Tuesday, March 6, 2012

A social obligation

Do hospitals have a social obligation to help more patients? This is an interesting concept. Hospitals have '“a social obligation to provide access to care,’’ said Dr. Timothy Ferris of Partners HealthCare, the parent organization of Mass. General and the Brigham.'

In the future doctors will be compensated on the care of the patient and given a budget per patient. If they have a larger patient pool, they create more wiggle room to allow for sicker patients. Patients will also need to have a primary care doctor. But there has been a long term shortage of primary care physicians and existing doctors are very prone to be overworked. It can be impossible to find a doctor accepting new patients. This is a nationwide problem but here in Massachusetts a few hospitals are starting to address the issue.

First of all, they are hiring more nurse practitioners and physician assistants to create teams so a patient can be seen by someone in the group. The doctors do less of the well baby, blood pressure follow ups, and other minor issues and can focus on the sicker patients or more complicated visits. Next, doctors are opening up their practices to allow for new patients but are evaluated not just on the number of patients they have but also on how sick they are. A doctor who has many patients with multiple ailments is credited for that.

If they do accept more patients, they will be paid more by the hospital. The "... hospitals are tying about 10 percent of doctors’ salaries this year to the size of their practice and the complexity of their patients’ illnesses." I think this is a good idea as long as the hospitals support them and follow through with their plans.

I think that doctors have felt overworked and would do one of the few things they could do to prevent more overwork by closing their practice to new patients. That makes sense but then it helped create the shortage of primary care physicians as there were fewer and fewer accepting new patients. There had been a lot of discussion on how to fix this shortage but now I think this is a plan which could work.

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