Letters

Coding discrepancies

To the Editor:
I take exception to Dr. Weinman's comments regarding coding and documentation [Letters, January 2002, page 14]. If the current guidelines are so much easier than biochemistry and can be mastered in one to two weeks, as Dr. Weinman claims, then why was there disagreement on six sample cases coded by five "experts" in the study conducted by Dr. King [King MS, Sharp L, Lipsky M. Accuracy of CPT evaluation and management coding by family physicians. J Am Board Fam Pract. 2001;14(3):184-192.]? And why did the coding review panel completely agree only 17 percent of the time in "Test Your Coding Skills" [FPM, February, 2002, page 41]? Unfortunately, when it comes to coding, the only correct answer is that of the auditor.

Jaymi S. Meyers, MD
Seneca, S.C.

Learning from those who've left family practice

To the Editor:
What an interesting letter from Dr. H. Jeffrey Wilkins [November/December 2001, page 12]. He extols leaving his practice due to many reasons - reasons I unfortunately experience daily. It is interesting, though, that just two-and-a-half years ago he lauded the virtues of his successful group practice model that was supposed to be the wave of the future ["Developing a Successful Medical Group," June 1999, page 27]. Even then I was skeptical of any model in which capitation payments went from "5 percent to 50 percent of revenue." Was this group model a failure and, if so, why did it ultimately not work? Perhaps there is more we can learn from Dr. Wilkins' experience.

Cary D. Douglass, MD
Austin, Texas

Author's response:
The sentiments in the letter I wrote in response to the article "Is It Time to Re-examine Family Practice?" [September 2001, page 43] are in sharp contrast to the philosophy our group benefited from in the late 1990s. The group practice model was not a failure. In fact, it is still alive and independent. The model did ultimately contribute to my departure. I found the vision and construction of the group stimulating. It was the bureaucracy of the group that was frustrating. When maintaining the group began to take more energy than fulfilling its mission, I knew something was wrong.

Was going from 5 percent to 50 percent capitation a bad idea? To me, yes. The income per patient was generally very high, but we never got a handle on the overhead. Patients saw all the employees that cluttered my office solely for the benefit of managed care and constantly questioned the increased number of staff.

Meanwhile, managed care changed the attitudes of my patients. Patients cared less about what I had to say about their problems than about where I was going to send them. Was it because they felt they were being rushed? Were they annoyed my automated phone system kept them on hold on a Monday morning? Were they angry because triage nurses counseled them to not come into the office? Did I resent seeing someone who really didn't need to be seen because I would be reimbursed only a $5 co-pay? The answers to these soul-searching questions helped me leave. When I announced I was leaving, the most common comment from colleagues was, "Wow, I've been thinking of leaving as well, but I didn't know what to do."

Rather than asking a group made up of salaried physicians who are shielded from malpractice insurance bills and health insurance premiums and have little visceral feel of a productivity-driven practice to address the problems facing the specialty, the AAFP should be talking to you or members of my group who thought we had a good idea when we got together six years ago. Family practice is drowning in a rough sea filled with sharks in the form of lawyers and health insurance companies. We deserve better. Our patients deserve better as well.

H. Jeffrey Wilkins, MD
Souderton, Pa.

Time to re-examine physician training

To the Editor:
Your article "Is It Time to Re-examine Family Practice?" [September 2001, page 43] interested me. As a recent graduate of a rural track residency program, I think it is time to re-examine the core requirements of family medicine training.

For instance, what percentage of graduates actually practice obstetrics five years after residency? Instead of catching babies for three months - all the while knowing I had no desire to do it after residency - I could have used two of the three months to get more experience performing colposcopies and implanting IUDs. I also question the value of first-assisting surgeons for three months of training. Post-op care is more important and could be mastered in a fraction of the time spent retracting or holding laparoscopic cameras.

Paul Henderson, MD
Hendersonville, N.C.