Primary Care

The University of Maryland School of Medicine will use a five-year $877,000 grant  on a program to increase the number of students who enter primary care fields. The school said Monday it will create a primary care track that will allow students to work one-on-one with faculty from family medicine, pediatrics, internal medicine and other primary care specialties. The new program is being developed as health care reform is expected to put further pressure on primary care doctors.

Allow me to reduce your 110 column inches on Mark Midei to the crucial one: "Reviewers saw 30 percent narrowings when Dr. Midei saw 90 percent. " ("Mark Midei fights for medical license, exoneration," Dec. 10.) The rest is rhetoric. A key role of primary care physicians is to prevent unnecessary procedures by specialists. This is impossible if the patient is sucked through an ER evaluation and stenting procedure like a goose through a jet engine, without ever calling the patient's physician.

With a potent mix of excitement and idealism, we set out to become physicians serving on the front lines - primary-care doctors who would be the first point of contact for patients we would follow over the course of a lifetime. Yet throughout our training, the ideals of a career in primary care have begun to fade as strong financial, administrative and lifestyle considerations push us steadily toward specialization. As the United States struggles with a shortage of primary-case physicians, the pressure to veer from general practice represents a systemwide failure to supply the well-trained primary doctors our communities deserve.

State officials on Tuesday announced a plan to increase the number of primary care health professionals by as much as 25 percent in the next decade through a wide range of goals that include increased educational opportunities, financial incentives and tort reform. Maryland and the rest of the country are dealing with a shortage of primary care physicians and fear the problem will worsen when health care reform adds millions more people to the insurance rolls. Nearly 360,000 new people will have access to insurance in Maryland by 2020.

Dr. Barbara Starfield, a professor and health services researcher at the Johns Hopkins Bloomberg School of Public Health whose work in the field of primary care and health policy brought her international acclaim, died June 10 while swimming at her home in Menlo Park, Calif. The former Mount Washington resident was 78. "She was found floating in the pool and may have died of an apparent heart attack. We are waiting for the autopsy report from the coroner," said her husband of 56 years, Dr. Neil A. Holtzman, a pediatrician and a professor at the Johns Hopkins University School of Medicine.

  The headline reads emergency room visits at Howard County General Hospital "might hit a high mark" this year. We know this means that the ER is being misused as a source of primary care. Don't feel bad, Howard County; in Massachusetts, the model for national health reform, emergency room visits hit a new high last year, and they have under 5 percent with no health insurance, while Maryland has a close to 15 percent uninsured. The overuse of the ER is a symptom of the lack of primary-care providers in the county.

  In response to the article, "ER visits might hit high hark," which ran the week of May 26, I agree wholeheartedly that the emergency room is not the ideal place to be treated for minor injuries or illnesses, nor for care that should be provided at lower-cost facilities, including urgent-care centers and primary-care practices. However, while the article encouraged individuals to seek medical attention for minor illness and injury from urgent-care centers, it totally overlooked the role that primary-care practices play in limiting unnecessary trips to the ER through comprehensive and cost-effective preventive and acute care.

One of the casualties of the recent budget deal is a potential game-changer in health care: nonprofit health insurance cooperatives (co-ops). Although not eliminated, the funding to help launch the co-ops was cut significantly. Let's set aside the fact that the "savings" from the $2.2 billion cut to the co-ops is budgetary sleight of hand, since the start-up funding to co-ops is in the form of loans which must be repaid in full. The unfortunate consequence of this ill-advised cut is that these incubators of innovative health care practice — which in many states will be the sole consumer-oriented competitors to the offerings of the big insurance companies — will be limited in number rather than exist nationwide, as originally envisioned by the sponsor of the co-op initiative, North Dakota Democratic Sen. Kent Conrad.

An aortic aneurysm can burst and kill within minutes, but a simple test – an ultrasound like the kind that detects a baby's heart beat – can spot a bulge in the aortic wall and surgery can repair it. Blockages in the carotid arteries that run up both sides of the neck and into the brain can cause a major stroke. Yet that same ultrasound wand can spot a blockage and that, too, can be remedied. Dare to CARE is a program started by Annapolis vascular surgeon Dr. John Martin, and he has screened – for free – more than 30,000 people since 2000, half of whom were found to have some vascular disease.

These days, it's nothing but a concrete cavern with a toilet in the middle. But within a few months, this first-floor space in an Annapolis office building will become the first community health center to be opened by Anne Arundel Health System, geared toward providing basic, low-cost health services to the area's working poor. Officials of Anne Arundel Health System, thwhich runs Anne Arundel Medical Center, said it will be the only one of its kind in the county — a public-private partnership offering primary care to people who are underinsured or lack insurance.