[blueash]

Mr. Morse's letter concerned me in two ways.

Firstly he used the term general practitioner to describe the type of doctor they are looking to employ. A GP is a person who has passed medical school thus has an MD or DO and done at least one year of rotating internship. The term is not synonymous with board certified Family practitioner who has done a 3 year residency in Family medicine (program designed to train the doctor in internal medicine (adult only medical care), pediatrics (child only medical care), obstetrics, gynecology, general surgery, and a little ER, hospital care, and psychiatry) Obviously trying to learn all these fields in a 3 year program means that one cannot get as much training as someone who does just one of these fields eg an internist or internal medicine doctor only does the adult medicine and adult hospital care training. A GP in the US has a lower level of training than a FP. You want your primary care doctors to be board certified minimum as FP or internists.



Second he frequently invokes the Mayo name as if the key part of Mayo is that the doctors are salaried. The key part is that they are very highly trained with specialty and sub-specialty experts in the same medical home who share resources and communicate as a team. There is nothing in the Morse letter to suggest that his new system will have anything other than primary care doctors on salary instead of fee for service, FFS. It is true that FFS can encourage excess office visits and in office procedures (beware of doctors with large in office labs and Xrays and cardiac testing and bone density... they have to run enough patients thru to pay for that stuff). You can be sure that you will not have limitless time for your visit. The office managers will know who is seeing fewer patients for the same salary. The practice will still be paid on volume as they are going to be billing the insurance companies based on services provided so for the practice to make money, the goal of all corporations, they will have to see enough patients per hour to make a profit meaning more than the cost of the doctor, nurse, manager, NP, secretary, billing clerk, receptionist in both salary and fringes, and the rent, supplies, insurance, utilities, maintenance etc etc . Don't think there wont be pressure to keep the patients moving. The only difference will be the doctor won't be paid per patient, but will not keep his/her job if working too slowly.