anyone following this FL story

[Shikima]

Really? It continues to be woefully inadequate in my state, so much so there is constant legislation to help bolster it through additional funding/programs. Many providers can't afford to take it (myself included) and people may "have" medicaid, but that doesn't mean they can actually use it effectively.

As for alternatives…out-pt clinics staffed mostly by mid-levels and support staff to see 95% of what comes through the ED that isn't actually an emergency. Keep the overhead down and push more preventative medicine and case management for chronic/frequent flyers.

How many hospitals have their internal medicine departments being run by a psychologist....

I'll wait.

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[WingedOx]

How many hospitals have their internal medicine departments being run by a psychologist....

I'll wait.

Regardless of your opinion of what T4C just posted, asking this neither refutes nor solidifies his/her point.

 

[Shikima]

Regardless of your opinion of what T4C just posted, asking this neither refutes nor solidifies his/her point.

It does.

But we'll look at it another way... how many Nurses with MBAs &/or DNPs are Dept Chair or Chief of an Internal Medicine Service?

 

[birchswing]

I find it rather amusing that this thread morphed into a universal healthcare debate. I'm not sure how we get from psychiatrist attempts to kill her husband to this debate. I guess not too many people would take the side of "it's okay for psychiatrists to shoot spouses" or maybe I'm way off base and everyone thinks it is ok.

I find it amusing that I didn't know what this thread was about until you pointed this out. I read the original article and didn't see the relation to psychiatry. I re-read it and didn't see it.

 

[Shikima]

Meh. Need a good thread derailing once in a while.... keeps it real.

 

[Therapist4Chnge]

How many hospitals have their internal medicine departments being run by a psychologist....

I'll wait.

You can wait all you want, but my point still stands.

Instead of re-inventing the wheel, here are some data from the article I cited. It is worth nothing that they limited their sample to physician leadership, so the actual breakdown of leadership across the country is not known. I'd hazard to guess it isn't high because that role has traditionally been held by a physician. Of course, in the past 5-10 years there has been a growing body of literature about leadership challenges within healthcare, which includes the very real challenges faced by clinicians who rose through the ranks because of clinical/research efforts and are now faced with being administrators…with little to no guidance. I added the bolding.

We asked respondents to identify the distribution of their total work effort and the distribution of work related specifically to their CMO duties; 149 responded to this question. Overall work effort, in order of decreasing frequency, was distributed among CMO duties (72%), personal clinical practice (13%), other administrative duties (7%), teaching (5%), research (2%), and other (1%). We evaluated the breadth of work effort by determining the percentage of respondents who spent at least some time in various other activities in addition to their CMO duties. Seventy-seven percent of CMOs reported that they participated in some clinical practice. Participation rates in other areas were teaching (64%), other administrative duties (39%), research (20%), and other duties (6%).

Within the subset of CMO duties (72% of total effort), effort was distributed among clinical quality and patient safety (31%), coordination of inpatient and outpatient clinical operations (21%), other (16%), graduate medical education (GME) (9%), risk management (7%), clinical information systems (6%), public relations (4%), professional liability (4%), and nursing services (2%). As with total work effort, we depicted the breadth of CMO duties by identifying the percentage of CMOs who reported at least some effort in the following activities: clinical quality (91%), patient safety (84%), risk management (76%), GME (70%), inpatient services (67%), outpatient services (65%) clinical information systems (63%), professional liability (61%), public relations (55%), other (48%), and nursing services (26%).

Of the areas they covered, what exactly makes the psychologist ill-suited for that role (politics aside)? Frankly, given the research training the typical psychologist receives, they are most likely in a better position to understand the various data. That was my point.

Derailment complete.

 

[Shikima]

My point was not about the lack of leadership or the incapability for leadership, rather ill-suited for the role as they're unfamiliar with service needs and demands and the medico-legal understanding with policy development which have an affect upon physicians. Understanding data is important, but not the full scope or capacity.

Why is this important? You sum it up nicely citing the 'change in winds' towards alternative management - this is already being developed at a grander level from the Feds on down. It slowly is changing with brunt of work being completed by other than physicians and physicians are taking on a management role. Without changes to how litigation is determined and reform of tort laws, this creates a dangerous precedence. There is no data to support that the shortage in MH and PCPs will worsen, but neither improve.

However, looking at from your point of view, if traditionally run department are mediocre and PhDs are better suited - then physician scientists would be the most desired for these positions. Politics determine otherwise.

 

[Therapist4Chnge]

My point was not about the lack of leadership or the incapability for leadership, rather ill-suited for the role as they're unfamiliar with service needs and demands and the medico-legal understanding with policy development which have an affect upon physicians. Understanding data is important, but not the full scope or capacity.

I agree these areas are important, but these are things that are not specific to being a physician. These considerations have little to do with medicine and everything to do with healthcare administration, changes in laws, and managing many egos. If there is truly something that requires expert knowledge, you consult with an expert and then try and make an informed decision.

However, looking at from your point of view, if traditionally run department are mediocre and PhDs are better suited - then physician scientists would be the most desired for these positions. Politics determine otherwise.

