Letters to the Editor - Oct. 8, 2007

Unregulated growth of retail clinics undermines primary care medicine

Regarding "Script for expansion: Increasing control, boosting business" (AMNews, Aug. 27): Your article points out that big pharmacy chains plan to expand to become "one-stop health shops."

As pharmacies expand from medical suppliers to being medical providers, I can't help but wonder about the future of primary care medicine.

Certainly no one can argue that staffing pharmacies with nurse practitioners would be cheaper and possibly more convenient than seeing a physician. However, I wonder if this furthers our primary care crisis.

With growing numbers of uninsured Americans, a shrinking population of existing primary care physicians and fewer medical students entering the field, I can't help but feel that the system needs primary care more than ever. Instead, we seem to be on the threshold of passing the baton to pharmacy chain stores and nurse practitioners.

If we allow primary care to fade away, the U.S. health care system transitions into a procedure-oriented system maintained by a nurse practitioner network. This sad state perhaps is our road of no return, unless something is done quickly.

Unless pharmacy-driven health clinics are regulated more strictly, we will continue to diminish the value of primary care medicine. Let's face it -- primary care physicians cannot compete with lower cost or waived insurance co-payments.

However, the real question yet to be answered has to do with quality of care. Are we ready as a country to have nurse practitioners handle this responsibility?

To me, there is a world of difference between the training and experience of a physician and that of a nurse practitioner. It is truly unbelievable that there seems to be a vacuum of regulatory structure allowing pharmacies, nurses and nurse practitioners to compete with primary care physicians. Indeed, for this to be occurring, leadership seems lacking.

Obvious reasons for this crisis result from reimbursement imbalances. Unless consultant fees are reduced and primary care fees are significantly increased, we will continue to lose our primary care physician base. Unless we stop the unchecked proliferation of pharmacy-driven medical care, patients will see fewer primary care physicians in practice.

If trends continue to disproportionately value a procedure-oriented, consultant subeconomy, physician-driven primary care medicine will ultimately be lost. The tragic irony is that the same economic pressure will ultimately cause the loss of the U.S. health system's best economic value: its primary care physicians.

--Braswell Drue Deen III, MD, Southfield, Mich.

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Sticking with paper records for now

Regarding "EMRs don't guarantee quality care, a review of 50,000 patient records shows" (AMNews, Aug. 13): In this article, Robert Lamberts, MD, of Evans, Ga., commented, "Would you go to a bank that kept all of their records on paper?"

Banks are allowed to pass their costs on to the customer, medical practitioners are not.

I am not surprised about the study findings that the quality is about the same whether we use paper or electronics. In the late '60s I was taught that computers work by the "garbage in-garbage out" law.

In the end, the technique of record-keeping is not as important as the content.

Until computers don't crash, and aren't hackable, and EMR systems are cheap to buy and usable out of the box without hours of lessons, I will stick to my paper records, thank you.

--Ann Ewalt Hamilton, MD, Riverside, Calif.

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