Primary Care Crisis

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Cover Story - December 2008

 

Tex Med . 2008;104(12):14-24.

By  Crystal Conde
Associate Editor

Children who aspire to become doctors dare to dream big. They long for the day they graduate from medical school, the shiny printing on their diplomas confirming they've been entrusted to care for those most in need.

Enthusiastic and optimistic, Juan Jose Ferreris, MD, FAAP, a San Antonio pediatrician, finished up at The University of Texas Health Science Center at San Antonio in 1994 and threw himself wholeheartedly into caring for children. He's the first person in his family to graduate from college and go on to professional school.

"I was taught that hard work would lead me to become a physician," he said. "I had no expectation other than the system would work and allow me to do what I love."

Forming personal, special relationships with patients is what Dr. Ferreris loves most about being a doctor. But over the course of the decade he's been in practice, he has witnessed a heartbreaking development in primary care: Physicians feel bogged down by increasing pressure to see more patients in less time while providing better quality care.

In the past 10 years, Dr. Ferreris has increased patient volume 40 percent. That's the only way he can cover skyrocketing business costs as reimbursement for preventive care decreases.

He still loves seeing patients but says he wouldn't have chosen pediatrics as a specialty if he'd known how the health care climate would decay for primary care physicians. And he has discouraged his two young children from aspiring to go to medical school.

He's not alone. One of the largest physician surveys ever conducted in the United States shows that 60 percent of physicians wouldn't recommend medicine as a career to young people.

The Physicians' Foundation " Medical Practice in 2008 " [ PDF ] national survey reveals that primary care practice conditions and professional morale are in distress. It paints a grim picture of physicians at the breaking point, disheartened by an eroded patient-physician relationship, government regulation, medical liability concerns, and reimbursement hassles.

To reverse that trend, Dr. Ferreris says government policy on health care must change.

"We really need the public to call their senators and demand a fix to the system," he said. "Patients need to tell their government leaders that the insurance industry is the main driver of costs and that the solution is primary care doctors."

Philip Chen, MD, a Plano family physician in a two-person practice, has been in practice since early 2002. He completed the survey because he wants his voice heard and because he hopes the findings will affect health care policy.

"I thought that if my voice wasn't reflected in the survey then I wouldn't have an opportunity to be part of the solution to what's wrong with primary care today," he said.

Respondents to the Physicians' Foundation survey had an opportunity to write additional comments to illustrate their frustrations with the current state of primary care practice. The responses are anonymous.

One physician wrote: "I have been in practice for 10 years now, the last five as a private solo practice owner. I'm very disheartened and disappointed over the state of the practice of medicine! The combination of low reimbursements, managed care issues, and patient attitudes over the last three years has made the practice of medicine almost unbearable. If not for a son who I'm working to put through college and a house mortgage, I would quit medicine in a heartbeat! I'm beat, tired, and underappreciated. Sometimes I cry myself to sleep, wondering why I got into all this. Am I paying myself this month? Do I have enough to pay this month's debt and lease?"

The Physicians' Foundation hopes to help disillusioned, discouraged physicians by working to improve the practice of medicine. Established in 2004 as part of a settlement in an antiracketeering class action lawsuit between physicians, medical societies, and Aetna, Inc., the Physicians' Foundation commissioned the survey in part to give physicians a voice. The foundation plans to share the survey's findings so that policy makers, employers, insurance companies, and the public will understand physicians' concerns.

The survey also sought to learn whether current practice conditions are eroding physicians' abilities to meet their patients' needs and to learn more about the daily challenges physicians face and what they see as medicine's future. (See " About the Survey .")

The Texas Medical Association's Board of Trustees was first to hear a summary of the Physicians' Foundation survey results at TMA's Fall Conference. Trustee Carolyn Evans, MD, a Plano pediatrician, says the survey's findings aren't shocking.

But she's afraid the depth of feelings the physicians conveyed signals possible depression among some primary care physicians. TMA's Committee on Physician Health and Rehabilitation has resources to aid physicians who struggle with substance abuse, stress, depression, and other conditions that impair judgment and functionality. (See " TMA Helps Physicians in Times of Trouble .")

Walker Ray, MD, Physicians' Foundation vice president and a retired Georgia pediatrician, says low physician morale, dissatisfaction with the current medical practice climate, and a shortage of primary care physicians should fuel physicians to unite in efforts to reform health care policy and improve the landscape. He encourages doctors to work closely with their county, state, and local medical associations; write letters to the editors of local, state, and national publications; and speak to community groups on behalf of the practice of medicine.

