By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer – Mon Mar 29, 3:18 am ET
WASHINGTON – Better beat the crowd and find a doctor.

Primary care physicians already are in short supply in parts of the country, and the landmark health overhaul that will bring them millions more newly insured patients in the next few years promises extra strain.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today’s seek-care-after-you’re-sick culture. To benefit, you’ll need a regular health provider.

Yet recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a field losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

A growing movement to change how primary care is practiced may do more to help with the influx. Instead of the traditional 10-minutes-with-the-doc-style office, a “medical home” would enhance access with a doctor-led team of nurses, physician assistants and disease educators working together; these teams could see more people while giving extra attention to those who need it most.

“A lot of things can be done in the team fashion where you don’t need the patient to see the physician every three months,” says Dr. Sam Jones of Fairfax Family Practice Centers, a large Virginia group of 10 primary care offices outside the nation’s capital that is morphing into this medical home model.

“We think it’s the right thing to do. We were going to do this regardless of what happens with health care reform,” adds Jones. His office, in affiliation with Virginia Commonwealth University, also provides hands-on residency training to beginning doctors in this kind of care.

Only 30 percent of U.S. doctors practice primary care. The government says 65 million people live in areas designated as having a shortage of primary care physicians, places already in need of more than 16,600 additional providers to fill the gaps. Among other steps, the new law provides a 10 percent bonus from Medicare for primary care doctors serving in those areas.

Massachusetts offers a snapshot of how giving more people insurance naturally drives demand. The Massachusetts Medical Society last fall reported just over half of internists and 40 percent of family and general practitioners weren’t accepting new patients, an increase in recent years as the state implemented nearly universal coverage.

Nationally, the big surge for primary care won’t start until 2014, when the bulk of the 32 million uninsured starts coming online.

Sooner will come some catch-up demand, as group health plans and Medicare end co-payments for important preventive care measures such as colon cancer screenings or cholesterol checks. Even the insured increasingly put off such steps as the economy worsened, meaning doctors may see a blip in diagnoses as those people return, says Dr. Lori Heim, president of the American Academy of Family Physicians.

That’s one of the first steps in the new law’s emphasis on wellness care over sickness care, with policies that encourage trying programs like the “patient-centered medical home” that Jones’ practice is putting in place in suburban Virginia.

It’s not easy to switch from the reactive — “George, it’s your first visit to check your diabetes in two years!” — to the proactive approach of getting George in on time.

First Jones’ practice adopted an electronic medical record, to keep patients’ information up to date and help them coordinate necessary specialist visits while decreasing redundancies.

Then came a patient registry so the team can start tracking who needs what testing or follow-up and make sure patients get it on time.

Rolling out next is a custom Web-based service named My Preventive Care that lets the practice’s patients link to their electronic medical record, answer some lifestyle and risk questions, and receive an individually tailored list of wellness steps to consider.

Say Don’s cholesterol test, scheduled after his yearly checkup, came back borderline high. That new lab result will show up, with discussion of diet, exercise and medication options to lower it in light of his other risk factors. He might try some on his own, or call up the doctor — who also gets an electronic copy — for a more in-depth discussion.

“It prevents things from falling through the cracks,” says Dr. Alex Krist, a Fairfax Family Practice physician and VCU associate professor who designed and tested the computer program with a $1.2 million federal grant. In a small study of test-users, preventive services such as cancer screenings and cholesterol checks increased between 3 percent and 12 percent.

Pilot tests of medical homes, through the American Academy of Family Physicians and Medicare, are under way around the country. Initial results suggest they can improve quality, but it’s not clear if they save money.

Primary care can’t do it alone. Broader changes are needed to decrease the financial incentives that spur too much specialist-driven care, says Dr. David Goodman of the Dartmouth Institute for Health Policy and Clinical Practice.

“What we need is not just a medical home, but a medical neighborhood.”

Primary care about to collapse, physicians warn
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By Maggie Fox, Health and Science Correspondent
Mon Jan 30, 1:44 PM ET

WASHINGTON (Reuters) - Primary care — the basic medical care that people get when they visit their doctors for routine physicals and minor problems — could fall apart in the United States without immediate reforms, the American College of Physicians said on Monday.

“Primary care is on the verge of collapse,” said the organization, a professional group which certifies internists, in a statement. “Very few young physicians are going into primary care and those already in practice are under such stress that they are looking for an exit strategy.”

Dropping incomes coupled with difficulties in juggling patients, soaring bills and policies from insurers that encourage rushed office visits all mean that more primary care doctors are retiring than are graduating from medical school, the ACP said in its report.

The group has proposed a solution — calling on federal policymakers to approve new ways of
paying doctors that would put primary care doctors in charge of organizing a patient’s care
and giving patients more responsibility for monitoring their own health and scheduling regular
visits.

U.S. doctors have long complained that reimbursement policies of both Medicare and private
insurers reward a “just-in-time” approach, instead of preventive care that would save moneyand keep patients healthier.

“Medicare will pay tens of thousands of dollars … for a limb amputation on a diabetic patient,
but virtually nothing to the primary care physician for keeping the patient’s diabetes under
control,” said Bob Doherty, senior vice president for the ACP.

The ACP plan called for innovations such as using e-mail to consult on minor and routine
matters, freeing up expensive office visit time for when it is needed. Doctors would be
compensated for an e-mail consultation.

The proposals include incentives for doctors to work more efficiently and to provide better
care, ACP President Dr. C. Anderson Hedberg told a news conference. “ACP proposals
would provide patients with access to care that is coordinated by their own personal
physician,” Hedberg said.

YOUNG DOCTORS AVOIDING PRIMARY CARE
The ACP cited an American Medical Association survey that found 35 percent of all
physicians nationwide are over the age of 55 and will soon retire.

In 2003, only 27 percent of third year internal medicine residents actually planned to practice
internal medicine, the group said, with others planning to go into more lucrative specialty
jobs.

“Primary care physicians — the bedrock of medical care for today and the future — are at the
bottom of the list of all medical specialties in median income compensation,” the ACP said.
The group, which represents 119,000 doctors and medical students in general internal
medicine and subspecialties, joins others that warn the U.S. health care system is untenable.
“If these reforms do not take place, within a few years there will not be enough primary care
physicians to take care of an aging population with increasing incidences of chronic
diseases,” said Dr. Vineet Arora, chair of the College’s Council of Associates.

Dr. Sara Walker, a Missouri physician, said she believed doctors were leaving general
practice because of drops in Medicare reimbursement to doctors.

“A drop in Medicare payments will not only force me to stop taking Medicare patients but
could force me out of business,” agreed Dr. Kevin Lutz, a solo practitioner in Denver.