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Primary care workforce delivery using estimates for 2010 emerging graduates across their careers:
US origin family medicine residency graduate – 25 Standard Primary Care years with 35 years at 85% active at 85% primary care at 100% of top volume
Caribbean US origin FM – 19 -22 SPC years (later entry, less retention)
Average graduate of Duluth medical school – 14 – 16 SPC years due to 45 – 50% family medicine
Non-Citizen International Graduate FM – 12 – 15 SPC years (late entry, some departure to other nations)
US origin pediatric graduate 12 SPC years (US average is just below 50% entering primary care now)
US origin internal medicine graduate – 5 SPC years due to 20% primary care retention for a career
Physician assistant graduate – 4 SPC years (33 yrs, 70% active, 70% volume, 25% primary care)
Nurse practitioner graduate – 3 SPC years (26 yrs, 65% active, 65% volume, 30% primary care)
Non-citizen internal medicine – 2 – 3 SPC years (28 yrs, 70% active in US workforce due to departure and inactivity, 80% volume, 20% primary care). The nation’s most exclusive medical schools also share this lowest level of primary care delivery per graduate.

Delays in entry to the US workforce, departures after graduation from primary care and from US workforce, lower volume, fewer years, and lower primary care percentages all reduce primary care delivery capacity. This is mainly common sense. All primary care sources are not alike, mainly because some are more likely to be hospital and specialty workforce sources.

Meanwhile the US elderly are doubling (2 to 3 times more primary care) and the US is increasing health care coverage, and has been dissolving continuity primary care (many posts), and pays too little for the cost of delivering primary care, and erects more barriers to efficient care, and continues to convert each primary care source steadily to hospital and specialty workforce. The 27,000 so-called primary care annual graduates a year only enter primary care at graduation less than 30% of the time. And more leave steadily in the years after graduation.

The US vision for health access is missing the one ingredient most needed and that ingredient takes the longest to restore – primary care workforce. Also the responsibility for sufficient primary care falls on the last two generations. About 50 years of effort is required to prepare basic health access workforce. The past two generations have failed the US for 2010 – 2030 primary care in designs for training, designs for support, and designs for distribution. And more family physicians will also not work even though this is the most efficient solution in primary care delivery per graduate, mainly because the US has to spend much more than 125 billion dollars a year to actually deliver the primary care needed. More graduates in primary care has only bounces more to hospital and specialty workforce. The US does not need more rearrangements, innovations, and reorganizations – it requires more primary care delivery.

Written by Matthew A. Piacentini Friday, 13 August 2010 00:00

Discusses Investigation Into Predatory Credit Cards

Attorney General Andrew Cuomo addressed Long Islanders this week, speaking at the Glen Cove Senior Center about health care-related credit card schemes targeting seniors and vulnerable patients. AG Cuomo said he has subpoenaed health care clinics and credit card companies including Chase Health Advance, Citi Health, and GE Money’s CareCredit.

The attorney general was joined in Glen Cove by a young woman named Miriam Simon, who said she was the victim of a $14,000 scheme relevant to this investigation. Simon said that she went to the dentist for an examination and her dentist told her she needed extensive work. He offered her a payment plan for the $14,000, but she said she had to go home and think it over.

“Then I got a bill for the full amount,” Simon told the crowd. “I never consented. I didn’t have any work done. It was a nightmare.” She said ultimately the attorney general resolved the matter, but warned others of these new credit schemes.

Cuomo thanked her for standing up to share her story. He said, “We’re getting dozens of complaints across the state. We are in a bad economy and a whole host of companies are exploiting people, making a bad situation worse. These are people who can’t afford healthcare.”

He said that an investigation by his office found that some health care providers use fast-talking sales pitches to pressure and deceive consumers into applying for health care credit cards such as Chase Health Advance, Citi Health, and GE Money’s CareCredit. He said, the investigation also found that CareCredit pays kickbacks in the form of rebates to the providers based on how much business they charge consumers on CareCredit cards.

Cuomo criticized doctors for participating in this way, saying, “You can either be a doctor or a credit card salesman. You can’t be both at the same time.”

The investigation was based in part on hundreds of consumer complaints received by the Attorney General’s Office. Consumers reported that health care providers promised that the credit card had “no interest, ” when it often carried retroactive interest of over 25 percent if not paid in full during a promotional period. Consumers were also unknowingly charged up front for services they never received, and their attempts to obtain refunds were often thwarted or ignored. Meanwhile, Cuomo said the credit card companies typically paid the health care providers in full within 48 hours of the charge.

