Obamacare's effects on Psychiatry

[Caring106]

Hi, I'm new here and I'm sorry if this thread is in the wrong place. Don't attack. I just have a genuine concern/question.

Psychiatry is my main area of interest, however I'm also becoming intrigued by dermatology too. (I know, completely different, but I have personal reasons and interests.) I understand the general idea of Obamacare and the effects it could have on healthcare professionals as a whole. But I am wondering what kind of effect the bill will have on specific areas of medicine, particularly the two areas I've specified above?

I'm also wondering what this could mean for nurse practitioners and other midlevels with regards to the physician shortage, which could possible worsen due to Obamacare.


Thank you.

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[PistolPete]

Go look at the anesthesia forum. Bottom line, no one has a crystal ball, but the top paying fields will most likely get hit hard and first by the ACA, with primary care fields staying constant in salary or seeing small bumps. PA's/NP's will most likely become more popular under the ACA overall, since they "save money," but that's just my rudimentary understanding. Psychiatry will probably not be affected all that much.

 

[peppy]

One thing I heard from a hospital administrator who was talking about the effect on psychiatrists in particular is that they're expecting that they will have fewer inpatient/ and inpatient consult services, more of a focus on outpatient psych services.
I am also concerned that all the new requirements of Obamacare/ACA will make it harder for private practice physicians in general to stay in business, forcing more psychiatrists to work for larger entities. One of the traditional advantages of psychiatry is that the low overhead made it easy to be a solo private practice psychiatrist, but I suspect that may not be true much longer.

 

[Salpingo]

Hi, I'm new here and I'm sorry if this thread is in the wrong place. Don't attack. I just have a genuine concern/question.

Psychiatry is my main area of interest, however I'm also becoming intrigued by dermatology too. (I know, completely different, but I have personal reasons and interests.) I understand the general idea of Obamacare and the effects it could have on healthcare professionals as a whole. But I am wondering what kind of effect the bill will have on specific areas of medicine, particularly the two areas I've specified above?

I'm also wondering what this could mean for nurse practitioners and other midlevels with regards to the physician shortage, which could possible worsen due to Obamacare.


Thank you.

Point - http://www.nytimes.com/2012/07/10/h...enefits-for-treating-mental-illness.html?_r=0
Counterpoint - http://thoughtbroadcast.com/tag/obamacare/

 

[BobA]

With hospital systems being in charge of population health via ACOs, I've heard you'll see more psychiatrists working in primary care as "embedded" psychiatrists essentially acting as outpatient consultants to PCP's.

From what I've been told, this idea has come up again and again over the years, but as I venture into the job market I'm finding high demand for this kind of service.

 

[DrAwsome]

With hospital systems being in charge of population health via ACOs, I've heard you'll see more psychiatrists working in primary care as "embedded" psychiatrists essentially acting as outpatient consultants to PCP's.

From what I've been told, this idea has come up again and again over the years, but as I venture into the job market I'm finding high demand for this kind of service.

Sorry to butt in here, but how do you think the salaries will really decrease in psych? I think the goal of Obamacare is to reduce the costs of very high paying specialties for one, and for two, things may even out when the no pays now pay something. But ultimately, I think things will fail because Obamacare is a bandaid that does not resolve anything. They will likely try to lower salaries to an unsustainable level, with no tort reform or medical education cost reform, and that will drive people out of medicine in masses. I think in the next 10 or so years, there will be a desperate need for doctors as less and less people go into medical school or get out of medicine as a lot of people are doing now. I will wait and see I guess.

 

[peppy]

They will likely try to lower salaries to an unsustainable level, with no tort reform or medical education cost reform, and that will drive people out of medicine in masses.

