Family medicine match numbers rise

The national fill rate for family medicine residency positions increased by 2.6 percent this year, following a slight downturn in 2003 and in previous years. According to preliminary data from the National Resident Matching Program (NRMP), 78.8 percent of the 2,864 family medicine positions offered in 2004 were filled; 41.8 percent were filled by U.S. seniors. All primary care programs, except internal medicine-primary experienced an increase in filled positions in 2004.

While the increase in the fill rate is good news for family medicine, AAFP President Michael Fleming, MD, expressed concern about two issues. First is the fact that 76 fewer family medicine residency positions were offered this year, continuing a decline that began in 1999. Many family medicine residency programs are facing financial challenges because of reduced payments resulting from the Balanced Budget Act of 1997. Second is the fact that, for the seventh year in a row, the number of family medicine residency positions filled by U.S. seniors has declined. “The decline was smaller than in recent years,” said Fleming, “but we in family medicine must encourage more U.S. medical school seniors to choose family medicine.”

U.S. graduates are more likely to stay in the United States and care for patients, while international graduates tend to practice abroad. Fleming noted that the AAFP is “working to ensure that this country doesn’t lose its family doctors.”

A warning about charging extra fees

Physicians who charge Medicare beneficiaries additional fees for “boutique” or “concierge” care might be violating Medicare laws. An alert issued recently by the Department of Health and Human Services Office of Inspector General (OIG) reminded physicians that charging extra for services that are already covered by Medicare could result in fines or exclusion from Medicare. The alert cites a recent settlement with a physician who provided “coordination of care with other providers” and “extra time” spent on patient care to Medicare patients in exchange for $600 a year. The OIG said that many of the services provided under the physician’s contract with patients were already covered and reimbursable by Medicare.

Outpatient medical errors

A recent study of malpractice claims suggests that medical errors are causing harm in the outpatient setting more often than in hospitals. The study by the Robert Graham Center, published in the April edition of Quality and Safety in Health Care, looked at U.S. malpractice claims in primary care settled between 1985 and 2000. The researchers focused on a subset of 5,921 malpractice claims that could most clearly be identified as errors. Negligent, adverse events were more likely to have severe outcomes when they occurred in hospitals, but the total number of high severity outcomes and death was larger in the outpatient setting, the study found. Sixty-eight percent of the error-related claims were for negligent events in outpatient settings, resulting in more than 1,200 deaths.

The HIPAA privacy rule: one year later

The patient privacy section of the Health Insurance Portability and Accountability Act (HIPAA) took effect one year ago, but an April study by the American Health Information Management Association shows that many health care organizations are not yet completely compliant. Only 23 percent of respondents reported full compliance in their organizations; however, 68 percent reported 85- to 99-percent compliance. Seventy percent of respondents said HIPAA had uncovered privacy problems within their organizations.