The investigation also found that CareCredit charges the providers a fee for the right to offer the cards, and then rebates part of the fee based on the amount of money the providers generated through CareCredit sales. This kickback arrangement, plus CareCredit’s payment in full to providers within two days of the charge, creates an incentive for providers to push consumers to use CareCredit rather than other methods of payment. In fact, providers pushed CareCredit over cash, he said.

“Our ongoing investigation has uncovered conflicts of interest and predatory practices in the health care industry that are hurting New Yorkers and patients across the country,” said Attorney General Cuomo. “Patients are being misled into paying for services they never received by the people they should be able to trust the most – their doctors. Doctors are supposed to represent patients, not credit card companies, no matter what kind of kickbacks they are offered.”

Cuomo issued subpoenas to 14 dental and health care clinics that promote CareCredit, as well as to GE’s CareCredit, Chase Health Advance, and Citi Health Card. The subpoenas seek marketing materials, applications, terms of credit, contracts and rebate agreements, policies and procedures, consumer complaints, and regulatory inquiries. This investigation is ongoing.

In addition, Cuomo is asking several nationwide and state-based medical associations, including the American Dental Association and the New York State Dental Association, to explain why they endorsed CareCredit and whether they received compensation for doing so.

CareCredit is accepted by more than 125,000 health care practices nationwide. The New York State Dental Association asserts that more than eight million dental patients and 80,000 dental practices use CareCredit nationwide. The credit card is advertised as a way to pay for services often not covered by insurance, including:

Chiropractic procedures

Infertility treatment

Weight loss procedures

In recent years, Attorney General Cuomo’s office received hundreds of complaints from consumers indicating that they were lured and misled by providers into applying for, accepting, and using health care credit cards. Among the complaints received by the Attorney General’s Office regarding the scam, including Miriam Simon, were:

An elderly Brooklyn resident was advised by her dentist that she needed extensive dental work. The consumer agreed to allow the dentist to check her credit. A few days later, she received a bill from CareCredit for $6,980. No dental work was performed.

A Bronx resident had $17,500 worth of implants charged to a CareCredit account up front by a dental provider. The provider went out of business before completing the work. CareCredit repeatedly refused the consumers requests to refund the money.

Chuck Bell, programs director for Consumers Union, nonprofit publisher of Consumer Reports, said, “Attorney General Cuomo’s investigation shines a badly-needed spotlight on deceptive practices used to market health care credit cards to elderly and low-income consumers. We are concerned that some health care providers are aggressively marketing these high-interest credit cards to patients, without providing appropriate disclosures, protections, or refunds. Consumers Union strongly supports the Attorney General’s investigation, and applauds his ongoing efforts to protect consumers across the nation.”

Catherine Dunham, president of The Access Project, a resource center for local communities working to improve health and health care access, said, “With the cost of health care already an enormous burden on Americans, we must do everything we can to filter out abusive or deceptive practices in how providers take payment for care. Attorney General Cuomo’s investigation into health care credit cards will help protect millions of patients across the country who are struggling with debt. We applaud his efforts and look forward to continuing to partner with him to protect patients.”

Consumers wishing to file complaints regarding deceptive health care credit card practices are urged to contact the Attorney General’s Office at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 800-428-9071. Consumer tips and more information about the investigation, including an example of the letters sent to trade groups, can be found online at www.ag.ny.gov.

The investigation is being conducted by Assistant Attorney General Carol Hunt of the Health Care Bureau under the supervision of Special Counsel to the Attorney General Linda A. Lacewell.

Subpoenas to Health Care Providers:

Allcare Dental Management Inc. – Buffalo

American Laser Centers – Farmington Hills, MI

Aspen Dental Management, Inc. – East Syracuse

East Syracuse Family Dental Arts – East Syracuse

Laser Cosmetica – New York City

Lifestyle Lift – Troy, MI

Northern Lights Chiropractic – Watertown

S & Y Diamond Dental P.C. – Brooklyn

Sunshine Dental – Watertown

Toothsavers – New York City

Gentle Dentistry – East Aurora

Judd Lesser, DDS – Hewlett

Concerned Dental Care of Westchester P.C.

Bernie Fialkoff DDS – Queens

Letters to Groups Endorsing CareCredit:

American College of Eye Surgeons

Society for Excellence in Eyecare

American Dental Association

Academy of General Dentistry

American Academy of Periodontology

American Association of Oral & Maxillofacial Surgeons

New York State Dental Association

American Society of Plastic Surgeons

American Society of Dermatologic Surgery

American Animal Hospital Association

New York State Veterinary Medical Society

American Hearing Aid Associates

American Society of Bariatric Physicians

Attorney General Warns LI About Health Care Lending

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