If there are doctor shortages, I think the answer will be to bring in more NPs/PAs, not to try to make things better for the docs.
I think Psych is very vulnerable to being replaced by NPs and PAs. Even though I do think a well-trained psychiatrist is able to understand the nuances of psych drugs better than an NP and deliver better care, unfortunately the reality is that giving out SSRIs indiscriminately to anyone who says they're sad or putting psychotic individuals on three different atypicals is "good enough" care to get by even if it's not really optimal care. People will tolerate that level of care.
With the pressures of increased regulation, declining reimbursement, and decreased autonomy, I think a lot of docs are not going to be happy about the direction things are going in - yet at the same time, we're seeing tons of new MD and DO schools opening, and there are plenty of NPs and PAs who want to play doctor, so I don't think that doctors are really in a good position to negotiate for better conditions.

 

[PikminOC]

salpingo thanks for the links: i will check them out.

For the future outcome derived measures: do I get a bonus if a pt does not commit suicide or if i prevent them from going inpt/ER?

Or will pt satisfaction be the biggest thing and I will lose my job due to all the axis 2 pathology?

 

[Caring106]

Thanks so much for the replies. Very informative.

If NP/PAs begin to fill in the roles for psychiatrists, will they be paid on or close to the same level as a psychiatrist? If so, what will that mean for the future of psychiatrists, especially in regards to their salaries? (Salary isn't my #1 focus, don't get me wrong. I'm truly just intriged by this area of medicine and it has always been an interest of mine).
Also, do you think that this will potentially hurt too many private practice psychiatrists and put most of them out of business?

The physician shortage in the future flat out scares me and I fear that Obamacare will only beat it to the ground even more.

I know that nobody can predict the future on this issue. Anything can change overnight and nobody knows for sure. But we can always gather an idea.

 

[PikminOC]

If want to become an NP, go ahead and do it.

The point of obamacare is to keep costs down, not pay less qualified people MD salaries.

Sheesh.

 

[Caring106]

I wasn't implying that I want to be an NP and I don't think that they should be paid the same as MD's. I was just asking. I understand the fine differences between physicians and NPs and I don't think MD's should be replaced by them. I'm asking if this would ever become a possibility if the shortage were to worsen dramatically. I'm concerned and that's why I ask...

 

[PikminOC]

:troll:

 

[Caring106]

:troll:

What? How am I troll for asking some questions? Isn't that the whole purpose of this forum? I'm not trolling or trying to spam the forums, these were just things I was wondering about and wanted to see if I could get answers. Is that so wrong? I recognize that I'm a little underinformed and that's why I posted.

I've come across countless posts on this forum over the concern of NP "taking over" the role of MDs in some areas. Obviously, I'm not the first person to bring this concern up on these forums. I don't see how it makes me a "troll" to ask the same questions and have the same concerns that many other people on here have. The reason why I think this relates to Obamacare is because I believe the bill may possibly lead to a larger physican shortage in the future. I just wanted some other insight and views on this.

I visit here fairly often and I just never registered or posted. Does that make me a troll?

 

[toothless rufus]

I think the good old days of medicine are making a comeback! And who cares about obamacare (DUMB NAME) I'm doing cash only private practice and the gov't can go eff off!

 

[Leo Aquarius]

I think the good old days of medicine are making a comeback! And who cares about obamacare (DUMB NAME) I'm doing cash only private practice and the gov't can go eff off!

Hear hear!

 

[peppy]

If NP/PAs begin to fill in the roles for psychiatrists, will they be paid on or close to the same level as a psychiatrist? If so, what will that mean for the future of psychiatrists, especially in regards to their salaries? (Salary isn't my #1 focus, don't get me wrong. I'm truly just intriged by this area of medicine and it has always been an interest of mine).
Also, do you think that this will potentially hurt too many private practice psychiatrists and put most of them out of business?

Not sure why someone called you a troll for this, but my view on this would be that if NPs/PAs end up flooding the market the salary for psychiatrists would decrease to be closer to the level of NPs/PAs rather than NPs/PAs getting a pay increase. The main reason NPs/PAs are so popular is that they're cheaper than MDs/DOs.
Of course, this is speculation on my part. Hopefully things will go better than I am speculating they will.

