To 2020 President’s message by Dr. Douglas DeLong delivered a reassuring and optimistic note regarding the future of general internal medicine, a primary care specialty that has struggled over the past decade with fewer and fewer residents choosing to join its ranks. The data shows that since 2011, the percentage of trained physicians in the US who have been assigned to primary care positions has decreased.
Many factors are responsible for this decline. One of the main factors has been the gap between the compensation of cognitive specialties such as general internal medicine and procedural specialties. From 2008 to 2017, specialist compensation increased by a weighted mean (SD) of 0.6% (1.2%) per year, from $ 378,600 to $ 399,300, while primary care compensation increased by 1.6% (2 , 2%) per year, from $ 214,100 to $ 247,300. The specialist “premium” decreased during this period, from $ 164,500 in 2008 to $ 152,000 in 2017, or from 77% to 61%. Even with this decrease, the gap is still substantial and shocking considering the done that the average trained physician in the US, regardless of their chosen specialty, ultimately pays between $ 365,000 and $ 440,000 for their education loans.
The high cost of administrative tasks
The increasing administrative burden that has affected physicians throughout the U.S. healthcare system has disproportionately affected primary care physicians who reportedly They dedicate more than 17% of their time to the necessary administrative tasks. This has been another important factor that has kept young people in training away from primary care specialties. These burdens have affected primary care specialties, including general internal medicine, due to reliance on electronic health record workflows heavily impacted by regulatory requirements. During the height of the opioid epidemic, there was also a heavy burden for primary care physicians to take on the identification and treatment of patients with opioid use disorders with little training and preparation.
Despite these negative forces, Dr. DeLong has an optimistic note about the future of general internal medicine. His optimism is based on several recent trends, including the significant increase in valuation of the assessment and management codes most frequently used by internists, the 2021 changes to billing rules that allow primary care physicians to count. and bill for the total time on the date. of the encounter that may or may not include counseling and care coordination. Eligible time includes both face-to-face and non-face-to-face time that the physician spends in person before, during, and after the same day visit. CMS has revised and improved how quality is measured, eliminating dozens of redundant and outdated quality measures with a projected savings of $ 128 million and an anticipated reduction of 3.3 million load hours through 2020. According to CMS, the Patients with paperwork The initiative is projected to save the medical community $ 6.6 billion and 42 million load hours through 2021. CMS has also created a Cargo Reduction Office, charged with incorporating this culture throughout CMS and all of its programs.
Dr. DeLong calls on general internists to embrace team-based care where general internists lead teams of healthcare professionals all working at the “top of their license” in support of true patient-centered care. in teams. He asks general internists to “reclaim” practice areas that were abandoned by the specialty as its members struggled. It refers to the care of patients with diabetes and congestive heart failure, HIV, and chronic kidney disease who have been referred to specialized care during the last decade. Dr. DeLong says it best at the end of his chairman’s message: “Paying internists according to their value, freeing up internists from data entry, allowing internists to dedicate their care to the most complex patients, and developing and By honing our superpowers, we can ultimately go back to the future and resume the mantle of the ‘doctor’s doctor.’
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