Regarding "In-store clinics hurt primary care" (Letters, Oct. 2): The condemnation, by G. Michael Summer, MD, of Lewisville, N.C., of in-store clinics (staffed by mid-level providers) has some validity, but here's the reason most people go to these clinics: They are sick or injured now, but can't get an appointment with their primary care physician (or one of their doc's mid-levels) until next Thursday. I work at a walk-in university clinic, and we see many students, faculty and staff who preface their visit with an explanation similar to that.

As a provocative note, it is disturbing to find, during our brief first encounters, that "our patient's doctor" has provided significantly deficient (and far from "primary") care. We're talking basic things, like recommending a patient whose blood pressure is always "borderline" log their blood pressure at home, or discussing with a patient that the discoloration around their neck (acanthosis nigricans) may have serious implications.

If primary care is in trouble, it is not due to predatory outside forces -- it is due to physicians' failure to provide true primary care.

--Iris P. Gonzalez, MD, Topeka, Kan.

Competition's outcome

Regarding "Physician-owned specialty hospitals: Lifting ban will lift quality of care" (Editorial, Oct. 9): I read your editorial with interest. Yes, competition breeds quality. I would like to add "competition does not build character but exposes it."

--V.K. Raju, MD, Morgantown, W.Va.