Your voice: Physicians need to focus on patient care, not patient reporting

The recent article “Payment Reform: Washington pitches new rules to reimburse doctors” (September 10, 2018), focuses once again on changing medicine from patient care to patient reporting.

I practice in a rural setting where consulting specialists are 45 to 60 minutes away. We take care of injuries, acute and chronic life threatening illnesses and complex patients with four or more diagnoses. To try and charge one payment for most of these complex patients will just exacerbate the tendency that is growing to put up signs “One complaint only.” And why should I study all information about what new drugs should not be used with renal failure, with certain race related blood pressures, with changing drug susceptibility, etc., if I get paid the same for making a referral to the consulting specialist to avoid mistakes and make me more money because I can see more patients. So patients have to travel, miss work, incur additional expense, time away from family, etc.
I have been practicing the specialty of family medicine for 54 years and will retire in December. I know it is all about money. What the proposal for single pay for a routine primary care visit (whatever that is) will accomplish is to encourage new physician students to go into other specialties (yes, Family Medicine is a specialty). 
New laws want to give Nurse Practitioners free hands without supervision. Since their training and ongoing education is not up to Family Medicine standards what does that suggest to you?
Money in medicine is a primary consideration but it cannot be a trump card that takes everything else off the table.  

Joe Baum, MD
Floyd, Va.

Physicians can recapture passion for medicine through political advocacy

In “How physicians can regain their passion for medicine” (September 10, 2018 issue), Ben Levin, MD, gives some practical advice for recapturing the passion that made them choose medicine in the first place. But his ideas for regaining autonomy left out the most important thing of all: the need for political advocacy.

Physicians must unite and protest publicly-with passion and persistence.  That cannot be repeated enough.
Our instincts tell us that it’s the right thing to do.

But the courage to unite and speak up forcefully to defend our professional autonomy are qualities that have has been bred out of most of us in medical school.

Without advocacy his suggestions will only continue and increase our servitude to insurers-and the other forces that are extending their control over the way medicine is practiced.

We cannot let timidity and fear of retaliation hold us back.

The practice of medicine is at stake. More importantly, our souls and our self-esteem are at stake as well.

Edward Volpintesta, MD
Bethel, Conn.