Hey Monty,

Thanks for the reply and good question...  You wanted my opinion, so here it comes... straight from the head and heart without ideological banter as I know we think so much alike when it comes to cluster headaches...

I'll be the first to admit I don't have all the answers...  I do know that growing a crop of new doctors and increasing the numbers of primary care physicians (PCP)/family doctors, involves a complex equation and nothing can speed up the process... 

11-13 years for a high school graduate and 7-9 years for a college graduate is a reasonable minimum bogey to produce a doctor... 

I know...  I was pre-med working on an undergraduate degree in chemistry going through the U of W in Seattle until I got a flight in a Navy T-34 near the end of my Junior year...  a few weeks before I was scheduled to take the MCAT...

After that, the decision between spending 18 months after graduation in the Aviation Training Command to get my Navy wings so I could fly fighters… and spending 7 to 9 more years of med school, internship/residency and fellowship before being able to hang out my shingle was an easy choice... and it wasn't about the money...  An Ensign's monthly pay in those days was $325 plus $25 hazard/flight pay for the privilege of getting shot off the pointy end of the boat day and night...

There aren't enough PCPs/family doctors or physician's assistants (PA) around now...  There's a very real shortage and it's not getting any better.  If there were any real incentives to keep more around past the age of 50, we might be able to start bridging the shortage gap.

There are a lot of excellent articles addressing the flow of physicians from private family practice…  The following link provides a good coverage on this topic:

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

We need incentives to keep qualified PCPs/family doctors in practice as long as possible and to attract more into this segment of the medical profession... 

Unfortunately, there doesn't appear to be any legislation over the past 15 years or more that provides the incentives for physician to stay in practice or to entice more applicants into the medical profession...  That's not to say they don't exist... if they do, they're not very effective.

Spending $1Billion a year on 16,500 new IRS agents for 10 years isn't the kind of incentive that will attract qualified people into the medical profession either.

You and I can disagree on the direction the administration and congress are taking the country, but I think it's safe to say we can agree that we'd like to see some meaningful medical tort reform...  This wouldn't cost us any new taxes and it could save billions each year...

If we want to demonize an industry that costs us untold wealth, then I think it's time to put some controls on lawyers with meaningful medical tort reform.

Meaningful medical tort reform won't put a dent in the growing deficit, but it will remove some of the negative factors affecting the decision process that qualified people with the desire to enter the medical profession go through...

I've spent 10 of the last 15 years as a professional guinea pig at the National Institutes of Health in Bethesda, MD.  I was a participant in four clinical studies trying to keep my eyes from falling out...   

With labs and exams every month and some times every two weeks for 10 years in a row, I've had the opportunity to spend a good deal of time with some incredibly brilliant physicians...

Every physician I spoke with spent time in private practice, but chose to enter the field of medical research to avoid clinical practice, malpractice insurance and the constant threat of litigation...  Moreover, all commented on the fact that private practice had become a numbers game... 

They had to see 30 to 35 patients a day, sometimes spending as little as 5 to 7 minutes per patient (they had to spend two to three times that on the patient's paperwork) in an attempt to make ends meet... only to have Medicare or Medicaid stiff them with underpayments after waiting as much as two months to see any payment at all.   

The shear bulk of bureaucratic regulations associated with Medicare and HMOs required additional clerical staff each year just to do the mandated paperwork.  One slip in documenting the Healthcare Common Procedure Coding System (HCPCS) entry in a patient's records and Medicare would refuse to cover the medial procedure or it would counter with another HCPCS code that pays a fraction of the actual cost.

For some, the decision to leave private practice and enter medical research was a simple matter of economics, for the majority, it was a better use of their skills, training and expertise so they could do the science and still spend quality time with the few patients they do see.

I spent an average of 30 minutes each month with the same ophthalmologist having my eyes examined and going over the results of the various eye tests I had each visit.  I also spent another 20 minutes each month with the study's Primary Investigator going over my labs and progress in the study...  All of it was quality time and I left each visit at NIH with accurate information on my condition and progress within the study.

Do we really need 16,500 more IRS agents at a cost of $1 Billion dollars a year for the next 10 years?  How is the IRS is going to improve the quality our health care or relieve the shortage of PCPs and PAs? 

Why don't we demand an amendment that scraps the IRS enforcement provision in the present HC bill completely and use funding from the porkulus as an incentive for more qualified students to enter the medical profession with student loans...  that would be paid in full if they entered family practice in designated urban and rural areas for a minimum of 5 years...  The Military Services have done this for years.

A billion dollars would fund 6000 new doctors or a mix of PCPs, PAs and RNs... we need more PAs and RNs too!  Why not take $10 Billion from the porkulus and make it $1 Billion a year for 10 years if the medical schools can handle the load...  now we're talking 60,000 more PCPs, PAs and RNs...

This would work, but it needs come from the top and it must be sincere...  I remember when President Kennedy said we're going to put a man on the moon in 1962...  The education system reacted overnight with a new and genuine emphasis promoting math and science classes to grow the needed engineers and scientists...

The co-pay for office calls on a PCP needs to be increased for all but the most destitute when seeing a PCP...  You can't go to your local Urgent Care facility for less than $100 a visit...

I'm sure there are other potentially effective incentives… but this is a start.

Take care

V/R, Batch