Friday, January 1, 2010
From A Practitioner's Perspective: An Interview with Dr. Phillip Duncan
Yesterday Dr. Phillip Duncan, a cardiologist in private practice in Richmond, VA, authored a guest post on how to reform the health care system. I conducted an interview with him to get a better idea of reform from a practitioner's perspective.What is your specialty and current level of practice?
I am a Cardiologist in private practice since 1983. I established my cardiology practice in Richmond, VA in April 1984.
What are a few things you're happy has been addressed in the reform bill (Senate version)? What are a few things that should have been?
The senate reform bill begins to address the problem of uninsured Americans. It restricts some of the most egregious practices of the insurance companies. It begins the journey down a road towards a better allocation of healthcare resources. It does a poor job of dealing with fundamental flaws in our healthcare utilization and delivery.
The ongoing reform is centered on lowering costs. What percentage of your patients are beneficiaries of Medicare vs. private insurance? How has Medicare changed and/or how has it affected your practice in the past 10 years?
As I can see the reform as written is really aimed at bending a cost curve that is unsustainable. The problem is that in order to do this effectively we must change behavior on the part of patients and those delivering care. While the health insurance industry is the main target of these changes, they are not a necessary part of the equation.
In my current practice Medicare is my single biggest payor( They insure ~40% of my patients). It has evolved over the years, but remains the most straightforward payor. With Medicare the rules are the rules. The rules evolve from year to year, but they are the least capricious payor.
Much attention has been paid to the likelihood of an oncoming primary care doctor shortage. I have even written about it myself. Do you believe this will transpire? If so, what effect will patients having less access to primary care have on specialty care?
Much attention has been paid to the likelihood of an oncoming primary care doctor shortage. I have even written about it myself. Do you believe this will transpire? If so, what effect will patients having less access to primary care have on specialty care?
Based on public need and expectations we are looking at a shortage of physicians. As in so many areas we are waiting to react to a healthcare manpower shortage, rather than dealing with it proactively.
Why do think doctors have seemingly shied away from communicating their thoughts on reform to the public?
To the contrary many doctors have shared their voice; others have felt it was futile. The problem is that today you need to have more than a voice you need a platform. If the views you express are not controversial enough to be entertaining then no one hears your views. Please read the letter that I sent to the President, and key leadership officials.
In terms of education, what are your thoughts on how well medical school prepares doctors?
In terms of education, what are your thoughts on how well medical school prepares doctors?
We have to make a decision about what we want doctors to be, so we can tailor medical education to meet the needs of the public.
Underrepresented minorities are still facing barriers to medical school entry. What do you believe these aspiring physicians need to know to succeed?
The reality is not sexy. It begins with discipline, literacy and training at home it continues with a strong elementary education.
For the aspiring physician it is what it is. The process is challenging but doable if you are prepared. Like every other discipline you don’t achieve goals just because you want to.
Do you feel cost is a large deterrent? If so, what can be done to alleviate that?
Do you feel cost is a large deterrent? If so, what can be done to alleviate that?
Cost is a hindrance, but not a deterrent. That being said; the cost of education robs us of tremendous potential in medicine and every other discipline.
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