1/2 of all primary care docs would consider quitting

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Interesting CNN article about the plight of primary care physicians. Paperwork seems to be a main culprit. Says only 2% of med students want to take up primary care...opinions?

I'm interested in primary care as a naive pre-med and the article makes me a little sad...

http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/index.html
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Frankly, the problem is with the people, just like the economic crisis. Everyone likes to blame it on the government's meddling and the insurance/financial institutions, but it all comes back to the people. The economic crisis wouldn't have happened had not so many people taken on loans and mortgages that they wouldn't have been able to pay off; similarly, the American's penchant for litigation for everything in healthcare simply turns healthcare into a minefield. Watch that step :boom: Ohh, too late.

This just means that the problem is much too difficult to improve significantly with just a change in policy or legislation; it requires a change in people's attitudes.
 
In a survey published in the Journal of the American Medical Association in September, only 2 percent of current medical students plan to take up primary care. That's because these students are wary of the same complaints that are causing existing doctors to flee primary care: hectic clinics, burdensome paperwork and systems that do a poor job of managing patients with chronic illness....


One of President-elect Barack Obama's health care promises is to provide a primary care physician for every American. But some health experts, including Pocinki, are skeptical.

"People who have insurance can't find a doctor, so suddenly we are going to give insurance to a whole bunch of people who haven't had it, without increasing the number of physicians?" he says. "It's going to be a problem."
 
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84% of statistics have a 52% chance of being complete crap, and you're hearing that from a stats major.
 
anecdotally, my own PCP wouldn't go into primary care if he could start over. His main complaint seems to be the lifestyle of having to get up early all the time to take care of hospitalized patients, and not enough vacation, combined with decreasing reimbursement and "cerebral medicine" not being valued. However with the rise of hospitalists, family physician groups are gaining more scheduling flexibility. I think there is a backlash going on, and I think in the next 20 years the profession won't be as bad as it is now. It seems like the more disgruntled FPs are those running their own practice, whereas those practicing in HMOs such as Kaiser feel better about their group, scheduling, patient care, etc. However if salaries continue to fall there will be fewer and fewer family doctors. I don't see a problem with having NPs take over some family practice territory if they can do so at reduced cost...but I think a scenario where mid-levels provide primary care exclusively, and hospitalists manage admitted patients would be worse for patients. FPs need to band together and create new institutions for providing care.
 
My own PCP also said she would not go into family medicine if she had to do it over again.

Ok, so here's my thought. We are a group of well educated, fairly intelligent people. Let's talk about some possible solutions. Someone in an earlier post said people's attitudes have to change about litigation. I completely agree with this, as many people want to get rich by suing someone into money. That being said, if a doctor is doing something dangerous, he should be able to be sued. How can you guarantee patient's rights if you can't fight for them?

Personally I think preventative medicine is the most important part of medicine. It keeps simple problems from ballooning into more costly, serious health issues. The article points out the problem of giving more people insurance without increasing the number of doctors. What if each doctor had more time to spend with patients instead of paperwork. If we simply made preventative medicine free to everyone, instead of all medicine, and had doctors focus on healthcare instead of paperwork, wouldn't this go a long way to help the problem?
 
in west europe doctors are middle class. and nothing changes for them. there is nothing you can do. i can only suppose that physician salaries would never drop below academic or military salaries, that's $120k/yr. resistance is futile.
 
If we simply made preventative medicine free to everyone...
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Exercise and healthy diets are already free, but millions upon millions of Americans don't take advantage of them. :shrug:

If you want more primary care doctors, you're going to have to provide some incentive for them to brave the hellish clinics they have. Double their salaries or something. Yes, seriously. The primary care scholarships just don't cut it.
 
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MilkmanAl said:
Exercise and healthy diets are already free, but millions upon millions of Americans don't take advantage of them.
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Exactly. People don't want their PCP to tell them to start an exercise program and stop eating cheeseburgers. They want a lap band.

Preventative medicine is one major solution to a lot of the problems, but it requires people to actually listen to their doctors.
 
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engineer
so what you are saying is that 60% of the time....it works all the time!
 
Internal medicine fellow here:

I think (but am not sure) that the 2% figure quoted in the article was 2% of students going in to internal medicine. So that would not count primary care peds or family practice. Also, you have to keep in mind that even if only 2% of students wanted to do primary care, more than 2% will be doing it because some will be forced in to it (i.e. couldn't get in to a more competitive specialty or a medicine subspecialty fellowship). So there will be more than 2% of docs doing primary care...some can leave/quit, but not all will be able to.

That doesn't address the larger questions/problems regarding primary care. The biggest ones are having to see too many patients/day (feels unsafe and is very stressful and very tiring), poor reimbursements vs. specialty care, way too much paperwork, and a lack of respect from some patients and other physicians. Also, what is the incentive to do an fp or general IM residency when a nurse practitioner can do a 2 year master's program (including clinical rotations) and no residency and essentially get the same or a very similar job? A doc can do an endocrine fellowship and only have to address 1-2 problems/visit (i.e. hyperthyroidism only, or diabetes only) or not do a fellowship and have to deal with both these, plus back pain, depression, and a vague "I'm just itching all over" type complaint all in one visit for very similar reimbursement. The future seems quite uncertain for general medical doctors. I don't think hospitalists are the answer to saving primary care...it likely improves the lifestyle, but may erode the salaries of primary care docs, and their place on the "medical totem pole" even more.

I also don't think preventive care is going to save us. I am afraid that many patients are not interested in preventive care, particularly the part that requires lifestyle change. I am saying that from personal experience. I think people know on some theoretical level that eating fast food every day for lunch and not exercising is bad, but many aren't very willing to make any changes. We might make some inroads as far as prevention by launching massive anti-smoking campaigns, particularly if they were aimed at adolescents.

Fear of litigation is another thing that makes general medicine/primary care, as well as working in an ER, scary in some ways. Like it or not, we are going to be held to a similar standard as a specialist in evaluating and treating many problems. At the least we have little margin for error in deciding to refer something vs. not (i.e. refer if you are even a little unsure, because if you miss anything your a-- is toast).
 
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I agree that many people don't want to change their lifestyles, but isn't that also a preventative issue? I don't know how many times I have seen some crazy girl (I say girl, not woman, because usually they look no older than 18-20) give her baby some cookies and chips as the baby drinks orange soda out of a bottle. That seems to be a lack of education issue. Part of preventative care is doctor involvement in his/her patients' lives. If these kids weren't drinking soda out of bottles as babies they might not be so addicted to junk food as older children/adults.
 
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jmillski said:
why would you do pc when a np can do the EXACT same thing? We are here on these boards because 1) we are humanitarians and 2) we are smart enough to be here- we have lots of utility. So I don't understand why we would spend all this incredible amount of utility we have now, and gain in medical school, to go into primary care when nurse practitioners can do the same. Use this utility to benefit the people of the world in a way that only we (hopeful future physicians) can- that only the utility we are able to gain in medical school can be used for. I don't know if the answer is to let np's take it over, or do more to push physicians back in the limelight. This is not banging pcp's at all; I have a great deal of respect for them for everything they have to deal with. Just my two cents and why I will never go into primary care.
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This is actually a great point. I recently went to a CVS "Minute clinic" for a minor skin infection in my toe. It cost $60 and I saw an NP. If I had gone to a doc for this, it would have cost almost $200 and I would have had to wait for 2 days minimum to get an appointment. I think we could easily set up clinics such as these that are staffed by NPs and PAs, leaving physicians to more serious cases (speaking of utility).
 
dragonfly99 said:
Fear of litigation is another thing that makes general medicine/primary care, as well as working in an ER, scary in some ways. Like it or not, we are going to be held to a similar standard as a specialist in evaluating and treating many problems. At the least we have little margin for error in deciding to refer something vs. not (i.e. refer if you are even a little unsure, because if you miss anything your a-- is toast).
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Not only does the fear of litigation discourage individuals from considering a career in medicine, but it also has a impact on the quality of care that doctors are providing. Doctors fear being sued to the extent that they are commonly practicing defensive medicine (unnecessary tests, procedures, referrals, etc.). Not only are there some dangers that come with over-testing patients, but such practices also reportedly drive up healthcare costs.

For those interested the Boston Globe published an article on this topic today: http://www.boston.com/news/local/ma..._fear_of_lawsuits_tied_to_added_costs_of_14b/
 
I would rather get hit with an icepick than be a pcp
 
What's wrong with eating cheeseburgers everyday and sitting around all day? Isn't that what everybody does? Why would anyone tell someone to stop doing those...it seems so hilarious. It's no wonder they don't listen to those doctors, they don't wanna hear outrageous claims like that.
 
WASHINGTON (Reuters) - Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.
And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.
"The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome," the Physicians' Foundation, which conducted the survey, quoted one of the doctors as saying.
The survey adds to building evidence that not enough internal medicine or family practice doctors are trained or practicing in the United States, although there are plenty of specialist physicians.
Health care reform is near the top of the list of priorities for both Congress and president-elect Barack Obama, and doctor's groups are lobbying for action to reduce their workload and hold the line on payments for treating Medicare, Medicaid and other patients with federal or state health insurance.
The Physicians' Foundation, founded in 2003 as part of a settlement in an anti-racketeering lawsuit among physicians, medical societies, and insurer Aetna, Inc., mailed surveys to 270,000 primary care doctors and 50,000 practicing specialists.
The 12,000 answers are considered representative of doctors as a whole, the group said, with a margin of error of about 1 percent. It found that 78 percent of those who answered believe there is a shortage of primary care doctors.
More than 90 percent said the time they devote to non-clinical paperwork has increased in the last three years and 63 percent said this has caused them to spend less time with each patient.
Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.
Seventy six percent of physicians said they are working at "full capacity" or "overextended and overworked".
Many of the health plans proposed by members of Congress, insurers and employers's groups, as well as Obama's, suggest that electronic medical records would go a long way to saving time and reducing costs.
(Reporting by Maggie Fox; editing by Chris Wilson)


i hate hearing things like this...
 
My primary care doctor seems to really enjoy what he does, though he did say he's thought about going back and doing a residency in ortho.

Anyway, I got a C in economics, so I'm not an authority on the issue by any means, but I had an idea. What if -rather than having primary care scholarships- the government were to subsidize primary care physicians' salaries during their residency up to about 100k. That way, they would be earning good money sooner than any other doctors. They still wouldn't make as much later on as other docs, but money is always worth more now than later. They could pay off their debt sooner, lowering the total they pay for interest. I think that would increase med students' interest in primary care; I know it would increase my interest.

Also, since the number of residencies is fixed, the government (or rather, the taxpayers) would know exactly how much they're paying out each year. It would be alot cheaper than, as some suggest, increase PC docs' slaries altogethor. Expensive, yes. But I wonder if it would cost 700 billion dollors.:rolleyes:
 
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sixpence said:
Many of the health plans proposed by members of Congress, insurers and employers's groups, as well as Obama's, suggest that electronic medical records would go a long way to saving time and reducing costs.
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ROFL. If this is what they believe, then it will never get any better. The increased paperwork is not related to charting. It's related towards reimbursements. As long as insurers, and not doctors, are part of the solution, this will not go well for doctors. The problem for primary care docs is that reimbursements have decreased, and filings to insurance companies have increased, such that the time spent on paperwork and the additional number of patients a doctor needs to see each day to earn as much as they did last year, means that doctors have to work longer hours and spend less time per patient. This has resulted in primary care docs feeling overworked, still underpaid, and they have lost the one part of the job they probably sought when they chose the field -- the time sitting and chatting with patients. Since none of these things will be addressed by things such as electronic medical records, I think the focus is all wrong and as a result doctors are going to be SOL. The insurance company and employer's groups are pushing a very different agenda than doctors. And doctors are likely not going to be invited to the boardroom to help navigate a solution (at least they weren't under Clinton, and probably not going to be under Obama). They are going to get portrayed as the bad guys -- threatening retirement or leaving patient care while the good guy insurance companies are being portrayed as the good guys trying to fix things by pushing hospitals to spend on electronic record keeping.


Note -- I merged the two threads on this article.
 
Many doctors in primary care--especially private clinics--have low salaries due to high overhead. In essence, the costs of running their clinics eat up any money left for a decent salary.

Texas is a wonderful example of how you can solve this problem.

Governor Perry signed into law legislation that caps the awards of medical malpractice suits.

And guess what? Insurance premiums have plummeted in Texas. Just a few months ago, the Wall Street Journal published an article about how many doctors are flooding to that state as a result. There are lower insurance premiums for people (a higher percentage of the population now has medical coverage), and doctors are not burdened by obscene medical malpractice insurance.

The trial lawyer lobby has fought similar reform in California tooth and nail. For good reason, too. They would want all of you to believe that government-run, nationalized healthcare is the only solution. With that system in place, the lawyers keep their paychecks.

Medical malpractice caps are fair: to both the doctor and the patient.

It's going to take good legislative policy to cure this problem. Doctors are being burdened with red tape, shrinking salaries, high insurance, and unnecessary litigation due to the legal climate.

And it can be changed. Just look at Texas.
 
jaguarms said:
Many doctors in primary care--especially private clinics--have low salaries due to high overhead. In essence, the costs of running their clinics eat up any money left for a decent salary.

Texas is a wonderful example of how you can solve this problem.

Governor Perry signed into law legislation that caps the awards of medical malpractice suits.

And guess what? Insurance premiums have plummeted in Texas. Just a few months ago, the Wall Street Journal published an article about how many doctors are flooding to that state as a result. There are lower insurance premiums for people (a higher percentage of the population now has medical coverage), and doctors are not burdened by obscene medical malpractice insurance.

The trial lawyer lobby has fought similar reform in California tooth and nail. For good reason, too. They would want all of you to believe that government-run, nationalized healthcare is the only solution. With that system in place, the lawyers keep their paychecks.

Medical malpractice caps are fair: to both the doctor and the patient.

It's going to take good legislative policy to cure this problem. Doctors are being burdened with red tape, shrinking salaries, high insurance, and unnecessary litigation due to the legal climate.

And it can be changed. Just look at Texas.
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Bear in mind that malpractice laws are not set up to stick it to doctors -- the vast majority of claims have legitimate basis. Meaning you are capping relief on people who were actually injured. So while it may work out good for doctors and bad for trial lawyers to place such caps, it really penalizes the folks for who the medmal laws exist in the first place. It's not so clear to me that the Texas model is the best approach. A smarter path would be to use specially trained juries/judges for medical cases, such that emotion is taken out of it and cases are decided based on actual standard of care, by folks who understand the issue beyond seeing a crying family member fighting against a faceless hospital.
 
MilkmanAl said:
Exercise and healthy diets are already free, but millions upon millions of Americans don't take advantage of them. :shrug:
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Ah, but healthy diets aren't free! One of the principal reasons why families lower on the economic ladder tend to have poorer health is because buying nutritious foods is expensive and oftentimes relatively inaccessible. The truth is, the neighborhoods with a high percentage of uninsured families are the same neighborhoods where it's unlikely to find many stores offering healthy options.
 
jmillski said:
i feel this is one of the wisest posts on this site. why would you do pc when a np can do the EXACT same thing? We are here on these boards because 1) we are humanitarians and 2) we are smart enough to be here- we have lots of utility. So I don't understand why we would spend all this incredible amount of utility we have now, and gain in medical school, to go into primary care when nurse practitioners can do the same. Use this utility to benefit the people of the world in a way that only we (hopeful future physicians) can- that only the utility we are able to gain in medical school can be used for. I don't know if the answer is to let np's take it over, or do more to push physicians back in the limelight. This is not banging pcp's at all; I have a great deal of respect for them for everything they have to deal with and breadth of medicine they must practice. Just my two cents and why I will never go into primary care.
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We do it because that is that is what our health care system needs. You say you are a humanitarian but you don't think about where will your skills do the most good for the population. Our country is in serious need of pcp's, np's and pa's. People get to medical school and then they see what their future will hold and the do what is best for them...not what is best for the population, the patients or the health care community. I understand all the reasons why it happens and your post illustrates a major one. As the health care system crumbles around us, we have our future doctors saying 'my skills are too good/too high to put them towards pc'...knowing that is where they would do the most good. We don't need more specialists...we need more primary care doctors and everyone knows it....who is going to do something about it? Obvisouly not our physicians....they are too good for that problem.

"I am compassionate and like to help people...but only 1-2 people a day and only for the right price"....yikes.
 
Law2Doc said:
Bear in mind that malpractice laws are not set up to stick it to doctors -- the vast majority of claims have legitimate basis. Meaning you are capping relief on people who were actually injured. So while it may work out good for doctors and bad for trial lawyers to place such caps, it really penalizes the folks for who the medmal laws exist in the first place. It's not so clear to me that the Texas model is the best approach. A smarter path would be to use specially trained juries/judges for medical cases, such that emotion is taken out of it and cases are decided based on actual standard of care, by folks who understand the issue beyond seeing a crying family member fighting against a faceless hospital.
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How is a 250k limit penalizing people? I would gladly submit myself to various forms of injuries and insults for a 250k payoff, the multimillion suits are just bogus and a clear indication of greed.

Also, there is no such thing as a rigidly defined standard of care. It is seemingly redefined in every case to make the defendant look bad.
 
saqrfaraj said:
Ah, but healthy diets aren't free! One of the principal reasons why families lower on the economic ladder tend to have poorer health is because buying nutritious foods is expensive and oftentimes relatively inaccessible. The truth is, the neighborhoods with a high percentage of uninsured families are the same neighborhoods where it's unlikely to find many stores offering healthy options.
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Spaghetti is a dollar for a box - easily 3 meals. Fruit is cheap. Lots of vegetables are cheap. Oats are cheap. Cereal can be cheap. Bread is cheap. Chicken is cheap. There's no way buying a Happy Meal is less expensive than eating healthily.
 
chessknt87 said:
How is a 250k limit penalizing people? I would gladly submit myself to various forms of injuries and insults for a 250k payoff, the multimillion suits are just bogus and a clear indication of greed.

Also, there is no such thing as a rigidly defined standard of care. It is seemingly redefined in every case to make the defendant look bad.
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$250k may seem like a lot to you, but it is injury dependent -- it shouldn't be capped without reference to the damages. There are people whose hospital bills can be a good chunk of that amount, and folks who need chronic care for various disabilities will go through more than that quite quickly. If a relatively young person needs lifetime meds and therapy and renovations to make their homes/bathrooms wheelchair accessible, and handicap friendly vehicles etc etc, you can go through many hundreds of thousands of dollars before long. There are, in fact, quite a few large dollar awards that aren't windfalls. But Texas just says scrw em.
 
MilkmanAl said:
Spaghetti is a dollar for a box - easily 3 meals. Fruit is cheap. Lots of vegetables are cheap. Oats are cheap. Cereal can be cheap. Bread is cheap. Chicken is cheap. There's no way buying a Happy Meal is less expensive than eating healthily.
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Unhealthy eating doesn't always have to be about fast food, and I don't agree that fruits and veggies are cheap for families on extremely limited budgets. It's hard to eat a balanced diet because the healthiest foods aren't nearly as cost-effective as their unhealthy counterparts. Fruits and veggies can't be bought in bulk and stored the way that processed food can be. For low-income families, the quantity of food they can afford is severely limited, and the need for filling meals becomes even more important. Fruits and veggies aren't nearly as filling as fatty or sugary foods. Furthermore, even if produce was more cost-effective, stores in low-income neighborhoods still tend to have lower quality, less appealing items that people are less likely to buy.

I think the key to the problem is education. Although they're more expensive in terms of short-term expenditures, the long-term benefits of fruits and veggies is well worth the cost.

Anyway, I don't mean to rant. I just think it's important to realize that lack of healthy eating in low-income families is often not just about laziness or disregard.
 
Law2Doc said:
$250k may seem like a lot to you, but it is injury dependent -- it shouldn't be capped without reference to the damages. There are people whose hospital bills can be a good chunk of that amount, and folks who need chronic care for various disabilities will go through more than that quite quickly. If a relatively young person needs lifetime meds and therapy and renovations to make their homes/bathrooms wheelchair accessible, and handicap friendly vehicles etc etc, you can go through many hundreds of thousands of dollars before long. There are, in fact, quite a few large dollar awards that aren't windfalls. But Texas just says scrw em.
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I was under the impression the 250k limit was for the nebulous pain/suffering only and any other expenses incurred due to injury such as hospital bills were a separate unlimited matter.
 
chessknt87 said:
I was under the impression the 250k limit was for the nebulous pain/suffering only and any other expenses incurred due to injury such as hospital bills were a separate unlimited matter.
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You are right that it covers "noneconomic damages". However noneconomic damages are a bit broader a term than just nebulous things such as pain and suffering. It also includes physical impairment, disfigurement, sterility, loss of sexual organs, and other losses such as loss of consortium, enjoyment of life. And individuals frequently have medical expenses above and beyond compensatory damage awards, particularly in chronic care situations where you may not be able to accurately gauge your medical expenses many years in the future, and so in non-tort damage cap states, folks would have a source of funds from which to cover these very real incidentals. All I'm saying is that in instances where someone is legitimately injured - the people for whom the malpractice law was created in the first place, expenses will run up faster than you can imagine. In most such cases folks weren't getting a windfall even before the tort reform, and the state has really stuck it to them after reform.
 
I still don't buy that people have to go the unhealthy route, even if we're talking about caloric needs, regardless of how poor they might be. You can get a hell of a lot of fat from oils. At the start of this semester, I bought 3 liters of olive oil for under $20. I still have a liter left, and I use a lot of olive oil. I also bought a huge pack of chicken breasts (4 pounds) for just under $7. That's your fat and protein and a load of calories. Canned vegetables and fruits are, what, 50 cents a can that has 2 servings?

I think the key to the problem is education.
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This I'll agree on. There are lots of people who honestly don't know what healthy eating entails. My mom would be one of them. Here's an example: beans and rice are healthy, right? Milk is healthy. By extension, cheese must be healthy too, right? And sour cream. Therefore, beans and rice with loads of cheese and sour cream must be healthy. :smack:A little basic dietary information and some scared-straight this-could-happen-to-you health information would really help if it was beaten into kids starting at an early age.
 
MilkmanAl said:
I still don't buy that people have to go the unhealthy route, even if we're talking about caloric needs, regardless of how poor they might be. You can get a hell of a lot of fat from oils. At the start of this semester, I bought 3 liters of olive oil for under $20. I still have a liter left, and I use a lot of olive oil. I also bought a huge pack of chicken breasts (4 pounds) for just under $7. That's your fat and protein and a load of calories. Canned vegetables and fruits are, what, 50 cents a can that has 2 servings?
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You're right, these factors are by no means universal. Low-income families can improve their eating habits with effort. I'm simply presenting these considerations as barriers to healthy eating. They do exist and they are often very difficult to overcome.
 
I am also very sad about what the article implies. I was talking to one of my mentors, who basically told me that it was not worth it to go into primary care. I was shocked and discouraged. He told me that he did not see the sense in spending so much years in school, studying day and night, working your *** off and ending up with the salaries of primary care docs...I could not believe he was outrightedly telling me "Change your mind from primary care."

*btw, he's a plastic surgeon
 
MilkmanAl said:
Spaghetti is a dollar for a box - easily 3 meals. Fruit is cheap. Lots of vegetables are cheap. Oats are cheap. Cereal can be cheap. Bread is cheap. Chicken is cheap. There's no way buying a Happy Meal is less expensive than eating healthily.
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Unfortunately saqrfaraj is very much correct. Fruit, vegetables, and healthy meat are more expensive than happy meals or other common fast-foods. Additionally, supermarkets aren't the same across neighborhoods. For example, a Vons/Safeway in La Jolla looks a lot different than a Vons/Safeway in South San Diego, yet the prices are the same.
 
saqrfaraj said:
Unhealthy eating doesn't always have to be about fast food, and I don't agree that fruits and veggies are cheap for families on extremely limited budgets. It's hard to eat a balanced diet because the healthiest foods aren't nearly as cost-effective as their unhealthy counterparts. Fruits and veggies can't be bought in bulk and stored the way that processed food can be. For low-income families, the quantity of food they can afford is severely limited, and the need for filling meals becomes even more important. Fruits and veggies aren't nearly as filling as fatty or sugary foods. Furthermore, even if produce was more cost-effective, stores in low-income neighborhoods still tend to have lower quality, less appealing items that people are less likely to buy.

I think the key to the problem is education. Although they're more expensive in terms of short-term expenditures, the long-term benefits of fruits and veggies is well worth the cost.

Anyway, I don't mean to rant. I just think it's important to realize that lack of healthy eating in low-income families is often not just about laziness or disregard.
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:thumbup: agreed. it's frustrating to see people (including sdn-ers) equate poverty with laziness to simplify issues that are in fact quite complicated.
 
b33sharp said:
:thumbup: agreed. it's frustrating to see people (including sdn-ers) equate poverty with laziness to simplify issues that are in fact quite complicated.
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On the other hand, you don't get fat by barely meeting your basal metabolic needs, and there are plenty of fat poor people. I'm betting that the people who really do need to eat unhealthily to get the calories they need are a very small minority. (I still don't buy the crap food is cheaper per calorie argument, but I'll go with it for the thread's sake.)
 
I mentioned this before: I had to quickly see a doctor. After waiting for about four hours, the doc spent only about two minutes with me (he did his job fine), but spent over 15 minutes doing charts only on the computer. This clearly shows that at least in this facility, digitalization of data has not done much. Perhaps each facility may save 10% on time and when you add that all across the nation it might materialize into big savings - much like the 200bln stimulus package that most of use only saw from zero to $300. Unless that's the case, I am not sure that the computerization is going to have much impact.
 
1. Don't forget that preparing a healthy meal (and/or making it palatable to finicky children) takes time. Do low income parents have the time to make a healthy meal for (and thereby teach healthy habits to) their children? Many of them work multiple, low-paying jobs just to make ends meet. It's not only cheaper to just pick up fast food, but it's also more time-efficient.

2. Malpractice is a vicious cycle. Overworked doctors who have little time to spend with patients are necessarily more inclined to make mistakes, no? The fundamental issue remains the same.
 
MilkmanAl said:
I still don't buy that people have to go the unhealthy route, even if we're talking about caloric needs, regardless of how poor they might be. You can get a hell of a lot of fat from oils. At the start of this semester, I bought 3 liters of olive oil for under $20. I still have a liter left, and I use a lot of olive oil. I also bought a huge pack of chicken breasts (4 pounds) for just under $7. That's your fat and protein and a load of calories. Canned vegetables and fruits are, what, 50 cents a can that has 2 servings?

This I'll agree on. There are lots of people who honestly don't know what healthy eating entails. My mom would be one of them. Here's an example: beans and rice are healthy, right? Milk is healthy. By extension, cheese must be healthy too, right? And sour cream. Therefore, beans and rice with loads of cheese and sour cream must be healthy. :smack:A little basic dietary information and some scared-straight this-could-happen-to-you health information would really help if it was beaten into kids starting at an early age.
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I emphasized the bolded portion, because saying canned and frozen vegetables are as healthy as fresh is not true at all. If anything the canned stuff is equally unhealthy because of all the preservatives, salt, and other things inside of them.

You can't simply equate fresh food with being the same thing as preserved food. Preserved food is often much, much unhealthier because of those other factors I mentioned.
 
Druzie said:
1. Don't forget that preparing a healthy meal (and/or making it palatable to finicky children) takes time. Do low income parents have the time to make a healthy meal for (and thereby teach healthy habits to) their children? Many of them work multiple, low-paying jobs just to make ends meet. It's not only cheaper to just pick up fast food, but it's also more time-efficient.

2. Malpractice is a vicious cycle. Overworked doctors who have little time to spend with patients are necessarily more inclined to make mistakes, no? The fundamental issue remains the same.
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This is a good point that you make in your first point, and something you should post to Lady Wolverine who seems to think she understands the poor judging from the other thread where the same issue is discussed. I'm not poor, but I've known plenty of people below the poverty line and they reduce the issues without knowing an individual's personal circumstances.

For instance, I had a friend who was nearly evicted out of her apt because she couldn't make ends meet even with 72 hours a week. Its easy to say you can afford healthy food, but they forget that people have bills to pay, rent to pay, insurance payments to pay if they have some, that when the gross income of a lot of poor folk come in, some of these things seem less economical then other options, especially if both parents are working and also have to have someone watch over their children.
 
mdmarty said:
Unfortunately saqrfaraj is very much correct. Fruit, vegetables, and healthy meat are more expensive than happy meals or other common fast-foods. Additionally, supermarkets aren't the same across neighborhoods. For example, a Vons/Safeway in La Jolla looks a lot different than a Vons/Safeway in South San Diego, yet the prices are the same.
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Agreed. And someone in the other thread brought up superwalmart. But not every poor person I know even owns a car. Sometimes the closest grocery store is not the nearest walmart. I know the windixie next to my old house was one of the worst quality grocery stores I've ever been too. I also know most of the poor African Americans and Latin americans I'd see around my old house in Tampa were often walking or bike riding everywhere not in cars where they could drive down the street to superwalmart or walmart which was quite a long way from that area.

Buses run on specific schedules and not always in tune with a person's personal schedule or route of where they need to go. So no its not easy for the poor. What's worse is the regular grocery stores up prices wayyyyyy up. I mean even my middle class parents complain that vegetable and fruit prices are wayyyyyyy to high compared to other foods, which is why they've started to go to the market instead of grocery stores for such things.
 
Obama's got some false promises to healthcare. