Physician, cut thy costs - medical providers are considering taking part in the cost cutting battle - includes related information on physician specialization, American College of Physician's reform criteria, and worker's compensation - Cover Story

Business & Health, June, 1991 by M. Mary Conroy

To stem the rising tide of subspecialists, several solutions have been offered, including uniting the fields of family medicine, internal medicine, and pediatrics into one "generic" primary care physician. Another solution, suggested by article co-author Jay Stein, M.D., professor and chairman of the department of medicine at the University of Texas Health Science Center in San Antonio, is to add a fourth year of residency training to the current three-year internal medicine residency program. That fourth year would concentrate on one or two subspecialty areas, such as dermatology or gastroenterology, enabling the internist to handle more complex cases and make fewer referrals to subspecialists.

Currently, the American Medical Association lists 50,201 members in its college of surgeons; the group also counts 22,000 radiologists, 26,353 anesthesiologists, 14,500 orthopedists, and 17,222 cardiologists fellows of the American College of Cardiology).

In the area of more general care, the American Academy of Family Physicians has about 70,000 members, the American College of Physicians (which includes general internists as well as subspecialists) lists 70,000 members, and the American Academy of Pediatrics boasts 41,000 members. Since physicians may belong to more than one organization, the figures should be interpreted accordingly.

If this year's post-medical-school residency matches are any indication, the trend toward specialization will certainly continue in the short term. in general, the higher the percentage of filled residencies, the more popular the specialty. For instance, according to the National Resident Match Program, 97.2 percent of the obstetric residency openings were filled, compared with only 80.6 percent for internal medicine. The United States should have enough specialists to last a long time.

A study appearing in the May 8 Journal of the American Medical Association speculates that by the year 2000 a surplus of practicing physicians will add between $21 billion and $41 billion to the nation's health care costs.

On doctor's fight against managed care

South Miami family physician Pepi Granat, M.D., doesn't like HMOs, IPAs, CMPs, or PPOs. She also doesn't like physicians who organize them or employers who use them. But most of all she doesn't like physicians whose zeal to earn exceeds their zeal to care for their patients at a reasonable cost.

Flying solo

Dr. Granat, a Florida native who has been in solo practice for over 19 years, is dedicated, she says, "to offering the best care for the patient, in the best setting, at the best price." She is also opposed to managed care plans, and becomes incensed when patients tell her that they are leaving her practice because their employers have signed on with a PPO or HMO. Hoping to forestall a loss of patients to what she perceives as inferior care, Dr. Granat takes it upon herself to argue with the employers.

In one such instance, Dr. Granat wrote to the Gator Shoe Corporation of Miami, saying, "There is only one reason for PPO organizations: To assure low cost medical care services. There is one group of physicians who have been giving low cost medical care quality services for many, many years: the family physicians."