"Don't be silent. We still have a chance to be grassroots. Although a lot of these changes will have to come from the top, everyone at the top should pay attention to what's happening on the ground," he said.

 

Primary Care in Short Supply

When asked whether the United States has a shortage of primary care physicians, 75 percent of Texas respondents (78 percent nationally) said yes. Among Texans surveyed, reasons for the shortage ranged from fewer graduates choosing primary care (about 63 percent) to practices closing due to rising cost and declining reimbursement (47 percent) and the aging/growing population (about 42 percent). (See " Reasons for U.S. Physician Shortage .")

A number of national organizations and physician groups have examined the shortage of primary care physicians.

The Institute of Medicine predicts the number of older adults in the country will nearly double between 2005 and 2030. Yet the Annals of Internal Medicine reported in 2004 that "assuming that the economy continues to grow at an annual rate of 2 percent, adjusted for inflation and population … there will be a shortfall of approximately 200,000 physicians, 20 percent of the needed workforce, in the period between 2020 and 2025."

The Journal of the American Medical Association ( JAMA ) looked at the decline in medical students interested in careers in internal medicine and the factors influencing their career choices in its Sept. 10 issue. The Clerkship Directors in Internal Medicine Task Force on Enhancing Student Interest in IM Careers surveyed 1,177 fourth-year medical students at 11 U.S. medical schools in 2007.

Of them, about 23 percent planned careers in internal medicine. But only 2 percent planned to work in general internal medicine. The survey revealed about 19 percent of respondents indicate that their core internal medicine clerkship made a career in general internal medicine seem more attractive, while nearly 49 percent said that it made a career in subspecialty internal medicine more attractive.

Perceptions of internal medicine among student responders showed they think it requires more paperwork and a greater breadth of knowledge, that it has a lower income potential and a less-competitive selection process, and that residents were less satisfied than those in other specialties were.

The JAMA survey concludes that students were more likely to pursue a career in internal medicine if they had more favorable impressions of the patients cared for by internists, the internal medicine practice environment, and internists' lifestyles.

The authors of the JAMA article, "Factors Associated with Medical Students' Career Choices Regarding Internal Medicine," acknowledge a need for internists in primary and subspecialty practice because these physicians care for a large portion of the older chronically ill and medically complex patients. They stress the importance of a national effort to address the low interest in primary care among medical students.

The internal medicine rotation experience at Texas Tech University Health Sciences Center encouraged Natalie Pardue, a third-year medical student and the TMA Medical Student Section reporter, to consider a career in primary care. She likes the variety and the opportunity to get to know patients.

"I enjoy seeing the same people. I like helping to educate them about their health. It feels good to empower someone else," she said.

Among her peers, she says debt from undergraduate and medical school is a primary factor affecting students' choice of specialty.

"Debt gets to be so much that some people do avoid particular areas that they're told aren't as lucrative. It becomes an issue when you start thinking about paying off loans," she said.

According to the Association of American Medical Colleges, the average educational debt incurred by 2007 medical school graduates was $139,517. That's an increase of 6.9 percent over the previous year.

Improved funding of Texas' Physician Education Loan Repayment program is part of TMA's legislative agenda. The program recruits and retains qualified primary care physicians to medically underserved areas of Texas and to certain state agencies. The association will work to increase annual loan repayment amounts to allow more physicians to benefit from the repayment program and to provide an effective recruitment tool for medically underserved communities.

More than 900 primary care physicians have received help through Texas' loan repayment program in the past 10 years. The state currently pays up to $9,000 annually, for a total of $50,000 toward a primary care physicians' educational debt. However, $50,000 covers only about one-third of the average debt accumulated over 11 or more years of education.

Despite the obstacle of debt from medical school, some young people are choosing primary care. For Kristy Anderson, MD, a family physician who is a little more than a year out of residency, the possibility of making a difference in a patient's life, the variability in the patient population, and the ability to do procedures on a daily basis in primary care led her to become a family physician. She is part of a Copperas Cove group practice with six physicians and three physician extenders.

In her short time on the job, she has experienced frustration in trying to get access to specialists for TRICARE and Medicaid patients. TRICARE is the nation's military family health care plan, covering care for active duty service members, National Guard and Reserve members, retirees, their families, survivors, and certain former spouses.

She also sees 31 patients a day, takes five to 10 walk-ins on top of that, and has a hard time making herself available to everyone who needs to be seen.

