Consumer Health Features

Primary care doctors strike back at healthcare changes

By April MacIntyre Jan 11, 2013, 8:25 GMT

Primary care doctors strike back at healthcare changes

Dr. Doug Pitman is taking a new path in his medical practice by focusing on "concierge medicine," which will allow him to focus on comprehensive, prevention-based medical care with a group of about 100 patients. Pitman talks with one of his longtime Columbia Falls patients, Jolie Fish, who is among the people who have enrolled in his concierge medical care. Karen Nichols/Daily Inter Lake

Young Americans are dying young, says a new study.

The notion of American exceptionalism is no longer a valid argument, as the U.S. doesn’t do everything better than anyone else in the world. The reality is that for years now, health professionals have known that the superiority of the American healthcare system is a myth – except for the very wealthiest of its citizens.

In fact, there are scores of countries that have better birth mortality and adult longevity rates than the U.S. We also lead in the world per capita in heart disease, diabetes, obesity, arthritis and other chronic illnesses.

But a new study by the Institute of Medicine and the National Research Council – a compendium of the nation’s leading research organizations including the National Academy of Sciences – makes the shocking point that even American’s best and brightest – it's youth – aren’t immune to the uniquely high rates in the U.S. of deaths by firearms, car accidents and narcotic overdose.

In short, Americans live sicker and die younger than people in other wealthy countries – and the gap is getting worse over time.

Gravity Of The Findings

"We were struck by the gravity of these findings," said Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report.  "Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health.  What concerns our panel is why, for decades, we have been slipping behind."
The report is the first comprehensive look at multiple diseases, injuries, and behaviors across the entire life span, comparing the United States with 16 peer nations – affluent democracies that include Australia, Canada, Japan, and many western European countries. 

Among these countries, the U.S. is at or near the bottom in nine key areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.

Disadvantages of Being Young And American

Many of these health conditions disproportionately affect children and adolescents, the report says. Besides among having the highest infant mortality rate of any high-income country, the U.S. also ranks poorly on premature birth and the proportion of children who live to age 5.  U.S. adolescents have higher rates of death from traffic accidents and homicide, the highest rates of teenage pregnancy, and are more likely to acquire sexually transmitted infections. Nearly two-thirds of the difference in life expectancy between males in the U.S. and these other countries can be attributed to deaths before age 50.

"It's a tragedy. Our report found that an equally large, if not larger, disadvantage exists among younger Americans," Woolf said. "I don't think most parents know that, on average, infants, children, and adolescents in the U.S. die younger and have greater rates of illness and injury than youth in other countries."

Now call it irony, coincidence or serendipity, but on the very same day the National Research Council study was released, a major article appeared in CMAJ – the leading Canadian medical journal that is also widely read by medical professionals in the U.S. – about an alternative approach to medicine that U.S physicians were experimenting with that focused on how to treat more effectively many of the chronic illnesses chronicled in the NRC study.

In the article, U.S. physicians who had switched their practice to personalized care, also known as concierge medicine, extolled the virtues of a “back to the future” style of medicine where they actually had the time to get to know not only their patients’ symptoms but the patients themselves and their long-term health goals.

Primary Care Doctors Strike Back

"As the doctor shortage worsens, you see family docs step out and go into concierge medicine," says Dr. Doug Pitman, a family and sports medicine practitioner in Whitefish, Montana, in the heart of ski country five hours south of Calgary, Alberta. "It's the closest thing to a primary doctor strike. We are withdrawing because we can't get paid for what we do, and our patients are going to outlive us because we are killing ourselves to try to keep up."

Pitman switched to concierge medicine in 2009 after family practice left him stressed and bored. "All I was doing was putting out fires." Instead of seeing 25 patients daily, he's limited his practice to 100 patients overall. He charges each $1,900 for a year's services. Married couples get a discount ($3,400), while snowbirds who are gone for the winter pay $1,300 apiece or $2,500 per couple.

Dr. Floyd Russak, an internal and geriatric physician in Denver with a personalized practice, had been seeing 30 to 40 patients a day when he decided to "get off the hamster wheel" in 2010.  He felt he wasn't "doing an exceptionally good job with any of them."

Today, his patients know they get a half hour of his time during a routine visit and round-the-clock access. If they go to the hospital, so does Russak. "For patients that can afford it, it's much better care," he says.

There's no question the care is improved, claims the California-based SignatureMD, a network of concierge practices involving 50 doctors in 14 states which was launched seven years ago. "The goal was to create a more direct relationship between patient and physician, a more direct financial relationship which facilitates better health care," says CEO Matt Jacobson.

Is it elitist?

Not in Jacobson's mind. "Should we send our kids to private school if that's something we value?" he asks. "Some people put value on health care, and want to put investment in health care. We have a democratic society."

Elitist or not, personalized medicine is becoming increasingly popular.

A Congressional advisory committee found that the number of concierge physicians had risen fivefold between 2005 and 2010 to more than 750. Those doctors were serving 100 to 425 patients each, down from more than 2000 they saw while working in a traditional practice. Most were internal medicine specialists or family physicians.


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