 

[notdeadyet]

I wasn't implying that I want to be an NP and I don't think that they should be paid the same as MD's. I was just asking. I understand the fine differences between physicians and NPs and I don't think MD's should be replaced by them. I'm asking if this would ever become a possibility if the shortage were to worsen dramatically.

This shortage already exists in primary care. NPs are not putting family practitioner's out of business. FPs are not having problems finding jobs. What happens in dramatic shortages like that is that mid-levels start filling the ranks but physicians are even more in demand. Many physician's actually profit by it by having practices in which they hire mid-levels, who have a higher profit margin.

 

[Chimed]

This shortage already exists in primary care. NPs are not putting family practitioner's out of business. FPs are not having problems finding jobs. What happens in dramatic shortages like that is that mid-levels start filling the ranks but physicians are even more in demand. Many physician's actually profit by it by having practices in which they hire mid-levels, who have a higher profit margin.

Agreed. I really don't think we need to worry about NP/PA's based on previous examples. There's already such a high demand for our services that will only increase that we will always be sought after and be able to demand higher salaries. It is highly unlikely that our salaries will be lowered to the level of an NP as someone suggested above regardless of the affordable care act. What could happen, however, is that we increasingly move to consultative positions in PCP clinics with the move toward ACO's as well as leadership positions in mental health clinics. Also, don't underestimate the fact that when more mid-level providers move in, there will always be people who will pay a higher premium to get their mental health services provided by a physician (MD/DO).

 

[Leo Aquarius]

A team of financial advisers spoke to residents at our program and revealed that the avg salary of psychiatrists have steadily increased over the past 5 years, and will continue to do so because of the shortage. This is probably no surprise to us, but I'm sure thankful for it. Many other specialties can't say the same thing.

 

[sunlioness]

Agreed. I really don't think we need to worry about NP/PA's based on previous examples. There's already such a high demand for our services that will only increase that we will always be sought after and be able to demand higher salaries. It is highly unlikely that our salaries will be lowered to the level of an NP as someone suggested above regardless of the affordable care act. What could happen, however, is that we increasingly move to consultative positions in PCP clinics with the move toward ACO's as well as leadership positions in mental health clinics. Also, don't underestimate the fact that when more mid-level providers move in, there will always be people who will pay a higher premium to get their mental health services provided by a physician (MD/DO).

Agreed. Both at APA and this APM conference I'm at now, "integrative care" has been the buzzword. Meaning moving to a system where psychiatrists don't actually see patients, but serve as consultants to the PCPs and mid levels who do. My place of work is nowhere near this model and showing no signs of moving toward it and I'm not sure I'd like it, but that's what people are talking about. Though part of me thinks how much less stressful it would be to tell someone, "don't give that guy Xanax" than to be the one in the office being directly asked for Xanax.

 

[F0nzie]

Agreed. Both at APA and this APM conference I'm at now, "integrative care" has been the buzzword. Meaning moving to a system where psychiatrists don't actually see patients, but serve as consultants to the PCPs and mid levels who do. My place of work is nowhere near this model and showing no signs of moving toward it and I'm not sure I'd like it, but that's what people are talking about. Though part of me thinks how much less stressful it would be to tell someone, "don't give that guy Xanax" than to be the one in the office being directly asked for Xanax.

Integrative really means cost savings. The irony is that the word "integrative" suggests quality which cannot be maintained when 3/4 of our work with patients is eliminated.

 

[toothless rufus]

Integrative really means cost savings. The irony is that the word "integrative" suggests quality which cannot be maintained when 3/4 of our work with patients is eliminated.

Oh that's what this means? We don't see our patients any longer? I hate these fancy models that are just disguising poor quality care in an attempt to save money. It's important to see a psychiatrist face to face with quality and significant amount of time spent in the interview. And for job satisfaction.