"We enjoy the daily interaction with the patients. There's still a personal connection," Dr. Anderson said. "What we don't enjoy now is a lot of the bureaucracy of what we have to do to give a referral, see a patient, get reimbursed. That's the frustration: It doesn't feel like you trained this hard to become a physician only to have limitations being placed on you."

The Physicians' Foundation survey reveals that women make up slightly more than 30 percent of all primary care physicians in the United States. Dr. Anderson says she thinks women will continue to be drawn to primary care because it's conducive to building relationships with patients.

"Women look for those bonds. You can foster those easily. Primary care allows you more options for later on if you end up tailoring your practice or if you have a family. Primary care offers more flexibility," she said.

 

Recruiting Key to Increasing Primary Care Ranks

Dr. Anderson says she had no problem being recruited. When the group practice hired her, it had been looking for a family physician for four years. She says the practice is still short two more family physicians.

About 29 percent of Texas physician respondents indicate they're currently recruiting to their practices. Nationally, 35 percent are currently recruiting new physicians, and about 45 percent indicate it's very difficult for them to recruit physicians to their practices. (See " Physicians Find Recruiting New Talent Difficult .")

Texas Tech University Health Sciences Center has proposed an innovative program in an effort to attract more medical students to family medicine and to place those physicians in the health care workforce one year earlier. The university's fast-track program would combine the fourth year of medical school with the first year of residency. (See " 3+3=Family Physicians .")

Another survey developed by the American Academy of Pediatrics (AAP) randomly samples graduates of U.S. pediatric residency programs to gauge residents' training, career choices, and job search experiences.

AAP's "Annual Survey of Graduating Residents 1997-2007" finds the number of male residents choosing primary care declined from a high of 65 percent in 1998 to 27 percent last year. The percentage choosing primary care is greater among female residents, at 48 percent in 2007. But even that is down from 74 percent in 1998.

The pediatrics survey shows that of those who didn't choose primary care, 35 percent selected subspecialty practice, 14 percent selected a hospitalist practice, 6 percent chose an option of primary care and subspecialty practice, and 2 percent indicated they were not entering a clinical practice.

Tim Norbeck, Physicians' Foundation executive director and former executive director of the Connecticut State Medical Society, worries that the uncertain future of physician reimbursement under Medicare may further threaten workforce supply in primary care. The Physicians' Foundation survey reveals that nearly 82 percent of physicians say their practice overhead would have been unsustainable if Medicare payments had been cut 10.6 percent in July as federal officials had planned.

"With a 20-percent Medicare cut looming in 2010, the number of primary care physicians could drastically dwindle," he said. "That's what scares me most about the future of medicine."

 

Access-to-Care Crisis Brewing

Low physician morale, practice viability challenges, and a shortage of primary care doctors create a formula for an access-to-care crisis in the United States.

The Physicians' Foundation survey finds that 78 percent of physicians indicate the practice of medicine has become "less satisfying" over the past five years. Only 5 percent say they now find the practice of medicine "very satisfying."

Art Klawitter, MD, secretary/treasurer of TMA's Board of Trustees and a Needville family physician, says physician morale affects access to physician services and overall quality of care.

"When physicians aren't overburdened with paperwork and reimbursement concerns, they're better able to be engaged with patients, focus on the delivery of care and treatment, and form that special bond with patients," he said.

Third-party payers have contributed to the erosion of the patient-physician relationship, according to Dr. Chen.

"I can work hard for a patient, but if that patient's insurance coverage changes and I don't accept the plan, the patient will go to another doctor. The loyalty that's the basis of the patient-physician relationship is becoming less important than the patient-payer relationship," he said.

The following survey results paint a murky picture for the future of health care:

  • Fifty-three percent of doctors indicate that reimbursement and/or time issues have compelled them to close their practices to some category of patients.
  • More than 33 percent of doctors have closed their practices to Medicaid patients, and 12 percent have closed their practices to Medicare patients.
  • Thirty-six percent say Medicare reimbursement is less than their cost of providing care, and 65 percent say Medicaid reimbursement is less than their cost of providing care.
  • Regarding impediments to the delivery of care in their practices, physicians rate "declining reimbursement" highest, followed by "demands on physician time."

Dr. Ferreris practices in a four-person group that doesn't accept new Medicaid patients or insurance companies that reimburse inadequately for vaccines. The practice also has to send children covered by TRICARE elsewhere for vaccinations because, Dr. Ferreris says, the plan reimburses poorly for them.

