letters

Do you think we need primary care?

The Opinion piece "Do We Need Primary Care?" by Douglas Iliff, MD [June 2007], generated a significant number of responses, many of them lengthy. Below are excerpts from selected letters.
- FPM

Thank you for Dr. Iliff's editorial. In the last six months in our community, five primary care physicians have called it quits. Some have gone into hospital medicine, some have gone into the more controlled atmosphere of nursing home medicine, some have gone into the fringe of nutritional medicine and one will simply be driving a truck cross-country commercially. The rest of us are running as fast as we can. We cannot accept any more patients. The medical students from the local university have decided on careers out of primary care. They are not as blind as we were entering practice.

Peter J. Gates, MD
New London, Conn.

Family doctors need to be able to unify as a group and tell payers to take a hike, but it is illegal to do this and legislators are not about to let this change. Doctors are only allowed to write letters while payers have access to lawmakers. It doesn't take a rocket scientist to see how this scenario is going to end.

Douglas Morrell, MD
Rushville, Ind.

Dr. Iliff has wonderfully articulated the frustration - if not despair - that I and others have lived with for decades. He is clearly a very worthy advocate. Dr. Iliff writes with an attitude that I hope will be generalized among family physicians: informed, strong, articulate and courageous.

L.F. Braden, MD
Camden, Ark.

Remarkable. Dr. Iliff has clearly earned the right to talk about primary care. Capitalism abhors a vacuum at least as much as nature, and the gap between the supply of primary care physicians and the demand for primary care will increasingly be filled by those unencumbered by knowledge or experience. They will, however, be skilled at self-marketing.

Bruce Kiessling, MD
Anchorage, Alaska

The huddle agenda

I read "Huddles: Improve Office Efficiency in Mere Minutes" [June 2007] with great interest, and I commend Elizabeth E. Stewart, PhD, and Barbara C. Johnson, PhD, on the simple tips they offered to make huddles an effective practice management tool. I would add that the discussion of patients with special needs should be an integral and important part of the huddle agenda. Because of improved life expectancies, we see growing numbers of patients with disabilities in our practices. Taking a few minutes to anticipate and address any special needs these patients may have will improve both patient and physician satisfaction with their visits. For example, you may determine that Mrs. Jones needs to be seen in the wheelchair-accessible exam room or that Mr. Smith needs to be taken to an exam room immediately upon arrival because he gets agitated in the waiting area. In addition, orders for medical supplies and equipment can be discussed and signed off on by the physician. Huddles can be of great assistance in our efforts to improve our care of patients with special needs.

Sweety Jain, MD
Allentown, Pa.

Grade your payers

I applaud your efforts to survey AAFP members regarding their interactions with insurance companies in "A Report Card for 32 Payers: Not Making the Grade" [June 2007]. I left private practice after 16 years and began working in an academic setting primarily because of these frustrations.

FPM is critical in keeping our primary care workforce on the front lines of health care. Until our nation recognizes the efforts of our family physicians, general internists and pediatricians, and pays them fairly, we will be at risk of losing a vital component of our health care team. And of course, we all understand what is lost when health care is fragmented and medical homes cease to exist.

Keep up the good work, and keep the pressure on the insurers to do the right thing. It's time we all get a little militant and transfer some of the pressure from us to the third parties!

Fred C. Beck, MD
Jacksonville, Fla.