Is this going to be rammed down our throats? Decrease earning potential? I'm getting really sick of all this crap. We need a union. Or policy makers with something resembling lucid thoughts and a modicum of intelligence. Physicinas need to be in charge of themselves.

Disheartening and sickening.

 

[sunlioness]

We need more psychiatrists. There simply aren't enough of us to do the job the way it needs to be done for everyone who needs it. It's a huge problem.

 

[digitlnoize]

I am much less doom and gloom than most of this. Here's my Tea Leaf Reading:

1. NP's and PA's are a minor threat, but they don't want our jobs any more than the other doctors do. Dermatologists should be VERY afraid of these guys, but us...They might take some business, but there is NOT enough of them doing psych to even put a dent in the shortage.

2. The Shortage. It's bad. Really bad. Worse than anyone thinks. 35% of our field works less than 30 hours per week, according to the most recent Medscape survey. A total of 75% of our field works less than 40 hours per week (that obviously includes the 35% working less than 30). Over half of psychiatrists will retire in the next 10 years. Most are half retired already, judging by the hours worked. We have been one of the slowest growing fields (in terms of residency slot expansion) for years, if not decades.

3. The Research. We are the "undiscovered country" in medicine. More and more attention is being paid to mental illness and it's impact on morbidity and mortality. Do you guys read the news? Not a day goes by that I don't see yet another news article about some mental health study that showed how Disease X is worse when you have Axis I disorder Y. The WHO has made it a top priority. Nature declared this the decade of mental health. Suicide and depression have been recognized as leading causes of morbidity and mortality. Research dollars are shifting our way. As we unlock more secrets, we'll have more/better treatments. But no one to deliver them (see #1 and #2).

4. Obamacare. Will there be changes? Of course. We are going to wind up with a three tiered health care system.
Tier 3 (the lowest tier) - Medicaid, community health, ghetto ER's. Care for the poor. This is going to suck, basically as much as it does now or much much worse.
Tier 2 (the blue collar) - Integrated Health Centers, Group practice, large hospital settings. We'll act as consultants, it'll be a nice insurance gig actually. Might have to work alongside some midlevels making almost as much as you. But you'll still be paid well, basically what these places pay now. 200k give or take.
Tier 3 (the white collar) - Cash only. Private practice will still exist. You may have to move to find it, but it'll be out there if this is the route you want to pursue. The shortage is real and quite bad, and this clientele will pay top dollar for a GOOD psychiatrist (keep in mind that in addition to the shortage, there are a LOT of bad psychiatrists out there). Especially true for child.

The government may try to take away tier 3 by tying licensure to accepting their insurance. This is unconstitutional though and won't stand. The government has no right to force anyone to be their employee. Slavery and indentured servitude were outlawed over a century ago. We have just as much right to life, liberty, and the pursuit of happiness as the next guy.

Rest easy. It may not be (and never was) a path to Scrooge McDuck's Money Bin, but medicine remains the most guaranteed way to have a 6 figure income with the best job security out there.

And always remember: People are not getting any less crazy.

We've got a generation of kids whose fathers were off at war. We've got soldiers returning from a higher-than-average risk for PTSD war. We've got more people living in poverty, more children growing up in poverty, legalization of pot, and decades of underserved psychiatric care.

It is going to be a wild ride. Hang on.

 

[billypilgrim37]

The government may try to take away tier 3 by tying licensure to accepting their insurance. This is unconstitutional though and won't stand. The government has no right to force anyone to be their employee. Slavery and indentured servitude were outlawed over a century ago. We have just as much right to life, liberty, and the pursuit of happiness as the next guy.

Digitl, dude, you know I love you, but I think you need to find a new constitutional lawyer. That situation is a) entirely unlikely, as cash only is such a small chunk of medicine that it simply won't make much of a difference in the scheme of things, and senators are sure going to be continuing to see THEIR private practice cash only psychiatrists, but b) entirely within precedent of the commerce clause. Just because something is absurd and unlikely doesn't make it unconstitutional.