Low physician participation in Medicaid has been a thorn in Texas' side for some time. The 2007 Texas Legislature made some progress, however, in improving payment for Medicaid services by approving a 25-percent increase in Medicaid services for children and a 10-percent increase for adult services.

According to TMA's 2008 Physician Survey, physicians who will accept all new Medicaid patients rose from 38 percent to 42 percent since the increase. However, Medicaid still averages only 73 percent of Medicare payments, which do not cover the physician's cost to provide care.

Among medicine's 2009 legislative agenda items, TMA supports establishing equivalent Medicaid payment rates for services for adults and children. The association would like Medicaid to reduce the "hassle factor" to entice more physicians to participate, modernize outdated information technology, and support expanded use of health information technology, such as electronic medical records (EMRs) and e-prescribing.

 

Doctors Plan to Restrict, Alter Practices

Practice restrictions are only part of what primary care physicians are doing to survive in the current landscape. In the next three years, 11 percent of doctors say they plan to retire, 20 percent say they will cut back on the number of patients they see, 10 percent say they will work part-time, 7.5 percent will work as temps, 7 percent will open concierge practices, and 7 percent will close their practices to new patients.

About half will continue to practice as they now do, 13 percent will seek a nonclinical job in health care, and 10 percent will seek a job unrelated to health care. (See " Physicians Plan to Alter Practices in Next One to Three Years .")

If they had the financial means, 45 percent of doctors would retire today. Seventy-six percent said they are either at "full capacity" or "overextended and overworked."

Dr. Ferreris says it's frightening that 20 percent of physicians plan to cut back on the portion of their job they love most - seeing patients.

"It's not that they don't want to see more patients; it's that they can't. It has become such a rat race that they don't feel they can give the level of personalized care they once did. They've lost the love and have become a hamster on a wheel," he said.

Physicians are willing to scale back in an effort to reduce bureaucratic hassles. One Physicians' Foundation survey respondent wrote: "I have opted out of Medicare and accept no insurance but workers' comp. Patients file their own insurance claims. We see anyone willing to pay for services when they are received. I have not yet been able to make a living doing this; hence I also maintain my government day job."

Dr. Ray worries that these restrictions on primary care practice and future alterations will accentuate the current physician shortage. And with health care reform on the agenda for the future of the United States, an influx of newly insured citizens and not enough doctors to care for them could be a recipe for disaster.

He cites the situation in Massachusetts, a state that has universal health care coverage for its residents. The annual Massachusetts Medical Society workforce study confirms that an influx in newly insured patients, combined with an exodus of medical residents, has produced a shortfall in 12 physician specialties in the state. Oncology, neurology, dermatology, emergency medicine, general surgery, orthopedics, psychiatry, urology, vascular surgery, neurosurgery, internal medicine, and family medicine lack an adequate workforce.

The Massachusetts Medical Society survey finds long wait times for new patients. New patients must wait an average of 50 days to see an internal medicine physician and 36 days to see a family physician. Compounding the problem is the fact that about 52 percent of medical residents leave Massachusetts. International medical graduates are filling the void, making up 23 percent of new hires at all teaching hospitals in the state.

 

Physician Shortage Raises Scope-of-Practice Concerns

Scope of practice is another concern brought about by potential health insurance expansion at a time of physician shortage. If primary care physicians aren't able to care for the patient population, physician extenders, such as physician assistants, nurse practitioners, and doctor nurses, may try to fill the gap.

"This has significant implications for all of us who want to be able to see a primary care doctor for illnesses so that physician can figure out what symptoms are indicative of serious illness and which symptoms are not," Dr. Ray said. "Those doctors can make the distinction between the two and help us avoid having to go to an array of specialists for every ache and pain."

He says the entire federation of medicine will have to make the case that physicians should be the ones to diagnose and treat patients, not midlevel practitioners.

To solve the physician supply problem, it's necessary to fix the current dysfunctional medical practice environment to attract and retain primary care physicians. Among the problems that need addressing, he says, are better reimbursement, more autonomy, fewer regulations, and more resources.

The Physicians' Foundation survey shows that physicians are aware other practitioners may replace them, should the shortage magnify. A survey respondent wrote: "Do not think that because there are ancillary practitioners willing to fill the primary care void that they will or can provide the same services as physicians. There are a lot of people who want to be doctors but who do not want to go to medical school."  

