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    Viewpoint: Argument does not hold up

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    Argument does not hold up

    In the article "War or détente?" (by Scott Baltic, September 25 issue), American College of Physicians board member Charles Cutler, MD, FACP, comments on the discrepancy of reimbursement rates between primary care physicians (PCPs) and specialists who perform the same procedure.

    He states that if different reimbursement rates are based on the type of physician performing the procedure, rather than where the procedure is done, he doesn't see an inherent problem with higher specialist reimbursement, given the lengthier residencies specialists usually undergo.

    Sorry, but that argument does not hold water. If Cutler's assertion is true, then why is it that midlevel providers, who have less than half the training of PCPs, are reimbursed exactly the same as PCPs for the same procedure? In my opinion, a punch biopsy on a rash done by me should not be reimbursed at less than half the rate as the same procedure performed by a dermatologist. Same is true for a sigmoidoscopy done by me versus a gastroenterologist.

    I appreciate Dr. Cutler's opinion, but as a member of the American College of Physicians Board of Regents, he should be advocating to help lower runaway health care costs; his assertion only adds to the costs.

    JOSEPH E. BADOLATO, DO
    Vancouver, WA

    No solution for government rules

    In his timely and truthful essay, "How much can you endure?" (From the Group Editor, September 10 issue), Daniel Verdon discusses the great burden imposed on physicians by government red tape.

    Clearly, government regulations and rules have intruded so deeply into medical practice and are so time-consuming and demanding that they dominate the mind-set of physicians to the degree that they have displaced physicians' integrity and professionalism. A few years ago, I spent several hours re-credentialing for Medicare even though I had been seeing Medicare patients for over 35 years.

    To survive, physicians must be as concerned about complying with regulations as they are about staying abreast of medical advances. If a physician is a member of a large group or employed by a hospital, complying with some of the regulations and coding may be made simpler because of the large pool of business staff available. But physicians in solo or small practices are definitely at a disadvantage.

    For all physicians, over-regulation leads to dissatisfaction and loss of joy in the workplace, be it the doctor's office or the hospital or the nursing home. And it is not only physicians who are affected. Every member of the health team experiences some degree of burnout. Nurses, receptionists, and ward clerks are all affected.

    I don't think there is a solution. Medicine has become too costly to eliminate the constraints imposed by insurers.

    All physicians are enduring the pressures put on them by government and private insurers. But primary care physicians (PCPs) are particularly affected because their coordinating role gets ever-larger, making it very difficult for them to be effective hands-on physicians in the ideal image that most medical students had while in medical school.

    The PCPs of the future will be hybrids. They will be trained in about 5 or 6 years instead of the current training period of 11 years. Moreover, they will expect to play a different professional role that is more of a coordinating/administrative role and they will be less involved with direct care. They will have accepted that their incomes will be much lower, compared with specialists, than they are now. This transformation will take place slowly over time. Although the idea may seem far-fetched, after a decade or two it will be commonplace.

    EDWARD J. VOLPINTESTA, MD
    Bethel, Connecticut

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