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  1. #1
    Good Enough
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    Default Somebody Get Me a Doctor?

    For those interested in the medical care and cost issues we all have - yes even those of us married to a doctor (and family medicine at that), we still struggle with outrageous health insurance costs and basic care.

    Here's a bit of insight.... please read the entire post. My husband is swamped with patients- turns patients away and gets double and triple booked in clinic. The majority of his patients are either non insured or under insured.

    One of our best friends is a radiologist... he was whining a few months ago because he took a 120K pay cut....( he makes 720K a year BTW). It's hard to sympathize with him most days!



    Where have all the doctors gone?
    By Joseph B. Martin
    May 27, 2008

    THE QUESTION OF whether there are enough doctors to care for patients, particularly if the nation moves toward a new scheme for universal health coverage, is the elephant in the room of the presidential campaign debate on health reform.
    more stories like this

    Fifteen to 20 years ago there were worries about too many doctors, particularly in some specialties. Now, the Association of American Medical Colleges is requesting medical schools to increase enrollments by 30 percent over the next seven to 15 years.

    Serious shortages are expected in fields like general surgery, particularly in smaller urban centers and rural districts, and in neuro-ophthalmology, where doctors, unlike ophthalmologists, have a tough time making enough to pay off school debts.

    And with an aging population there will be an increasing demand for geriatric medicine as well.

    But the gravest concern is about the lack of primary care doctors to work in settings where the patient load is high and the pay is less.

    Indeed, Massachusetts is finding that there are not enough primary care venues to deliver care to all the enrollees in the new universal healthcare plan.

    Let's step back and put this medical supply-and-demand equation in context. Every year US medical schools graduate about 15,000 students. They welcome another 6,500 foreign medical graduates into first year post-graduate residency slots; most of these international graduates will remain in the United States, unfortunately depriving their home countries of the work force required to deliver adequate medical care there.

    Where do all the new doctors go? The current view is that they are hitting the ROAD: Radiology, Ophthalmology, Anesthesiology, and Dermatology. In all these specialties the pay is better and lifestyle issues permit regular work hours, a point often of great importance to women graduates, who now make up a full 50 percent of the graduating doctors.

    I've done some checking on doctors' career plans based on their residency match. They show some distinct trends. At both Harvard and the University of Rochester medical schools, for example, 16-27 percent of the graduates chose internal medicine, 10-15 percent pediatrics, 4-11 percent obstetrics and gynecology and 7-11 percent general surgery. Sadly, at the low end of the spectrum, less than 5 percent went into primary care and family medicine.

    This march into more lucrative medical specialties is severely crimping the ranks of needed primary care doctors at the very moment the demand for primary care is on the rise.

    So what can be done to deliver the quality of care expected by patients? How will healthcare increasingly focus on the importance of prevention and public health measures - encouraging parents to vaccinate their children, supporting major initiatives to stop smoking, developing regimens for weight control that actually work, and turning the focus from treatment to preventing and managing chronic diseases?

    The solution entails more than simply producing more doctors; it requires educating doctors and care givers in new collaborative ways. Those who are trained need the right training and the right jobs with the right pay commensurate with the contributions made.

    But most important, new models of healthcare delivery must be developed - with a new focus on team work, where, for example, doctors, nurses, pharmacists, and social workers form efficient groupings to consider patient-centered care. Teamwork and new ways of delegating treatment will take the load off of the hard-pressed primary care physician.

    Also needed to be addressed is the disparity in reimbursement where doing procedures pays well but thinking deeply about a patient's problems has financial limitations. Reimbursements should be based on quality of care, not quantity.

    Bottom line: the new requirements in medical care require new thinking in how to deliver that care.

    And new thinking is what is needed in an election year featuring a major debate on healthcare. This debate needs to move beyond the issue of access and coverage to how the delivery system can be restructured to provide the best healthcare possible at an affordable cost.

    So let the real debate over health reform begin.

    Dr. Joseph B. Martin, professor of neurobiology and former dean of Harvard Medical School, is chairman of the New England Healthcare Institute.
    Model Citizen, Zero Discipline


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  2. #2
    Eruption ChrisTheEdHead's Avatar
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    IMHO, the best thing that could be done to increase the percentage of grads going into these under-manned specialties is some sort of student loan forgiveness.
    A lot of people don't seem to realize that some of these med students graduate with over $100k in debt. If I were looking at specialties AND that kind of debt, you'd better believe I would be going for the money, too. The disparity in income is just too great to ignore. The family doctor gets maybe $200 per YEAR (plus your $25 co-pay, or whatever) to care for you. If you get an x-ray, the radiologist may get $500 for reading ONE x-ray. PLUS, the radiologist didnt have to take the phone call from the ER at 2 AM, approve the treatment, and then follow up at the hospital the next day.
    They do this sort of student loan forgiveness for some doctors in rural areas already, why not for under-manned specialties?
    "Look, I'll pay you for it, what the f**k?!"