Ensuring licensed physicians provide treatment and diagnosis for patients is one of TMA's legislative priorities. The association will support the role of physicians as trusted leaders by thwarting efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners' education, training, and skills in the upcoming legislative session. TMA works to uphold the definition of medical practice, the physician's role as leader of the health care team, and the physician's right to delegate and supervise medical services while remaining responsible for patient care.

 

Texans Satisfied With Tort Climate

In the Physicians' Foundation national survey, liability/defensive medicine pressures ranked second, at 46 percent, among what physicians find most unsatisfying about medical practice. Texas respondents differed in this ranking, with liability/defensive medicine pressures coming in fifth place, at 40 percent considering it most unsatisfying.

The TMA 2008 Liability and Access to Care survey reveals that nearly 85 percent of those surveyed rated Texas' liability climate "excellent" or "good." And more than 90 percent of physicians who have successfully recruited new physicians rated the current liability landscape as "very" or "somewhat" important in their success.

Tort reform has also had an impact on physician licensure. The Texas Medical Board (TMB) licensed a record 3,621 new doctors this fiscal year, up from 3,324 the previous fiscal year. Since 2003, TMB has licensed 14,499 new physicians.

Medical liability rates are down, as well. The Texas Medical Liability Trust, the state's largest medical liability insurance provider, has approved an average 4.7-percent cut in liability insurance rates for its policyholders and a 22.5-percent dividend for physicians renewing their policies, effective Jan. 1. Altogether, since 2003, TMLT will have saved its insured physicians about $380 million.

TMA anticipates tort reform will be under attack in the next legislative session and will fight to protect the cap on noneconomic damages, emergency services protections, and other provisions.

 

Survey Findings Highlight Obstacles

With medical liability becoming less of a concern, Texas respondents rate reimbursement issues (56 percent) highest among what they find most unsatisfying about medical practice. Medicare/Medicaid/government regulations (54.5 percent), managed care issues (about 53 percent), and nonclinical paperwork (44 percent) follow. (See " Texas Physicians' Dissatisfaction With Medical Practice .")

Dr. Ray says physicians often feel powerless against insurance companies because the system is out of balance, the insurance companies having an advantage in contract negotiations. Federal antitrust law further hinders physicians by limiting joint physician activity.

TMA supports federal antitrust reforms to lay the foundation for fair contract negotiations to preserve clinical autonomy and patient interest and to redirect medical decision making to patients and physicians.

Mr. Norbeck recognizes that improving reimbursement would enhance the medical practice environment and help cultivate the medical home concept.

"Primary care physicians and a lot of doctors are feeling the financial pinches of maintaining viable practices. It would help them greatly to fix the reimbursement system in the public and private sectors," he said.

Practice viability seems to be threatened among solo physicians, one of whom wrote: "Solo practice stinks. You have to be in a group to handle insurance companies and lawyers."

Overall, Mr. Norbeck says most of the survey findings don't shock him. But he says he does find it surprising that 42 percent of respondents believe, given alternatives, that a single-payer health care system is now warranted. The number of Texas physicians who advocate a single-payer system is lower, at 37 percent.

Dr. Ferreris says that level of support for a single-payer health care system is unheard of.

"Never have I seen a number so high," he said. "Doctors don't think a single-payer system equates to better quality care. It's that we think things are so bad and the crisis so great that we see it as a last resort. That may be all that keeps us alive in primary care and continuing to see patients."

Also surprising to Mr. Norbeck is the amount of charitable care given by physicians across the nation. Forty percent of doctors indicate they provide $50,000 or more a year in uncompensated care, while an additional 35 percent provide up to $25,000 annually.

"You'd think that because physicians are hurting financially it would be harder to give uncompensated care," he said. "This shows their commitment to provide access to care."

 

Physicians Hope for Improved Medical System

On the other side of the coin, Texas physicians' responses to what they find most satisfying about medical practice correspond to the national perspective. Nationally, nearly 46 percent rated patient relationships most satisfying. The number for Texas physicians is 49 percent.

Forty-four percent of Texas respondents indicate intellectual stimulation is most satisfying, followed by professional/collegial relationships at 22 percent. (See " Texas Physicians Enjoy Patient, Professional Relationships .")

"As primary care physicians, we enjoy having a personal relationship with patients," Dr. Ferreris said. "It's not about the money. We know going into it that primary care pays the least. But it gets hard to form a special bond with patients if you're just running them through like an assembly line."

He worries that his practice can't stay afloat if the primary care climate remains unchanged.

