HomeWhat's NewPerspectivesHope for Primary CareLetter from Susan Andrews, MD

Hope for Primary Care

A letter from Susan Andrews, MD
Family Practice Partners - Murfreesboro, TN

Yes, reimbursement is going down while costs are going up. It is getting harder for recent grads to pay off the huge loans they leave med school with. We are having to work smarter and harder to maintain our standard of living - real take home pay is dropping for primary care while pay for our nurses and other staff is going up (up 40% in 3 years in our practice). We do have to spend a lot of money on staff who have to deal with insurance companies to make sure we do get paid what we are due. Few students are choosing to enter primary care for fear they won't be able to pay off their loans and make a living, but communities that have a higher percentage of primary care doctors as opposed to specialists have healthier citizens. The incentives are warped.

The US ranks very low in quality of health of its citizens compared to other first world countries- only 55% of patients are receiving the indicated care according the Rand Group in 2006.

The positives:

Efficiency can be improved:
We implemented an EHR 8 years ago and cut down on staff by 1 1/2 FTEs per MD which has more than paid for the EHR. We have drastically changed processes, getting rid of unnecessary steps- literally and figuratively.

Quality can be improved:
We began working on quality improvement - health maintenance and disease management- in a coordinated way in 2003. At that time, our quality ranked at the 50th percentile of the research group practices. Now it ranks well up in the 90th percentile. Our patients do seem to be healthier now- we hospitalize significantly fewer patients with strokes and myocardial infarctions, fewer patients are going on dialysis, and very few of our patients are developing retinopathy. As part of our quality efforts, and particularly because of participation in TransforMED, we now work as a team.

I no longer see patients in the room by myself with no other help- my contact with the patient is no longer in isolation. My nurses help me by focusing on quality and taking care of keeping them up-to-date with immunizations, mammograms and other tests.

We're also activating the patient and getting them to do some of the work by their own histories. They have access to their charts online and can message the nurse at any time. We can reach them online as well. We are offering group visits which the patients love and which help their overall health.

We can be patient-centered:
I no longer practice medicine encounter to encounter, taking care of the problem the patient presents with. I take care of them in between visits online, plus I use each visit as an opportunity to improve their overall health, addressing any overdue health maintenance or disease management with the help of my nurses. I do take care of my patients how and when they want to be seen as much as I can, whether it is in the office, online, or by phone and letter.

Do I need to get reimbursed for my extra time and effort? Absolutely! The insurance companies tell me I'm among their most efficient doctors and my quality data says my patient are receiving high quality care. It does cost me more to provide this care, so pay me for it.

Do all of my patients need good insurance or coverage? Certainly! It is difficult to work with patients who can't afford to see you, to buy their medications, or to get needed tests done. This is a huge problem.

I love my job. I look forward to working with my staff each day. It is a real pleasure seeing a nurse or MA, a receptionist, or an office manager stretch herself and grow. I treasure my interactions with each and every patient. It is a privilege to be a part of a patient's life story, to be part of his or her family. It is a challenge to continue to improve not just my knowledge, but the processes that help me use that knowledge in a systematic way to help my patients. It is gratifying to know what I'm doing for patients is improving; it is wonderful to get the hugs and thanks from my patients every day.

I am hopeful for the future of our profession- we offer the most efficient and highest quality care in the US. Every medical student should have the opportunity and encouragement to be a family physician. I cannot imagine being anything.

Susan Andrews, MD
Family Practice Partners
Murfreesboro, TN

Visit the Family Practice Partners Web site »