The Primary Care Dilemma

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The Primary Care Dilemma

• Dennis Paradis, MPH
• Executive Director, Michigan Osteopathic
  Association

This presentation is available on the Physician
Section of our website www.mi-osteopathic.org
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Survey of Physicians 2005

• Total number of physicians licensed in Michigan
  is 39,159
• 32,414 are doctors of allopathic medicine (MD)
• 6,745 are doctors of osteopathic medicine (DO)

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Employment Status

• 60 percent (23,495) of physicians licensed in
  Michigan are providing patient care services in
  Michigan

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Practice Specialty

• 34 percent of active physicians are primary care
  doctors
• 67 percent of active physicians are specialists
  in an area other than primary care

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Primary Care FTE Projections
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Michigan Primary Care Physician Supply Detailed
Specialty Forecasts, 2005 - 2020
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SCS Primary Care vs. Non-Primary Care
Number of Residents 2000 to 2005
800
600
Primary Care
400
Non-Primary Care
200
0
2000
2001
2002
2003
2004
2005
Primary Care
367.5
318.5
281.5
289.5
261.5
276
Non-Primary Care
499.5
493.5
530.5
593.5
629.5
703
Combined Primary Care/Specialty Residents, e.g.
FM/ER, are Counted as a .5 FTE, all FM IM
Emphasis and Track Interns are Included in these
Numbers as well as MDs who participate in SCS
programs. Traditional interns are not included.
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National MD Experience
Comparison of Primary Care Positions Filled with
U.S. Seniors In March 1996-2006
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• Primary Care The number of medical school
  students choosing to practice internal medicine
  is declining and more needs to be done to
  increase interest, according to the American
  Academy of Family Physicians, the Albany Times
  Union reports. 20 of third-year internal
  medicine residents in the U.S. planned to pursue
  careers in general internal medicine in 2005,
  compared with 54 in 1998, according to a report
  released Monday by the New York chapter of the
  American College of Physicians. To generate
  interest in the field, the report recommends a
  loan-forgiveness program for medical students who
  become primary care physicians grants for
  physicians in primary care practices to fund
  office technology improvements and staff
  training and asking medical schools to make
  practicing internal medicine "a more prestigious
  option for medical students," according to the
  Times Union (Crowley, Albany Times Union,
  1/30).February 2007

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Primary Care is the Backbone of the Health Care
System

• More Primary Care Physicians / 100,000
• Lower Cost
• 2, 3, 4, 5, 6
• Higher Quality
• 7, 8, 9, 10

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What are the Impediments?

• Medical School Debt
• Undervaluation of Cognitive Skills
• Inability to Work Harder

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Primary Care Building Blocks

• Compensation
• Medical Students
• Residency Positions
• Non-Physician Extenders
• Debt Forgiveness
• Practice Transformation

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Effect of RVUs

• Value of procedures increasing faster than volume
  of office visits
• Specialists overrepresented on Relative Value
  Unit Update Committee
• All physicians are penalized for the growth in
  volume
• Private insurers exacerbate the gap because
  specialists negotiate higher reimbursement

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How does Michigans physician reimbursement
compare to inflation? Ten year comparison
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Family Practice Starting Salaries

• Michigan 120,000
• Indiana 130,000 - 160,000
• Pennsylvania 140,000 ( incentive)
• Ohio 140,000 - 145,000

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Primary Care Building Blocks

• Compensation
• Medical Students
• Residency Positions
• Non-Physician Extenders
• Debt Forgiveness
• Practice Transformation

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Issues for the Future

• 1) Survival
• 2a) Practice Transformation
• 2b) Insurance Transformation

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References

• Michigan Department of Community Health 2005
  Survey of Physicians
• Medicare Payment Advisory Commission
• Weiss, LJ, Blustein J. Faithful Patients the
  effect of long-term physician-patient
  relationships on the costs and use of health care
  by older Americans. AM J Public Health
• DeMaeseneer JM, DePrins L, Gosset C, Heyerick J.
  Provider continuity in family medicine does it
  make a difference for total health care costs?
  Ann Fam Med
• Greenfield S, Nelson EC, Subkoff M, Manning W,
  Rogers W, Kravitz RL, et al. Variations in
  resource utilization among medical specialties
  and systems of care. Results from the medical
  outcomes study. JAMA
• Parchman ML, Culler S. Primary care physicians
  and avoidable hospitalizations. J Fam Pract.
• Welch WP, Miller ME, Welch HG, Fisher ES,
  Wennberg JE. Geographic Variation in expenditures
  for physicians services in the United States. N
  Engl J Med
• Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ,
  Lucas FL, Pinder EL. The implications of regional
  variations in Medicare spending. Part 1 the
  content, quality, and acessibility of care. Ann
  Intern Med.
• Fisher ES. Medical care is more always better?
  Editorial. N Engl J Med.
• Baicker K, Chandra A. Medicare spending, the
  physician workforce, and beneficiaries quality
  of care. Health Aff (Millwood)
• Bodenheimer T, Berenson R, Rudolph P. The primary
  care specialty income gap why it matters. Ann
  Intern Med.
• Complied by the Michigan Health Council, March
  2007