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But it’s not to enhance quality. There are very good NPs and PAs, don’t get me wrong. But the training of a physician, four years of medical school, residency, all the boards you have to take—that doesn’t compare to the training of an NP or PA. (Matt, family physician) A Typical Workday in Primary Care 39 Internal-medicine practices participating in the study appeared to use NPs and PAs the most in their daily work, with pediatricians employing them to a much lesser extent. The typical arrangement involved a ratio of perhaps one nonphysician clinician for every two or three PCPs in a given practice.

If patients have multiple issues, which many do, often the PCP cannot bill for treating both diagnoses in the same encounter but instead must bring the patient back for separate visits to address each of the issues in a way that provides adequate reimbursement. This emphasis on both speed and numbers raises tensions in the practice of today’s primary care medicine; tensions that never existed for the generalist of 1970. For example, as greater numbers of patients with behavioral health issues present in the PCP’s office, and the PCP’s reimbursement system is not set up to pay them adequately for this type of care, PCPs have four suboptimal 18 Practice Under Pressure choices before them: either attempt to provide appropriate care by spending time with the patient, thereby sacrificing other office visits and earning less money for the practice; attempt to provide more complex behavioral medicine within the confines of fifteen- or twenty-minute visits that may produce lowquality care; offer “quick-and-dirty” prescription therapies to patients; or refer patients to behavioral health specialists who are in short supply causing delays of weeks or months before they are seen.

Organization of the Book and the Physician Sample This book is organized into two major sections. The first section describes the current everyday primary care work setting and how PCPs think and act within that setting. Through the eyes of PCPs, it tells the story of how primary care has changed over the past couple of decades and how PCPs have processed and adapted to the changes. A key point supported by these findings is that PCPs have acted strategically to align their thinking and behavior to the current business model in which they practice.

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Blackwell Science Handbook Of Mri Technique


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