"Where will our 10,000 patients go if our practice folds?" he asked. "We're at a precipice. We're looking into a valley, and the decisions we make now will determine whether we jump off into the darkness. We've been sounding alarms for years, but nothing in the system has changed."

Dr. Chen hopes policy makers will become aware of the survey findings and that physicians and the public will work together to improve the health care system. One of the biggest problems facing medicine today, he says, is the question of what constitutes good medical care.

"If we can define and recognize good medical care, we can implement ways to reward, encourage, and nurture it," he said. "Right now, the system recognizes volume and is market-based. I'm not surprised we're being treated as we are because of how the system is set up."

Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at  Crystal Conde .

 

SIDEBAR

About the Survey

Louis J. Goodman, PhD, CAE, executive vice president and chief executive officer of TMA and Physicians' Foundation president, says the foundation created the "Medical Practice in 2008" survey after determining it needed to focus on addressing doctors' needs.

The foundation awarded more than $20 million in grants in the first two years to 44 nonprofit organizations to enhance patient safety, physician education, efficiency of medical practice, and adoption of health information technology. Yet a review by the Isaacs/Jellinek consulting firm revealed that the grants weren't having a substantial impact, in part because physicians lack the time and resources necessary to adopt change in their practices.

In an effort to affect policy, the foundation determined it would focus on drawing national attention to the current state of the medical practice environment and how future developments in this area can affect patient care.

"Access to care needs to be on the front burner for policy makers, insurers, and politicians. They need to understand that we need more primary care physicians," Dr. Goodman said. "The message needs to be: Do something now, or you won't have a doctor when you need one. The environment needs to change by reducing bureaucratic red tape and payment hassles."

Dr. Goodman received the 2008 Texas Society of Association Executives (TSAE) Distinguished Executive Award. He served as chair of the TSAE Board of Directors in 2003-04.

Each year, TSAE recognizes one executive who reflects outstanding leadership and achievement in association management. In addition to serving TSAE, distinguished executives also contribute to other voluntary membership organizations and participate in civic and community affairs.

Merritt Hawkins & Associates conducted the Physicians' Foundation survey, sent to virtually every actively practicing primary care physician - about 270,000. About 50,000 practicing physicians in non-primary care specialties, selected randomly through a national physician database, received the survey. These encompass general surgeons, cardiologists, orthopedic surgeons, otolaryngologists, and others.

In all, more than 12,000 physicians responded to 48 separate questions, with multiple responses possible on some questions. Of those respondents, some 9,000 practice primary care.

One-quarter of responses came from physicians in New York, California, or Texas. Family physicians have the highest representation among respondents at 27 percent, followed by general internists at more than 20 percent, pediatricians at more than 17 percent, and obstetrician-gynecologists at more than 8 percent. More than 4,000 physicians provided written comments.

Survey results are available on the Physicians' Foundation Web site,  www.physiciansfoundations.org .

Dr. Goodman and the Physicians' Foundation Board of Directors have a commitment to improving the practice landscape for physicians.

"Recognizing a shortage in primary care and taking no action will lead to adverse consequences," Dr. Goodman said. "Current practice conditions are hindering physicians from meeting patients' needs and discouraging bright and talented students from entering the primary care field."

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SIDEBAR

TMA Helps Physicians in Times of Trouble

Because the everyday pressures of maintaining a medical practice can take a toll on many physicians, TMA's Committee on Physician Health and Rehabilitation offers help. Some of the educational course topics focus on identifying and intervening when struggling with chemical dependence, coping with stress, creating balance in life, effectively managing challenging patient encounters, recognizing disruptive behavior in physicians, and monitoring physicians in recovery.

From the TMA Web site,  www.texmed.org , select  CME courses from the menu for more information. Also, physicians can request help for colleagues in trouble by calling the Physician Health and Rehabilitation toll-free 24-hour hotline at (800) 880-1640. 

The committee also offers self-help groups for physicians who are recovering from chemical dependence, access to a drug-screening program, assistance for physicians' family members, information on International Doctors in Alcoholics Anonymous, and an assistance fund to help physicians who can't afford treatment or whose families need help with short-term living expenses while a physician receives treatment.

Resident physicians and medical students can also get help with managing stress and burnout, maintaining professional boundaries, and effectively managing problem patients. The committee has developed literature to assist residency training program directors with identifying, intervening, and monitoring residents who may be impaired.

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Dec 08 CS physician shortage

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Dec 08 CS Recruiting

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Dec 08 CS Physicians Enjoy

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Dec 08 CS Dissatisfaction

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Dec 08 CS alter practices

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