 

[digitlnoize]

Digitl, dude, you know I love you, but I think you need to find a new constitutional lawyer. That situation is a) entirely unlikely, as cash only is such a small chunk of medicine that it simply won't make much of a difference in the scheme of things, and senators are sure going to be continuing to see THEIR private practice cash only psychiatrists, but b) entirely within precedent of the commerce clause. Just because something is absurd and unlikely doesn't make it unconstitutional.

I agree that it's unlikely, but it's a favorite Chicken Little argument around here, so I felt it must be addressed. Your point that it's a small slice of the pie is valid...for now. It's going to become a larger and larger slice as things move along, especially in psychiatry.

Obviously, the Commerce Clause has been used to pull some pretty questionable things over the years, and our current Supreme Court hasn't exactly been a friend to liberty...

Still, I find it difficult to conceive that the United States could ever get away with forcing it's citizens into unwilling employment. I, personally, would leave if it ever came to that. I have the same rights as anyone else to own my own business...that shouldn't change because I'm a doctor. If it ever did...see ya later.

 

[F0nzie]

I am doom and gloom but maybe because I'm in an underserved and underfunded state. Employers aren't clamoring for psychiatrists. They simply get more psych Nps. Problem solved.

 

[notdeadyet]

More and more attention is being paid to mental illness and it's impact on morbidity and mortality. Do you guys read the news? Not a day goes by that I don't see yet another news article about some mental health study that showed how Disease X is worse when you have Axis I disorder Y.

You know what is also in the news a lot? Climate change. Yet cue the tumbleweeds... And obesity. Yet cue the Big Gulps...

I'm not doom and gloom either, I think psychiatry is on a trajectory up, if anything. But you will quickly grow broke betting on this country's will and ability to implement change just because it knows it should.

 

[toothless rufus]

This "tying licensure to accepting insurance" is very concerning. As was posted elsewhere Massachusetts (I think) is proposing this very thing. What's to stop government from doing this nationally or even forcing all physicians to be solely govt employees and work for 50K a year or something, with the excuse (mandate) that "it's for the greater good of the people" or other some such nonsense?

 

[digitlnoize]

This "tying licensure to accepting insurance" is very concerning. As was posted elsewhere Massachusetts (I think) is proposing this very thing. What's to stop government from doing this nationally or even forcing all physicians to be solely govt employees and work for 50K a year or something, with the excuse (mandate) that "it's for the greater good of the people" or other some such nonsense?

It's called the 13th Amendment. Or we can just leave. Plenty of other countries in need of a good psychiatrist.

 

[toothless rufus]

It's called the 13th Amendment. Or we can just leave. Plenty of other countries in need of a good psychiatrist.

Fair enough. Just hope it holds up, there are no loopholes either already in place or specifically created, or that they don't try to amend the amendment.

Physicians and their salaries are becoming easy targets. It's the wrong target, like fixing the economy by withdrawing funding from PBS (wow, that was such a dumb plan.

While I love to travel, moving to another country entirely is something I don't think I'd ever want to do. I think.

 

[billypilgrim37]

It's called the 13th Amendment. Or we can just leave. Plenty of other countries in need of a good psychiatrist.

You've been in the South too long if you're going to equate slavery with professional licensure being tied to accepting public insurances. That would get you cut in some of the neighborhoods near me!

 

[toothless rufus]

You've been in the South too long if you're going to equate slavery with professional licensure being tied to accepting public insurances. That would get you cut in some of the neighborhoods near me!

Drat! So then physicians could be forced into taking public insurance??!?!?! Crapola!! I do believe that I am starting to develop a case of the vapors.

 

[Therapist4Chnge]

Sorry to butt in here, but how do you think the salaries will really decrease in psych? I think the goal of Obamacare is to reduce the costs of very high paying specialties for one, and for two, things may even out when the no pays now pay something.