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  3. #3
    Baluchitherium Mikey Metalhead's Avatar
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    greed will kill us all long before disease
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  4. #4
    Romeo Delight amorton's Avatar
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    Quote Originally Posted by ChrisTheEdHead View Post
    IMHO, the best thing that could be done to increase the percentage of grads going into these under-manned specialties is some sort of student loan forgiveness.
    A lot of people don't seem to realize that some of these med students graduate with over $100k in debt. If I were looking at specialties AND that kind of debt, you'd better believe I would be going for the money, too. The disparity in income is just too great to ignore. The family doctor gets maybe $200 per YEAR (plus your $25 co-pay, or whatever) to care for you. If you get an x-ray, the radiologist may get $500 for reading ONE x-ray. PLUS, the radiologist didnt have to take the phone call from the ER at 2 AM, approve the treatment, and then follow up at the hospital the next day.
    They do this sort of student loan forgiveness for some doctors in rural areas already, why not for under-manned specialties?
    I'm a radiologist. I agree with loan forgiveness as an incentive for practice in underserved areas. I had over 100k in loans coming out of school. I love what I do and am good at it, but the money certainly didn't deter me from my choise in specialty. But I will tell you that I don't know any radiologist who makes $500 bucks from an xray. I can tell you insurance companies used to pay about 30 bucks for an xray of which maybe 5-10 dollars went to the rad after paying for supplies, tech who took film, paying for equip etc. Of course CT and MRI and more expensive because the machines now cost in the million and up range.

    As far a not taking phone calls at night from the ER, radiologists absolutely work at night. In todays malpractice climate lots of ER docs want "formal" reads on almost all studies- we have about 3-4 rads who do only that all night long. Not to mention myself who takes call to do minimally invasive procedures in the middle of the night such as controlling gastorintestinal bleeding, doing emergency nephrostomies, etc. And I take call at least 18-20 weeks a year. It takes a big toll on yourself and your family.

    Medicine is changing. Lots of internal medicine doctors won't even come to see you in the emergency room. And if you get admitted, you sometimes get put on a hospitalist service with your doctor as a consulting physician.
    I may not go down in history, but I will go down on your sister.

  5. #5
    Romeo Delight
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    Every attending who has been out a few years and has had their eyes opened knows how completely warped medicine is. Professionally its a total disaster too. We are being pulled in a million directions and have completely lost autonomy. Without sounding paranoid, Medicare contiues to pay hospitals more and docs less which ultimately gives the hospitals and government control. The next 20 years are going to be very ugly. No one outside of some knowledgable attendings and a few hospital administraters can outside can possibly understand what is really happening financially
    Obama, Hillary, McCain have no real idea. Cost can not be contained as spending is a huge economic driver (16% of GDP). Everyone already has free health care. The insured just pay for it (cost shifting). Literally 100's of thousands are spent on fixing the 95 yr old lady's hip with the complicated hospital course leading to her inevitable death. Happens 1000's of time a day
    Complete waste of resources. Ted Kennedy should get one round of chemo, xrt, and one operation if necessary. Then he gets the morphine drip. I would wager his end of life bill will be in the millions of dollars unless his family has some sense. Oh, yeah, medicare will pay for it all eventhough his family has 100s of millions. Can't continue. I'm just scratching the surface here. We won't even dive into patients responsibilities (or complete lack therof in most cases) for their own health.
    My rant is done. I have to go take care of a 25yo self pay illegal immigrant g6 p5 350lbs HTN, DM, OSA, coke + lady for rC/S. Hospital stay, pharmacy, doc charges, supplies, OR time = $50,000. She pays $0. She thanks all of you in advance for paying for her health care. Happens all day every day.
    We are in big trouble.

  6. #6
    Future's in the past....
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    This is almost one of those subjects that should just as well be lumped in with politics and religion. I am the only one with no health insurance in our home, yet I am hypo-thyroid, which means multiple blood tests per year ($$$$) that have to come out of pocket. I save some money by getting my scripts filled up in Canada. My TSH levels have been steady on the same meds for over 5 years, yet the doctor feels it neccessary to draw a level every 6 months, sometimes more often.

    Meanwhile, every migrant worker that shows up at the hospital and basically gets what amounts to a free pass for their health care.

    Sorry for the rant...
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  7. #7
    Sinner's Swing!
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    Quote Originally Posted by desandsevo100 View Post
    I have to go take care of a 25yo self pay illegal immigrant g6 p5 350lbs HTN, DM, OSA, coke + lady for rC/S.
    Be sure to give her something to get her sugar under control. So she can bring it to the walgreens, and ring it up with her 8 liters of coke and margarita mix. Had that happen the other night, tax dollars hard at work.

 

 

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