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Clinicians and Costs

Among those responding to "The Family Doctor: A Remedy for Health-Care Costs?" (In Depth, July 6) were a number of fed-up physicians. Many blame insurers, malpractice premiums, and demanding patients for medicine's high price. But study after study shows doctors overtreat, because they're paid by the number of services they render. The answer, say "medical home" advocates: Having primary-care doctors oversee all of a patient's needs. —Catherine Arnst

Good doctors aren't necessarily good managers—they need to learn how to work smarter, not harder. The government should establish SBA-type programs that help family doctors identify ways to increase efficiency.

Screen name: Allen

I own an independent primary- and urgent-care practice in a small town in the Ozarks. Like many primary-care physicians, I plan to quit medicine within the next two years. Here's why:

• The only way I can earn as much as a schoolteacher is to cram so many patients into every day that I'm perpetually exhausted, and my patients are often angry and irritated because of long waits and short visits.

• My staff and I waste enormous amounts of time being jerked around by insurance companies, Medicare, and Medicaid, all of which seem dedicated to using any pretext to avoid paying.

• For every minute I spend taking care of my patients, I spend approximately another minute of clerical drudgery trying to find the right combination of "diagnosis codes," "billing codes," and documentation.

• I have no control over what I can charge for my services. The only way I can attract patients is to be "in network" with the major insurers, Medicare, and Medicaid, all of which forbid "balance billing" [for the difference between what an insurer pays and what a provider charges]. This is de facto price-fixing, pure and simple.

Daniel Jones, M.D.


As a physician, I applaud the stamina and professionalism of Dr. Peter Anderson of Newport News, Va., the "medical home" practitioner profiled in your article. But his practice has been changed into a well-meaning assembly line. About 95% or more of what primary-care practitioners need to know to make an accurate diagnosis is obtained in face-to-face history-taking. In Dr. Anderson's practice, that task is given to nurses. I'm not implying that nurses can't take a thorough history. But clinicians will lose their history-taking skills if these skills are not used and honed regularly.

Steven Reznick, M.D.


Why President Obama Needs to Act Fast

I understand the Welches' concern that President Obama's fast decisions might involve inadequate consideration ("Not So Fast, Mr. President," The WelchWay, July 6). But there are reasons for the President to act quickly, including the artificial 100-day "report card," the Presidency's short term (being eroded by backward-creeping election campaigns), and the urgency of the problems that he inherited.

Mahmoud Abdelaty


The AMA: Committed to Universal Coverage

Contrary to the impression given by "Bitter Medicine for the AMA" (New Business, June 29), the physicians of the AMA gave President Obama a standing ovation when he spoke to them in mid-June.

There should be no doubt about the AMA's commitment to passing reform to give all Americans affordable, high-quality health coverage this year.

We have invested more than $15 million in our Voice for the Uninsured campaign to call attention to the plight of the uninsured and to lay the groundwork for health reform that would cover all Americans.

We will stay the course until reform is passed and physicians can focus on what they do best: caring for patients.

J. James Rohack, M.D.


American Medical Assn.


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