The goal is to reduce cost AND cover more people. The easiest way to accomplish these goals is through slashing provider rates. Don't be fooled by any of the double-speak about 'quality' service and making things more efficient.

The government may try to take away tier 3 by tying licensure to accepting their insurance. This is unconstitutional though and won't stand. The government has no right to force anyone to be their employee. Slavery and indentured servitude were outlawed over a century ago. We have just as much right to life, liberty, and the pursuit of happiness as the next guy.

If Obama gets his way, you will need to worker harder for less money because someone needs to pay for Obamacare.

We've got a generation of kids whose fathers were off at war. We've got soldiers returning from a higher-than-average risk for PTSD war. We've got more people living in poverty, more children growing up in poverty, legalization of pot, and decades of underserved psychiatric care.

One of these things is not like the others....

 

[Silent Cool]

How likely do any of you think it that licensure in medicine will be tied to taking medicae/medicaid? In other words, you will be required to take public insurance to practice medicine.

 

[toothless rufus]

The goal is to reduce cost AND cover more people. The easiest way to accomplish these goals is through slashing provider rates. Don't be fooled by any of the double-speak about 'quality' service and making things more efficient.



If Obama gets his way, you will need to worker harder for less money because someone needs to pay for Obamacare.




One of these things is not like the others....

It's tilting at windmills though. Provider rates are not the problem; forcing us to work for peanuts will not help much. Even if it solved the problem, it's not right to do so.

How likely do any of you think it that licensure in medicine will be tied to taking medicae/medicaid? In other words, you will be required to take public insurance to practice medicine.

Indeed. I am starting to fear very. And it's bumming me out. It's the slick-lawyer way to do things. And they will recruit people with extra altruism genes to be the next gen of physicians, who are willing to work like crazy merel for the privilege of oxygen and food. Or they will start breeding a line of humans with ultra high altuism ad low need for financial reward to harvested for the role (no, then truly a calling!) of physician. Bastards.

 

[toothless rufus]

I am doom and gloom but maybe because I'm in an underserved and underfunded state. Employers aren't clamoring for psychiatrists. They simply get more psych Nps. Problem solved.

Midlevels need to go the way of the dodo. The argument for their existence just creates an argument for our nonexistence. Or at least a more nearly perfect coexistence, in terms of reimbursement. Too bad well-defined roles don't stay that way.

 

[digitlnoize]

One of these things is not like the others....

Pot has been linked to increased rates of psychosis in kids. That's all I was getting at. Much like having a parent off at war increases your chances of having depression. So, it's actually kind of like the others.

All things being equal, I'm for the legalization of pot. It's the right move socially...but that's different from saying its the right move medically.

But Obama can make us do stuff....[\quote]

Salaries can only drop so far. We have more than enough options nearby who would gladly pay us what we're making now. If US salaries drop below these, we're going to lose docs in droves to Canada, the UK, etc. I would gladly be one of them if it came to losing my liberty completely. What's the point of living in America if you can't pursue your dreams?

The Commerce Clause is the loophole...but many of us would fight that tooth and nail, all the way to the Supreme Court (or beyond) if need be. The CC gives Congress the power to regulate interstate commerce, which has been abused in the past...but if they think my practice in a small town is "interstate commerce", they've got another thing coming.

Much of the country would stand with us. If they do it to doctors they can do it to you. What's next? A plumber forced to work for the government? You think that would go over well? Montana would secede if they started pulling this crap.

Anyways, I value my personal liberty. That's what this country was founded on, and its something we've forgotten, with the drug wars, Patriot Act, and yes, Medicare. If I lose the last vestige of liberty, the ability to pursue my dream, I'm out. Period. I hear Australia is nice and pays pretty well....

 

[OldPsychDoc]

Your small town practice may not be Interstate Commerce, but the health insurance policies that your patients rely on are. Unless you envision a barter-based economy (prozac for chickens?) this is the cold, hard reality.

