Dear Colleagues:
Nearly all physicians experience the financial pressures of providing medical care. Certainly those in private practice know the difficulty of making ends meet, but employed physicians are also feeling the crunch as they are more commonly being reimbursed based on their productivity and “relative value units.” The “old GPs” did everything. They delivered babies, they performed appendectomies and hysterectomies, repaired hernias, and more. As medicine specialized, many primary care physicians dropped these procedures along with simpler things, like skin biopsies, treatment of hemorrhoids, vasectomies, and even incision and drainage of abscesses. It’s time to reconsider acquiring some of these basic skills, if you don’t already have them.
Primary care physicians have many excuses as to why they exclude procedural skills from their practices. They cite liability concerns, start-up costs, and lack of training, among other things. These are lame excuses and don’t justify the loss of benefits that procedures could provide.
When physicians offer procedural skills to patients, they provide a more comprehensive quality of care.
- Performing procedures helps the provider learn more about the disease process.
- Keeping procedures in-house can reduce health care costs.
- People prefer treatment from someone they know and trust.
- Carrying out procedures provides more opportunities to enhance all health care efforts.
Performing procedures in the office and the hospital doesn’t just improve quality of care, decrease costs, improve patient satisfaction and decrease liability; it also increases your financial bottom line.
Too often, primary care physicians do the work of screening problems and are paid a paltry amount for the difficult care of ailments like diabetes, chronic pain, and hypertension while they send patients away for higher paying procedures that take less time and less expertise. Studies have confirmed that physicians providing procedures during their patient care receive a higher financial return. That makes sense—just think about how many patients you have to see to charge out the $600 or more that a 30-minute vasectomy reimburses. Similarly, you can treat the majority of basal cell cancers in less than five minutes using cautery and curettement, with a reimbursement that averages over $250.
Here’s the secret those of us who offer procedures are happiest to share: doing procedures is fun and many of us look forward to performing them!Not only thathere is immediate feedback on the benefits that procedures provide. Patients are thankful and their problems are resolved right there in your office.
Most surgical procedures can be learned after residency training. I learned 90 percent of what I do now after I left the teaching position I held for 12 years. These procedures include no-scalpel, no-needle vasectomy; colonoscopy; sclerotherapy; infrared coagulation of hemorrhoids; most of the aesthetic procedures (Botox, microdermabrasion, intense pulsed light, laser); and more.
Courses are available through many societies and educational organizations, including the National Procedures Institute. I hope you will join me by attending an NPI course!
If you say you can’t, you’ll be correct—you can’t. But, if you say you can, you will also be correct! Not only can you perform procedures, but you can do them well, and with your broad background and expertise, you will give your patients so much more than they would receive if you sent them to other specialists.
Sincerely,
John L. Pfenninger, M.D.
Founder and Senior Consultant, National Procedures Institute
Editor, Pfenninger and Fowler's Procedures for Primary Care
