Doctors worry about need to treat sicker patients
Nearly 33% of primary care doctors report that they are treating sicker patients now than in the past, according to a recent study. Twenty-five percent report concern over the extent of care expected before they refer patients to specialists. Cited as the causes are the pressures of managed care and capitated fees. "The findings merit attention from public and private decision makers," said Robert F. St. Peter, MD, at a recent press conference. St. Peter is principal author of the study and senior medical researcher for the Center for Studying Health System Change, an independent Washington, DC, research organization funded
by the Robert Wood Johnson Foundation of Princeton, NJ.
It is still unclear whether the concern is the result of techniques that managed care plans use to control access to specialists, advances in diagnostic and treatment options, or other factors. According to St. Peter, the results point to the need for providers to monitor access to specialists as a component of quality.
According to the study, which was published in the New England Journal of Medicine,1 24% of the primary care physicians surveyed reported concern that the level of care they are expected to provide to sicker patients without referring them to specialists is greater than it should be. Supporting this finding, 38% of the specialists sampled said the complexity or severity of a patient’s condition was greater than it should be at referral. Changes in
the scope of care in the past two years: none or decreased, 16%; increased, 41%.
Family physicians and general practice physicians were less likely than internists and pediatricians to express concern about the scope of patient care expected of them. St. Peter observes that perhaps something in the training and culture of family practice medicine makes them more comfortable with a broader scope of practice. His recommendations include training and continuing education opportunities for internists and pediatricians, as well as family practitioners to better meet the increased demands.
The findings also strike a brighter note: The majority of primary care doctors reported that the scope of care expected of them was about right, and more than half of the specialists reported that complexity of care at the time of referral was about right.
Reference
1. St. Peter RF, Reed MC, Kemper P, et al. N Engl J Med 1999; 341:1,980-1,985.
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