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Panel targets primary care

When it comes to providing primary care, physicians should adopt the motto of the German minimalist architect Ludwig Mies van der Rohe: "Less is more." That is the message of a set of recommendations published online May 23 in Archives of Internal Medicine that advises internists, family physicians and pediatricians on the top five commonly ordered interventions that should be avoided in each of their specialties. A panel of 15 physicians analyzed medical literature to compile top-five "don't" lists of health care activities that are wasteful because they are not supported by evidence. Examples from the three top-five lists include: imaging for low back pain of less than six months when neurological deficits are not present; ordering blood chemistry panels or urinalyses for screening in healthy adults; prescribing antibiotics for sinusitis; and annual electrocardiograms for asymptomatic patients. Researchers then surveyed 255 primary care physicians about whether they agreed t ...

Medicare privatization plan hits wall in Senate

Washington -- The Senate on May 25 declined to consider a House-approved plan to cut spending by $4 trillion over the next decade in part by changing Medicare into a voucher program and Medicaid into a block grant program. A motion to bring to the floor the plan, crafted by House Budget Committee Chair Paul Ryan (R, Wis.), failed on a 40-57 vote, with five GOP senators joining Democrats against the motion: Sens. Lisa Murkowski of Alaska, Scott Brown of Massachusetts, Rand Paul, MD, of Kentucky, and Susan Collins and Olympia Snowe of Maine. The House had approved the Ryan plan on April 14 by a largely party-line vote, although a few Republicans voted with the Democrats in opposition. Democrats have attempted to brand Republicans and the Ryan proposal as representing an attack on the health security of seniors and the poor. But despite backing off some of their initial rhetoric on the plan, most Republicans have stood by Ryan even as polls show that most Americans oppose the propos ...

Young doctors find general internal medicine doesn't pay

Many young physicians continue to steer away from general internal medicine, despite increased exposure to the field during medical school and a more favorable view of the specialty among medical students. The decline is contributing to a growing shortage of primary care physicians when demand for such services is on the rise, said Mark D. Schwartz, MD, associate professor at New York University School of Medicine. He is the lead author of a study on the subject in the April 25 Archives of Internal Medicine. ( The widening gap in pay between primary care physicians and specialists, large medical school debts, inflexible schedules and heavy workload are some of the factors that influence students' decisions, he said. "What's happened in primary care practice is that physicians feel they are on a treadmill to maintain their salary," said Dr. Schwartz, a general internist. "Pay hasn't kept up with inflation, so to keep up, ...