The schools — some are new and independent, others are extensions of existing universities — are responding to a very dire need for more physicians due to the aging of the population and the already acute need for clinicians in underserved communities. In fact, several of the schools are billing themselves as “specializing” in training general practitioners and family practice physicians. The hope: Adding many more doctors in those specialties will fill in some of the gaps in access to primary care, and improve overall health care quality.

But skeptics doubt many of these newly-minted docs will end up in family practices, or in rural communities. The reason is the same one that caused the current crisis: Doctors can make more money by specializing and/or working in more affluent metropolitan areas.

What’s your take? Do we need more doctors or more incentives for those already practicing to work in different specialties? Sound off in the comments.

A recent story in the L.A. Times highlighted a model-turned-doctor who closed her family practice to focus on a more profitable niche. The practice now exists almost wholly as a place to get marijuana “recommendations,” which are then filled at local dispensaries. The practice also provides some other services, including Botox and a weight loss program (no word on whether it addresses weight gain from the munchies).

Did we mention the Caribbean-trained doctor in question, Sona Patel, bills herself as “Dr. 420” and uses her old modeling photos in her ads?

To be fair, Dr. Patel says she only recommends marijuana for patients with chronic diseases who have not seen improvement in six months or more under conventional treatment. She also claims to turn away two to five patients a day who don’t have a condition suitable for treatment with marijuana.

She concedes that moving from a traditional family practice to her current roster of services is much more profitable. But she says her main motivation was seeing patients with chronic diseases like diabetes get little to no relief from prescription drugs while often suffering serious side effects.

Regardless of motivation, Dr. Patel has plenty of company as a mostly-pot-based practice — there are several hundred in California alone. And there are an increasing number of claims that some of these practitioners don’t take the maximum care to ensure only patients with serious need get access to a controlled substance that has real street value.

Who watches the watchers?

There isn’t much downside to being a liberal dispenser of marijuana prescriptions. Despite the proliferation of pot dispensaries and marijuana-specialty practices, since 1996, there have been only 81 complaints against “pot docs” according to the Medical Board of California. (Then again, patients abusing the system probably feel too good to complain about much.)

Subsequent investigations of those complaints resulted in disciplinary action against only 10 physicians.

That concerns both folks who think it’s a bad idea to allow medical marijuana use as well as more traditional doctors who believe pot has a place in the pharmacy — when properly supervised.

Should medical marijuana use be more tightly controlled? Or does that simply make a useful pharmaceutical harder to get in the hands of patients who need it? And do practices that play up the recreational aspects of marijuana help remove a stigma, or are they just updated Dr. Feelgoods?

Share your thoughts in the comments.

Roughly 3 billion claims per year are being processed on paper. And 90% of all claims are paid with paper checks.

That’s enough paper to choke any system.

Speaking at the World Health Care Innovation and Technology Congress, Bill Bartzak, the CEO of MD On-Line, said that most of the paper claims are submitted by smaller practices with five or fewer doctors and that converting those users to electronic claims could save up to $11 billion each year.

Of course, converting the die-hards is easier said than done. Even if doctors are interested in making the switch (not a given), the logistics are more difficult for smaller practices.  They have fewer staffers on hand, and some specialties, like family practice, may have very slim budgets to work with.

In his address, Bartzak suggested making digital claims mandatory for providers and insurers. Would that cause more problems than it would fix? Share your thoughts in the comments.

Pros: Better patient care overall. Cons: Docs working longer hours to make the same income.

That’s the result of recent research published in the Archives of Internal Medicine.

The research team collected retrospective data on more than 46,000 visits to primary care doctors by adult patients, between 1997 and 2005. The study showed that the number of visits increased 10% over that period and the average length of a visit increased 16%, from 18 minutes per patient to almost 21 minutes.

Some types of visits increased in duration more than others:

• regular check-ups increased by 3.4 minutes
• high blood pressure checks increased 3.7 minutes
• diabetes diagnoses increased 4.2 minutes, and
• joint disease diagnoses increased 5.9 minutes.

Part of the reason for longer visits is that patients are learning to be more involved in the health care decision-making process, so they come to appointments armed with questions about tests, medications they’ve seen advertised and that tip Aunt Hilda passed on about how eating raw garlic can ward off arthritis.

While few would argue against patients being more engaged in their own care, dealing with those questions does take up valuable clinical time — and like it or not, doctors don’t get paid for their bedside manner. The end result is longer hours for doctors, while total compensation stays the same — if they’re lucky.

What can help

Some practices are instituting smart strategies to free up doctors’ time while still giving patients the time and attention they need and want.

Those strategies include having other staff on hand (physician’s assistant, nurse practitioners, etc.) to handle routine care, as well as group visits, where patients with similar conditions can meet with clinicians to discuss outpatient care and self-management.

Don’t assume EHRs will automatically lead to a reduction in staff.

While that’s often the case, an organization’s staffing needs “post-EHR” will vary greatly depending on its size and goals.

For example: A large hospital looking to eliminate paper will face a far different scenario than a small family practice looking to improve overall patient care and reduce time spent on administrative tasks. In the case of the family practice, which is probably already running lean, chances of reducing staff are small. But the current staff may be able to take on expanded roles, and even open up additional lines of revenue. In the case of the hospital, jobs that are paper-reliant (like filing clerks) will most likely be eliminated — or at minimum, greatly changed.

Implementing EHRs

Experts advise that the health care providers not make any decisions regarding EHRs until they’ve quantified their long-term goals: Seeing 10% more patients, eliminating paper records, saving X dollars per year, etc. With that goal in mind, it’s easier both to implement a program as well as to plan for life after implementation.

During, and just after, implementing EHRs, it’s typical to require more staffing, if for no other reason than people are adjusting to new processes and new roles. In an organization that isn’t already running at peak efficiency, the switch can be particularly chaotic.

Case studies: Some reduce headcount, some add

American Medical News recently profiled several organizations’ staffing needs before and after EHR implementation. For example, one three-doctor endocrinology practice was able to save more than $15,000 a year in reduced costs. Rather than reducing head count, it saw the program as a way to invest in existing employees and retrain them to take on higher-level duties and expand operations. Eventually, it tripled the size of the practice and added two full-time employees to handle the increased workload.

On the flip side, a multi-site neurological practice that originally had 165 employees was able to reduce 12 positions after implementing EHRs. In the process, it saved $435k from cost reductions and increased revenue.