Unfortunately physician scientists are often some of the worst people to tap because they live and breath research, grants, and publishing…literally the least allocated opportunities for CMOs.

 

[WingedOx]

Unfortunately physician scientists are often some of the worst people to tap because they live and breath research, grants, and publishing…literally the least allocated opportunities for CMOs.

Ain't that the truth. Getting some research psychiatrists in leadership positions to understand what needs to be done down at the clinical level is like pulling teeth... on a cat... unsedated.

/nope, no personal experience here with that, not at all.

 

[PikminOC]

http://www.cnbc.com/id/102332520

The U.K.'s National Health Service (NHS), for decades the case-study in postwar universal healthcare for governments around the world, seems to be facing its biggest ever crisis of confidence.

Almost every area of U.K. state-provided treatment from cancer to the emergency room and midwifery is complaining of overcrowding and underfunding. With an aging and growing population increasing the burden on healthcare -- and a government which is trying to keep a lid on its spending -- the NHS appears to have an impossible task.

During his struggle to set up Medicare, U.S. President Barack Obama praised the NHS as "something that Brits take for granted – a health care system that ensures you don't go bankrupt when you get sick." At the time, Republicans, particularly members from the Tea Party, were quick to point out the NHS's perceived failings. They might be even quicker to leap on the most recent headlines.

Since the start of the year, concerns and controversy have reached fever-pitch. You can't open a newspaper in the U.K. without seeing a hair-raising headline...

 

[splik]

yes but this is because the government is trying to privatise it and thus let it fall into such a state. there is no national health service anymore in the uk

 

[splik]

regardless i am not sure what this has to do with the price of fish. you only have a healthcare system like that in places like the UK, italy, spain etc. It is not something that would necessarily be appropriate for the US. however the NHS has been shown to be the most efficient health care system in the world because there is no layer of insurance, and satisfaction from those who actually use it is quite high. there are failings with all models of healthcare financing, but most of problems with the NHS (which really exists in Scotland and Wales now and not in England) are not to do with the model itself but the way particular changes have been enacted. it's also far cheaper than health care expenditure in the US by GDP proportion.

also if people want to go private they are more than welcome to do so. 10% of people have private health insurance in the UK. and it's not to get better care (its the same doctors) but faster care.

 

[clausewitz2]

I will say when I had to see a specialist in Britain I shelled out for a private facility where I was seen the next day, rather than the 4 months wait I was quoted for the public hospital down the road. Still ended up being less than 300 USD, including significant diagnostic testing and some imaging, without my having any kind of private insurance. I cannot begin to imagine where I could have accomplished that much for that little in this country.

 

[Ceke2002]

I will say when I had to see a specialist in Britain I shelled out for a private facility where I was seen the next day, rather than the 4 months wait I was quoted for the public hospital down the road. Still ended up being less than 300 USD, including significant diagnostic testing and some imaging, without my having any kind of private insurance. I cannot begin to imagine where I could have accomplished that much for that little in this country.

Yeah, see I actually don't mind waiting for an appointment in the public healthcare system. Apart from the fact that I can't afford to pay for full private coverage anyway (I'm in Australia, two tiered system), I just think the idea of a waiting list based on the needs of the individual patient is a very fair one. It's like 'Okay, your knee's giving you a bit of gripe, but we've got this bloke whose knee was basically destroyed in a car accident and he'll need an urgent knee reconstruction, so oi you, get in line and wait your turn like everyone else has to'. Seems perfectly reasonable to me. Maybe if I could afford full insurance I'd feel different, I don't know.

And the Government trying to dismantle Medicare (our universal healthcare system), usually by trying to fly under the radar with dodgy parliamentary bills and proposals, is not taken to kindly too down here. Mess with Medicare too much, and you'll have Doctors rallying through the streets.

 

[masterofmonkeys]

95% of DM2 expenditure is completely avoidable by moderate attention to diet and exercise.
50-70% of CHD and CVA as well.
20-50% of Cancer.

I could go on but you get the point. The biggest driver of costs is lifestyle choice. Oh and before someone gets all high and mighty and says all those things relate to socioeconomic status and access to healthcare, South Asians in the US have the highest prevalence of DM2. Anyone seriously going to argue that South Asians in the US have low SES or poor access to healthcare? Hell, most South Asians either ARE or are closely related to someone in healthcare.

 

[masterofmonkeys]

I will say when I had to see a specialist in Britain I shelled out for a private facility where I was seen the next day, rather than the 4 months wait I was quoted for the public hospital down the road. Still ended up being less than 300 USD, including significant diagnostic testing and some imaging, without my having any kind of private insurance. I cannot begin to imagine where I could have accomplished that much for that little in this country.

The ability to do this is limited in places that take insurance and especially those that take Medicare. There are a number of cash only transparent pricing places opening up, though. Most prominently in elective surgery, but increasingly with laboratory and imaging diagnostics as well. They're doing quite well.

 

[Igor4sugry]

Updates to the original story:
http://www.gainesville.com/article/...ound-guilty-in-shooting-of-federal-prosecutor