By George H. Rice, MD (retired)
On physician reimbursement, I think all physicians should be on salary. The salaries could be based on local factors such as the Rockwood Clinic or Group Health, statewide clinics such as the Everett Clinic and national clinics such as Kaiser, Mayo, etc. My friends in those settings seem to be happy with their salaries. I think fee for service is a bit of a joke anyway, the insurance companies are going to pay you their set fee no matter what you charge. Also, setting a salary would do away with unnecessary visits and extra tests.
Electronic records are a must and record banks need to be organized where all of a patient’s information is collected and can be easily tapped into by providers at any time. In other words the medical data on an individual is obtainable almost immediately. All provider visits are recorded, as are pharmaceuticals, lab tests, hospital visits, x-rays, CAT scan, MRIs, etc. The biggest hurdle is communication between the disparate entities and the ability o f a provider to tap into the system when approved by the patient. A wonderful example of how the system would work is the Cancer Northwest network, where no matter what office you visit, they have all your current information readily available. Patients should also be allowed to tap into the record bank so they can be active participants in their own care and can read results or know what tests they have had or vaccinations they have received and when.
The way we provide care needs changing. I think it should be divided by age such as birth to 18, 18 to 65 and 65 to death. The providers of care in those settings would be nurse practitioners/physicians assistants. The initial providers would receive backup by physicians in their respective fields, say pediatricians for birth to 18, internists and gynecologists for 18 to 65 and gerontologists for 65 and older. In addition other specialties would be available for consultations and some special cases such as obstetrics, cancer, heart care, etc. would have independent practices for that special treatment. You notice I have not included family practitioners. I think that is a bit of a misnomer. They should be incorporated into the mix of pediatricians, internists or gerontologists. I think, in today’s advanced medical care it would be extremely hard to be a “jack of all trades.” Many family physicians do not have hospital privileges and do not do obstetrics or surgery today.
As an adjunct, I would add that the medical home would fit into the above setting nicely with four to six nurse practitioners/physician assistants in the home with one or two physician backups. Also, it would work in the rural setting with the home being in the local town and the possibility of home visits a reality.
I think this would meet the need of the baby boomer population that is looming and also would be cheaper way to provide care for all our citizens. I realize we need more gerontologists and that should be the focus of our “new medical school.”
