Wednesday, 2 November 2011

US Family Medicine vs UK General Practice

A fascinating glimpse into US family medicine - an interview with a US family physician.

Question. What is medicine like at the moment in the US? How is the US coping with the global recession?

Answer: ‎US hospitals are living in fear of RAC attacks. NHS hospitals are also facing huge cuts to services and staff.

Question. What is a RAC attack?

Answer: The US government sends in a private company to audit a hospital, and if they are found to be overcharging for Medicare, the hospital gets hit by multimillion dollar fines, as the government is trying to get their money back! I compared this to a recent meeting at the Department of Health in which the Chair of the Department of Health meeting on payment by results had made a suggestion to impose fines on NHS hospitals who overspent by 2 deviations from the mean!

Question: How are US family physicians coping?

Answer: There is a rise in law suits and malpractice premiums in the States. US doctors are now advised how to dress DOWN in court. No $5k tailored suits, fancy watches, or any outwardly sign of their wealth so the jury can relate. How their body language is assessed to ensure they do not come across as arrogant. How they are coached on how to speak and what words to use in court. In the UK, a medical defence organisation shared that malpractice premiums had to be increased 20-50% due to the surge in GMC referrals and that premiums were higher for private GPs.

Question: How much does a US family physician make?

Answer: If academic, $120,000. If private, $1 million a year. Private family physicians in New Jersey are earning one million dollars a year. In the UK the average salaried GP makes £7k a session or £56k a year versus the average GP partner £110-120k.

Question: How can they earn a million a year?

Answer: They own their own practice, buy or lease an exercise stress test and echo machines, pay hourly rates for a visiting cardiologist to see their patients in their family practice so that the family physican may claim for both the GP consultation and the cardiology specialist referral and investigations on the health insurance policy.

I shared the UK saga of the 5-yearly revalidation of doctors on the horizon. He was shocked! He then asked why GPs were afraid of commissioning? And commented that the food at a GP conference was very healthy compared to US physician conferences. I asked in what way? He said in the States the dinner sizes are huge and extended his arms to show me. He closed by commenting that I reminded him of Dr Mehmet Oz, America's most famous doctor and surgeon and personal friend of Oprah. I have since googled Dr Oz!