The practice of medicine: Changes are evident -- From med school training and technology to concierge medicine

Download PDF Copy

May 5 2010

News outlets report on issues affecting physician practices:

Kaiser Health News, in partnership with The New York Times, explores what medical students are taught about health care costs: "Doctors in training have traditionally been insulated from information about the cost of the tests and treatments they order for patients — in fact, for decades, the subject was virtually taboo when professors and trainees discussed treatment decisions during hospital rounds. ... Until recently, most schools included little information on financial factors, like how the insurance system works and how treatment costs affect patients' behavior. As a result, most physicians enter practice with little sense of how to make the most cost-effective choices for patients, or how their own decisions affect the patient's — and the nation's — medical bills. … But escalating costs and the national debate over the health care overhaul are forcing medical schools and residency programs to grapple with teaching about the financial side of their profession. Accrediting organizations now require such teaching, and students and residents recognize that they need to understand finances as well as blood tests" (Okie, 5/3).

KHN/The New York Times, in a related story: "Health policy experts hope that technology will become a tool for educating doctors about the cost of care. More widespread use of electronic medical records, they say, will help keep costs in check by providing doctors with precise information on the price of tests and drugs even as they are deciding what to order" (Okie, 5/3).

The Washington Post, on how the new health law might change physician practices: "Fifty years from now, it is likely that almost all doctors will be members of teams that include case managers, social workers, dietitians, telephone counselors, data crunchers, guideline instructors, performance evaluators and external reviewers. They will be parts of organizations (which either employ them or contract with them) that are responsible for patients in and out of the hospital, in sickness and in health, over decades." Records will be electronic. "Software will gently remind them what to consider as they treat, and try to prevent, diseases. How the patients fare will be measured and publicized, and used in part to judge practitioners' performance." In addition, the health care law will likely shift the focus of medicine to primary care, and physicians will be better coordinated, and readmissions could be reduced (Brown, 5/4).

AZCentral.com, on the physician shortage and the new health law: "After Massachusetts started rolling out its 2006 law to ensure that nearly every one of its residents had health insurance, the sudden influx of newly insured patients created long waits to see primary care doctors. Now, physicians worry the entire country could see the same thing happen when the recently passed health care law takes full effect in 2014" (Vock, 5/3).

The St. Petersburg Times, on concierge medical practices: The concept is "expanding to a middle class market, as more patients worry about access to health care and doctors look for alternatives to the bureaucratic hassles of private practice. Some concierge doctors accept only cash. Others accept insurance, but charge patients a membership fee. That allows them to limit the number of patients they see at a time when primary care doctors routinely have thousands of patients on their books in order to make ends meet. The American Academy of Private Physicians estimates that 3,500 U.S. doctors practice some form of concierge medicine" (Stein, 5/4).

Meanwhile, dentists "are warning they may become unintended targets of legislation designed to overhaul Wall Street," The Hill reports. "Lawmakers and lobbyists have clashed for more than a year over whether a new consumer financial protection office would cover industries and companies that had nothing to do with the financial crisis of 2008. … Dentists could fall under the Senate financial bill because they often allow patients to pay in installments, [Michael] Graham [managing director of government affairs at the American Dental Association] said. According to a 2009 ADA survey, roughly half of dentists offer this type of billing for three or four months" (Brush, 5/3).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.