FP Report -- September 1999
Letters
HCFA audits
To the editor:
In response to your article "Idaho FPs Speak Out Against HCFA Audits" (July FP Report): The revelation from Stephen Gleason, D.O., that over 2,000 hours of initial training and 500 hours per year of continuing education is required to learn and keep up with issues related to the Health Care Financing Administration really puts this issue into perspective for me.
Most full-time, 40-hour weeks contract for about 2,080 hours per year. Thus, it takes about a full year to learn about these changes, then one-fourth of a working year to keep up with these changes. If one adds in the requirements of managed care contracts, CME for recertification, etc., it could be concluded that one cannot practice medicine and be adequately trained to do so simultaneously.
ROLF NALEY, M.D.
Irving, TexasUniversal coverage
To the editor:
Was the juxtaposition of "Idaho FPs Speak Out Against HCFA Audits" and "Medical Groups Seek Universal Coverage" in the July FP Report meant to be instructional, or was it an accident? Although many people think that the eventual emergence of a single-party payer is inevitable, I recall that it was thought to be just around the corner when I started to practice in 1974. Must we be so shortsighted as to support something which has at least as much negative as positive?
Physicians are all too willing to relinquish their autonomy, professional status and ability to influence the course of evolution of our health care delivery system when they practically volunteer to become federal employees.
While the AAFP might well have to help its members learn to deal with increasing government involvement in health care, I dislike seeing my society's support of universal coverage.
On a related question, the letter by Richard Gage, M.D., "Drop in Match," while quietly understated, should not be ignored. I, myself, have advised students to avoid primary care.
JAMES CRICHTON, M.D.
Helena, Mont.The reason: money
To the editor:
Regarding the letter from Richard Gage, M.D., in the July FP Report, Dr. Gage came close to (the source of) the problem of expanding competition from nonphysicians -- but he failed to point out why an FP or other provider would employ these folks. MONEY, plain and simple. They're worried about the loss of an office visit. The advanced registered nurse practitioners, certified registered nurse anesthetists and "nurse-wives" are petitioning the states for independent practice privileges because the M.D.s who used them have proved that they can provide services cheaper without the M.D.
One other thing. HMOs and hospitals have been pushing for all of their provider M.D.s to be boarded, theoretically to provide a higher level of quality and expertise to their enrollees. Then why do they allow their providers to hire less-qualified nonphysicians to see patients and make rounds?
JULIAN FIELDS, M.D.
Marianna, Fla.Genetics, spirituality, end-of-life care
To the editor:
I was pleased to see the July FP Report's special section on human genetics and also the articles on spirituality and discussing the patient's faith. These are all areas that I have thought needed more attention, and I'm pleased to see progress in each area.
The quality of FP Report's coverage of end-of-life care, which appeared in the June 1998 issue, and of human genetics has been excellent. Best wishes on AAFP's continued progress in these areas.
WILLIAM REICHEL, M.D.
Timonium, Md.To the editor:
Regarding the issue of "spirituality" (see the July FP Report), several points should be kept in mind. If spirituality is completely subjective, and therefore not "real" except as a figment of the imagination, then physicians may well be justified in paying it little attention. If, on the other hand, spirituality is a manifestation of some aspect of reality, then it (spirituality) has a certain nature, just as all aspects of reality have a certain nature (e.g., a tree has a plant nature, etc.). What is the reality of this nature? Is it solely caused by the matter and energy in the universe, perhaps mediated by human brains?
It is unwise to meddle with things we don't understand, unless we are reasonably sure that the outcome is positive. If we in our profession, both individually and as a group, just blindly recommend or approve of "spirituality" without investigating the nature, claims, and evidence for and against the various brands, we do our patients a disservice. For instance, if the Christian view on these subjects is correct, then other views are incorrect. A wrong choice in that case would have disastrous consequences!
JEREMY KLEIN, M.D.
Louisa, Ky.
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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