Viewpoints: Readers comment on Medical Economics stories

September 10, 2010

Letters address career contentment, electronic health records, and midlevels.

Contentment with recent article

The article on careers ("Career contentment," [by Michael Hafran, MD, and Jeff Garton], July 9 issue) was really excellent. I am sending a copy to my daughter, who is an internist in a difficult academic situation. I am hopeful that it will help her with some of the stressors she has been struggling with. I am looking forward to part 2 of this topic. (Part 2, "Career contentment: Keeping the feeling alive," was published in the August 6 issue.)

KAMILIA SNYDER, MD
Royal Oak, Michigan

As a busy primary care physician, I strive to make my practice the best I can by utilizing all tools available. The implementation of electronic health records (EHRs) in my practice and the use of physician extenders have allowed my practice to grow significantly.

EHRs have made it easier to grow my practice by eliminating paper charts, which were a major impediment to expanding my practice. Five years ago, before I instituted an EHR, my office was cluttered with charts. I had 3,000 patients at that time and had a difficult time adding new patients. There was no space in our office to file new charts. Also, our office staff was overburdened with filing incoming labs, consults, etc.

Utilizing an EHR, our office staff now works more efficiently, and my practice now has close to 8,000 patients, employing 3 physician extenders (2 PAs and 1 NP). Additionally, the wait time for seeing new patients has been reduced from 1 to 2 months to less than 1 week! On top of that, I feel more in control of my practice than before, with a lower likelihood of overlooking things.

The benefits of employing qualified and experienced physician extenders are numerous and for starters include increased practice revenue along with improved patient care by eliminating an overcrowded schedule. More time can be spent with patients, resulting in the potential for reduced liability, along with improved patient satisfaction. In addition, patients without exception can be accommodated immediately for all sick visits, resulting in a reduction of emergency department referrals. The savings to the healthcare system are tremendous just based on this fact alone!

I have no doubt that most primary care practices could successfully incorporate the use of physician extenders, resulting in improved practice efficiency. Most doctors utilizing this model-especially if midlevel services (with physician oversight) were reimbursed at 100% of the physician fee schedule rather than the 85% coverage from most insurers currently-would realize greater office profitability along with an improved lifestyle while providing cost-effective care to their patients.

FRANK MICHAEL D'ALESSANDRO, MD
Lincoln, Rhode Island

Clarification

The article "Healthcare reform: What it means to you, your patients, and your practice" in the May 21 issue reported that Medicare-covered patients will receive an annual wellness exam without paying a copay or deductible. The article should have made it clear that Medicare's coverage of annual wellness visits at all is also new.