August 2001 • Volume 7 • Number 8
Get training in all areas
To the editor:
I respectfully disagree with chief resident Paul Lewis, M.D. (June FP Report), who asks why he's obligated to do several months of obstetrics training even though he doesn't plan to practice obstetrics. "My time would be better spent mastering other skill sets that I would more frequently use," he says.
Family medicine is a practice that "specializes" in knowing something about all aspects of the family and the disease process.
As a family medicine residency faculty member for many years, I am amazed that many residents fear that everything they will ever learn, they must learn in these three years, and anything they might not want to do should be excluded. Most of my skill sets were learned after residency. Residency is the basis for all you will learn in the future. Leave out an area and you have no basis to build on, or even refer to, when anything comes to your office that involves that organ system, that set of family experiences.
A much better way to tailor our training would be to offer more "fellowship" opportunities to add to the basics, or perhaps the "diploma" system used in Britain, for further credentialing generalists into their areas of interest, without sacrificing what makes us special: our very generalism.
Rebecca Bingham, M.D.
Anchorage, AlaskaProblem with mandated coverage
To the editor:
I was happy to see that the issue of health care coverage for all is still in the forefront of at least two congressmen (May FP Report). Although I agree with many of the proposals by Reps. McCrery and McDermott, there is a simple reason why "mandated" health coverage in the private sector will not work: money.
Health care reform that provides even the basics of coverage for all is not inexpensive; within the current system, the two major payers are employers and governmental agencies. If you don't have a job, and you've not been able to get on disability, where will you fall within the proposed system? After reading this article, I couldn't but wonder what provisions this plan makes for the unemployed/underemployed.
Under this plan, low-income patients will be forced to choose, again, between health care and other necessities. Doctors will continue to find themselves searching for ways to provide health care to those who can often ill afford it. I, for one, am tired of having to make these choices. It is time for the AAFP to join many other health organizations and lobby for meaningful health care reform. Who else is the best advocate for our patients?
Pamela Cobb, M.D.
Yellow Springs, OhioEditor's note: The May coverage noted that "some mechanism should be established to get funds to people who can't afford to pay for insurance and then wait for the tax credit."
Bipartisan patient protection bill
To the editor:
In this bill's case, nothing is being done for the uninsured in America; in fact, it may create more uninsured. If passed, it will probably hurt many FPs who will have to pay higher premiums for their families (most of us aren't covered by employer plans anyway).
A key component of the bill is making sure patients can bypass FPs and go straight to specialists. How's that for PR for FPs? I will urge my congressmen not to support it.
Bruce Burton, M.D.
Corydon, Ind.To the editor:
Regarding the bill, the AAFP has lobbied for our protection, for "immunity from liability for health plan errors such as denial of treatment." But physicians are not to deny treatment due to lack of insurance coverage. Health plans may deny payment, but their denials are not to affect adversely the delivery of your medical care.
I know quite well that this stance may cause a strain in our personal and corporate character and commitment. However, if we have not faced the question before, I ask us: "Why are we here, in this profession, in this place, at this time?" Our failure to answer that question, or to answer it properly, has and will continue to lead us down the trail of more and more problems, laws, regulations, penalties, professional cephalgia, loss of freedom, poorer patient care, physician dissatisfaction and burnout -- and to a new breed of conformant physicians who expect to practice medicine under close state scrutiny and direction, with its logical police actions.
We have the responsibility to treat the patient -- to simply treat them as we would like to be treated if we were in their situations. Draw your own line in the sand. The rewards are too great to be missed.
Robert Eckert, M.D.
Athens, TexasMedicare drug benefit
To the editor:
To the reader: Write us letters of 200 words or fewer (subject to editing), using the FP Report addresses at the bottom of page 2.
I disagree with Dr. John Parham's suggestion (May FP Report) that a Medicare drug benefit should be scaled by recipients' ability to pay. Medicare is a social contract between those who pay the tax and those who use the services. Those taxed will receive the benefit when eligible. If charged more for benefits, they're less likely to support Medicare.
We should instead support a sound financial basis for Medicare. Currently, surplus taxes are tossed into the General Fund. This money should be invested. Additionally, we should support a level of tax to provide a drug benefit. Lastly, we should cap drug prices for all Medicare benefits. Currently, my patients who are least able to afford full price must pay it, since they cannot afford insurance that protects beneficiaries from high prices.
Charles Nester Jr., M.D.
St. Louis, Mo.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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