[NPInfo] An answer to the HealthLeaders article. See below.

[Carla Anderson]

Regarding what the author wrote below, I plan to show him he is wrong about the trends.  Maybe "physicians will close up shop, but as an NP, I just "opened" a small micro clinic, or mom and pop shop if you will.  I am getting busier everyday, patients love it, and they do not want commercialized medicine. I can negotiate with payors, on my own thank you very much! And patients are actually asking me if I have gotten paid yet, as they are concerned.  They do not want me to close down.  I forwarded my calls to my cell phone while on conference in Seattle, made 6 appointments while driving back with my appointment book in my lap. Once I get to 4 patients every day, I will then hire some help, but otherwise, the scanning, shredding, letter writing, faxing, phone calls, and of course charting and billing will be up to me! Oh, and I now have several regular housecall patients, that love what I do, and welcome going back to the "old fashioned care"..  And I have calculated, that
 by keeping my overhead low, I only need 7 patients a day, to put me in the black as a single person, to pay both my home mortgage, bills, and office expenses per month.  That will enable me to see patients the way they need to be seen, and have adequate time spent with them, to really listen and care.   Carla/Oregon.
   
  Rick Johnson, for HealthLeaders News, Nov 08, 2007
> 
> Over the past few weeks, I've been on the road at conferences and
 meetings
> talking with healthcare administration and physician leaders. In my
> conversations with these industry experts, I've asked them to
 forecast changes
> that will have the most impact on physicians. Here are five
 predictions for
> the near-future:
> 
> 1. Small practices will perform a disappearing act. We're already
 seeing many
> solo and small physician practices close shop. Many of these join
 large
> multi-specialty groups that can negotiate with payers, gain
 operational
> efficiencies of scale, and better afford capital investments. Simply
 put,
> costs are too high and reimbursement is too low for mom-and-pop
 shops. Expect
> this trend to continue--especially as more experienced doctors look
 to sell
> their practices and fewer emerging physicians look to start their
 own.
> 

  

David Mittman <dmittman at comcast.net> wrote:
  ADVOCACY!

Dear Rick: 
I respectfully want to comment on your recent article entitled, ³Looking
Upstream² that ran November 8th in HealthLeaders.
In reviewing changes that you feel will hit healthcare system over the next
few years, I actually agree with most. One prediction hit me as being
awfully one sided in it¹s view. That was the one titled ³Family Docs Will
Step Aside². While I also agree with what you said about that prediction, I
have to point a few other thoughts out.
I am a PA who graduated my training program in 1975. I have been involved in
medical politics for almost 40 years and have lived through many changes to
our healthcare system. NPs and I might add PAs (whom you omitted) have been
providing high quality primary care for decades. There are about 100,000 in
the primary care specialties and another 80,000 spread over a large number
of other specialties. The fact that we already provide a large portion of
primary care to the citizens of our country is not new. We are not
interested in ³taking over² primary care, just the acknowledgement that both
professions are already providing a considerable share of it. Also that both
professions do bring something to the table regarding the future of medical
care and what we bring, may in fact, help to save primary care. Why? Because
as you pointed out, physicians generally do not want to practice in the
primary care specialties any longer. They are making this decision with
their feet. Many physicians are looking at medicine¹s future and seeing PAs
and NPs as a solution to a number of the inequities seen in today¹s system.
We would ask that the larger organized physician groups start to view us not
as competition, but as colleagues who want and value a relationship with
them where we are given recognition as valuable professionals. We will be
glad to give that recognition and support back. All one has to do is read a
few articles on the retail clinics where organized medicine has made
unprofessional remarks telling patients we will ³miss things² or that we
don¹t ³know our limits². Statements like this show that these groups are not
ready to provide a comprehensive solution to this mess we call primary care
delivery, as they will have to work with and recognize PAs and NPs (as
hundreds of thousands of their members do now), to have these changes
succeed. They should realize statements like those only serve to drive away
the very groups they need to be closer to.
My last point would be to ask why you see the increasing use of NPs and PAs
as a negative? To quote the article, ³I'd be especially interested in any
predictions that are favorable for healthcare. Those are pretty hard to come
by². I think prediction number two is quite positive and am surprised that
as a health leader it appears you do not feel the same.

