What Primary Care Physicians Want for Christmas


Dear Santa, all we want is some help to do our jobs.

Fam Pract Manag. 2020 Nov-Dec;27(6):52.

Author disclosure: no relevant financial affiliations disclosed.

Exhausted primary care physicians are providing deeply gratifying care, signing volumes of paperwork, mastering a bizarre billing system, and feeling increasingly bitter as our health care system grows in dysfunction while our input isn't sought out or is ignored.

So I offer the following wish list this holiday season.

1. I want to stop completing paperwork that costs me time and money — but helps others get paid. For example, when a patient presents to the emergency department (ED) with a serious fracture, that patient's care may not be covered by insurance unless we in primary care make a referral. We don't need to see the patient. The patient clearly needs orthopedics. But the insurer won't pay orthopedics unless primary care completes the referral paperwork.

The same thing happens with optometry and ophthalmology. Frightened patients rush to the eye doctor. Most of the time, they do need to see the eye doctor. But then they call their primary care physician, and we stop what we're doing to complete paperwork that will protect them from the bill.

2. I want to stop having to repeat myself. For example, anesthesia might ask me to send X, Y, and Z data for a patient who needs surgery. But I already sent the data to the surgeon whose opinion I requested. Is it unreasonable to expect health care professionals to communicate with each other about shared patients so we don't have to repeat ourselves?

3. I want easier coding and billing rules, but I don't want more new codes. One of my pet peeves involves advance care planning. I don't want to nickel-and-dime the system or my patients when I discuss advance directives with them, so I only bill for the service in conjunction with a Medicare wellness exam, which saves patients a deductible. As a thank you for my cost-consciousness, I get to complete the task of making sure the visit is 365 days from the last one, or at least I think that's the rule. I can't keep it all straight. And if the patient dares to want a problem


Dr. Antonucci is a family physician in solo practice in Farmington, Maine.

Author disclosure: no relevant financial affiliations disclosed.


The opinions expressed here do not necessarily represent those of FPM or our publisher, the American Academy of Family Physicians. We encourage you to share your views. Send comments to, or add your comments below.


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