Monitor

Primary care shortage questioned
In response to a recent front-page article in the Boston Globe proclaiming a surplus of primary care physicians and bleak job opportunities for the primary care specialties, Jordan Cohen, MD, president of the Association of American Medical Colleges (AAMC), issued a statement that "nothing could be further from the truth."

The Boston Globe article cited a recent survey of 12,000 residents seeking employment. The article quoted Michael Whitcomb, MD, AAMC senior vice president and a co-author of the study, saying, "What our analyses suggest is that in recent years, there has been no insufficiency in primary care doctors. We were giving people the wrong message."

But Whitcomb's comments do not translate into a surplus of primary care physicians, and according to the AAFP's Directors' Newsletter, the Academy doubts the validity of such interpretations, at least as far as family physicians are concerned. The newsletter quotes AAFP Board Chair Patrick Harr, MD, as saying, "We are unaware of any national trend toward decreasing job opportunities for family physicians. Indeed, the data we are aware of continue to suggest the most limited job opportunities are for physicians with subspecialty training."

The Boston Globe reported that roughly 11 percent of residents going into general internal medicine had not yet landed a job by the time the survey was conducted; another 7 percent were working only part-time or had found work in another specialty. Pediatricians faced similar unemployment rates, while family physicians fared "much better"; the article did not report the specific percentages for family physicians. In the AAMC's response, Whitcomb put the numbers in perspective by adding that overall, primary care graduates are still less likely to experience employment difficulty than subspecialists.

"When faced with counterintuitive information," said Harr, "don't believe it until you read the data." The study is reportedly scheduled for publication in the Journal of the American Medical Association later this year.

Tye L. Shortage of doctors turns into a surplus. Boston Globe. April 13, 1998:A-1.

American Academy of Family Physicians. Academy urges caution in interpreting reports of primary care oversupply. Directors' Newsletter. April 17, 1998.

Medicare slows payment of claims
HCFA has directed Medicare carriers to pay physicians and other providers more slowly in order to save the program money. The agency reports that the volume of claims has increased in recent years while its budget for processing claims has remained nearly flat.

Many carriers have been paying claims daily. But by reducing the number of check runs and by sending multiple checks to providers in single mailings, the agency hopes to cut costs. The move means that some carriers will miss deadlines for paying claims and will have to pay interest on them, but these costs could be offset by the additional interest the government will earn by holding the money longer.

In other cost-cutting moves, HCFA officials have told carriers to mail fewer notices to beneficiaries and to use voice mail more often to answer calls from practices seeking information on the status of payments.

Pear R. Medicare billings face more delays. The New York Times. April 27, 1998:A-1.

Hospitalist group affiliates with ACP
The National Association of Inpatient Physicians (NAIP) has become an affiliate of the American College of Physicians (ACP). The relationship was made official at NAIP's first annual conference, which was held this spring as a pre-session to the ACP annual meeting. NAIP will have its own membership requirements and bylaws, although its budget and policy statements will be subject to approval by ACP. At the spring meeting, NAIP leadership reported that the group has 1,800 names on its mailing list. None had yet paid dues to join the organization.

Despite the affiliation with ACP, the founders of NAIP remain interested in attracting family physicians and pediatricians who practice as hospitalists; physicians needn't be members of ACP to become members of NAIP. NAIP co-founder Winthrop Whitcomb, MD, characterized the hospitalist as a "conductor" who can provide inpatient continuity and help patients and their families navigate inpatient care. He stressed four attributes that hospitalists can bring to the arena: service, availability, focus (or continuity within the hospital system) and comprehensiveness.

Controversy remains about whether the hospitalist movement should eventually evolve into a separate specialty and about what competencies a hospitalist certification exam would address. NAIP co-founder John Nelson, MD, noted that the American Board of Internal Medicine is considering the issue, and he suggested that they might test for efficient use of hospital resources and understanding of hospital systems, including quality improvement and end-of-life care.

NAIP's next business meeting will be held in November.

Proposals simplify electronic claims
The Department of Health and Human Services (HHS) has proposed two rules intended to simplify electronic filing of health insurance claims.

One rule calls for issuing each provider a single identification number to be used with all electronic claim submissions for both public and private insurers. The identification number would remain the same even if a provider changed specialties or moved to a different state.

The other rule would require health plans to accept a standardized format for electronic claims. The proposal also would standardize the formats of other electronic transactions, including payments to providers and authorizations of services and referrals.

HHS estimates that these proposals would save at least $1.5 billion in health care costs over five years. The rules appear in the May 7 Federal Register.

Kaiser-union pact: Nurses to evaluate quality of care
In an agreement between Kaiser Permanente and its Northern California nurses' union, nurses will serve as quality watchdogs at Kaiser's 15 Northern California hospitals. Eighteen registered nurses selected by the union will have the authority to force prompt attention to abuses and oversights in patient care. The agreement is part of a four-year contract that, if approved by union members, would end more than a year of one- and two-day strikes by nurses.

Analysts called the agreement "a striking breakthrough in patient protection and labor-management relations." A mediator involved in the negotiations concluded that "nurses will play a greater role in the design of patient care" and that the agreement would be a model used in negotiations elsewhere in the country.

Kaiser employs 7,500 members of the California Nurses Association in the region and has 2.7 million enrollees in Northern California.

Kilborn PT. Nurses get new role in patient protection. The New York Times. March 26, 1998:A-12.

Copyright © 1998 by the American Academy of Family Physicians.
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