I have a question regarding “A Multiple-Service Rule for E/M Services” [Opinion, June 2008] by Nancy Ness, MD: When can we start?

Dr. Ness' brilliant idea addresses many of the questions and problems associated with the great inequity in medical reimbursement in one fell swoop.

Why do we allow gross underrepresentation of primary care specialties on the committee that determines relative value units? Why are multiple procedures reimbursed while multiple problems are not? Why are procedures reimbursed at a much higher rate than cognitive work? Why are cardiologists, ENTs, etc., paid three to five times more than we are? Why are medical students abandoning primary care and going into higher-paying specialities? Why is there projected to be a massive shortage of primary care physicians to care for our elderly?

The AAFP needs to champion this idea with all its might.

I have just one word for Dr. Ness' article … brilliant!