Sincerely,
Dave Mittman, PA
Secretary 
American College of Clinicians
Natick, MA

> Looking Upstream
>  
> Rick Johnson, for HealthLeaders News, Nov 08, 2007
> 
> Over the past few weeks, I've been on the road at conferences and meetings
> talking with healthcare administration and physician leaders. In my
> conversations with these industry experts, I've asked them to forecast changes
> that will have the most impact on physicians. Here are five predictions for
> the near-future:
> 
> 1. Small practices will perform a disappearing act. We're already seeing many
> solo and small physician practices close shop. Many of these join large
> multi-specialty groups that can negotiate with payers, gain operational
> efficiencies of scale, and better afford capital investments. Simply put,
> costs are too high and reimbursement is too low for mom-and-pop shops. Expect
> this trend to continue--especially as more experienced doctors look to sell
> their practices and fewer emerging physicians look to start their own.
> 
> 2. Family docs will step aside. In the October HealthLeaders magazine, our
> cover story investigated what's often referred to as the "looming physician
> shortage." Many regions are already feeling the impact of this shortage. With
> family physicians taking the biggest reimbursement hit over the years, we're
> seeing fewer new physicians entering primary care. Since the need isn't going
> way, patients are getting care from nurse practitioners--in the office setting
> as well as retail clinics. One chief medical officer told me recently that he
> thinks family physicians will someday be a profession of the past. He said NPs
> are already providing primary care--and in many cases they do it better.
> 
> 3. Hospitals will keep hiring physicians. One development in healthcare that I
> find somewhat surprising is how quickly hospitals have taken to hiring
> physicians. No doubt necessity has required hospitals to break from the
> traditional medical staff model. Hospitalists have proven effective at
> improving quality of care and ED throughput, but now many administrators are
> bringing on orthopedic-, neuro- and cardio-traumatologists. The upside of
> these specialists has been widely reported, but one potential downside is that
> independent physicians have fewer reasons to enter the hospital. While the
> rise of the hospital-based physician might improve coverage, quality,
> efficiency, and the lifestyles of the medical staff, are they also creating
> another barrier between independent docs and the hospital?
> 
> 4. Patients will continue to foot more of the bill. Big employers keep
> grumbling at the high cost of healthcare. And some have been predicting
> alternative coverage models for years. Even if you don't buy into the
> healthcare consumerism movement, the fact is that copays keep climbing. With
> more of their own money as stake, patients are going to become more selective
> and demanding about their healthcare purchases. Not only will medical groups
> need to react to these fickle consumers, but they'll also need good systems in
> place to be sure patients pay their bills. Collecting from third-party payers
> might seem like a chore, but consider the challenge of chasing down individual
> patients.
> 
> 5. Fewer doctors will take Medicare, Medicaid, and charity care. We've heard
> this one a few times, haven't we? It seems like whenever Medicare releases the
> physician fee schedule, the major physician and medical group associations
> warn that docs will stop accepting Medicare patients. Now practices face a
> 10.1 percent payment cut with Medicare's release of the 2008 physician fee
> schedule. Last week at the MGMA conference, I spoke with the association's
> president, Bill Jessee. He talked about how reimbursement declines are
> affecting physicians and how he thinks practices will respond. Doctors today
> have to deal with the high cost of running a practice and lower reimbursement.
> Factor in that many are practicing in large multi-specialty groups and
> hospitals. What you're left with are fewer physicians in the community who can
> afford to care for uninsured and underinsured patients.
> 
> I didn't intend for this list to seem so dismal, but these are the things I've
> heard as I've been on the road the last few weeks. If you have comments,
> questions, or concerns about what my sources are saying, please drop me a note
> and correct me. I'd be especially interested in any predictions that are
> favorable for healthcare. Those are pretty hard to come by.
> 
> 
> Rick Johnson is a senior editor with HealthLeaders Media. He can be reached at
> rjohnson at healthleadersmedia.com.
> 
> 


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Carla R. Anderson, FNP-C
  Healing Presence Family Practice, PC  
  carla_rayne at yahoo.com
  503 819 9726