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Letters |

On Being a Doctor: Leaving Is Not the Answer

Maria Maldonado, MD
[+] Article, Author, and Disclosure Information

From Stamford Hospital, Stamford, Connecticut.

Potential Conflicts of Interest: None disclosed.

Ann Intern Med. 2013;158(11):849-850. doi:10.7326/0003-4819-158-11-201306040-00017
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Keeping Doctors in Primary Care
Posted on June 6, 2013
David L. Keller, MD
Torrance, CA
Conflict of Interest: None Declared

I agree whole-heartedly with the comments of Dr. Maria Maldonado; unfortunately, the situation is getting worse for primary-care physicians. The accountable care organizations (ACO's) will only increase the amount of bureaucratic interference with the doctor-patient relationship. I see clinicians being "promoted" to managerial roles in the ACO's which are forming, enabling them to attend endless meetings rather than care for patients. I overhear physicians in managerial roles discussing how to divide up the windfall of money obtained by the "savings" which, in reality, can only be realized by skimping on or denying care. Physicians working under severe time constraints have been known to develop a "hearing problem" when a patient first mentions a new complaint or symptom at the very end of their appointment. The most affluent patients are being attracted to concierge practices which totally reject all outside meddling, whether by government or private insurers. These physicians can afford to spend the proper amount of time with a patient and provide treatment that our professors in medical school would have approved of. Unfortunately, this solution is not available to all patients or to all physicians. In my view, we need to strip away all of the bureaucratic mandates which create extra work for doctors without improving patient care, starting with submission of "meaningful use" data, Hierarchical Condition Categories and prior authorization for medications, tests and referrals. Then, we might have time to improve actual patient care.

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