 

[digitlnoize]

Your small town practice may not be Interstate Commerce, but the health insurance policies that your patients rely on are. Unless you envision a barter-based economy (prozac for chickens?) this is the cold, hard reality.

Not in a cash only world. Chickens are cool too.

 

[peppy]

This "tying licensure to accepting insurance" is very concerning. As was posted elsewhere Massachusetts (I think) is proposing this very thing. What's to stop government from doing this nationally or even forcing all physicians to be solely govt employees and work for 50K a year or something, with the excuse (mandate) that "it's for the greater good of the people" or other some such nonsense?

Since many of the advocates for increasing public health care here seem to find inspiration in Canada's model, I do think we have reason to be concerned that private physicians and private clinics may eventually be greatly restricted through one method or another. As this article from a few years back or
this more recent commentary by Dr. Day discuss, Canada has tried to stop private clinics from operating there even though the sheer volume of the demand for medical services (and people's discontent with waiting lists for care) has allowed private clinics to operate despite the official efforts to stop them. I wouldn't be at all surprised if we go down a similar road...although my hope is that by the time that the situation in the USA is truly fusterclucked that Canada will have reformed its system enough that immigrating there will be a worthwhile option if necessary.

 

[michaelrack]

The government may try to take away tier 3 by tying licensure to accepting their insurance. This is unconstitutional though and won't stand.

State governments could do this. I agree that by any reasonable interpretation of the Constitution, the feds could not do this.

 

[Therapist4Chnge]

Pot has been linked to increased rates of psychosis in kids. That's all I was getting at. Much like having a parent off at war increases your chances of having depression. So, it's actually kind of like the others.

The issue I have with pot and psychosis research ( at least what i've read) is the jump to push causation. I think those two things are interacting (research has show higher sub abuse w a psych Dx like schizophrenia), but I am highly suspect that pot will increase the prevalence rate of psychosis.

 

[digitlnoize]

State governments could do this. I agree that by any reasonable interpretation of the Constitution, the feds could not do this.

Agreed. And some states (Montana, I love you) won't ever consider something that restrictive, so we could always go there. For most people this probably won't make that much of a difference, since many take the govt insurance anyways. And I may do that to even...but it should be my choice.

Freedom isn't free. It costs a buck o five.

 

[sunlioness]

I've yet to meet a doc from Canada who complains nearly as much as docs here say they will complain if we emulate Canada's system. I actually met several at the conference I just got back from. They appeared to be well-fed, well-dressed, had some money to eat nice food at a conference, and also didn't have to deal with a lot of hassles that we need to deal with on an almost daily basis. None of them wanted to trade systems.

That's a totally unscientific sampling, but I'd actually welcome going to more of a Canadian single-payer type system. I don't like Obamacare because I don't think it goes far enough or solves the fundamental problem.

 

[notdeadyet]

I've yet to meet a doc from Canada who complains nearly as much as docs here say they will complain if we emulate Canada's system. I actually met several at the conference I just got back from. They appeared to be well-fed, well-dressed, had some money to eat nice food at a conference, and also didn't have to deal with a lot of hassles that we need to deal with on an almost daily basis. None of them wanted to trade systems.

Good point, sunlioness. Though to be fair, this is likely also a cultural thing. One thing that becomes more clear with time, is that as a culture, we Americans are a whiny bunch. And it ain't limited to medicine.

 

[digitlnoize]

I'd be much more inclined to accept insurance if the pay was fair and it didn't cost an army of employees to process it all.

 

[michaelrack]

Agreed. And some states (Montana, I love you) won't ever consider something that restrictive, so we could always go there. For most people this probably won't make that much of a difference, since many take the govt insurance anyways. And I may do that to even...but it should be my choice.

Freedom isn't free. It costs a buck o five.

You could also come to the south.

 

[digitlnoize]

You could also come to the south.

Already there, technically.

 

[DOC PENGUIN]

I am so glad that i am not in this thread. i might die.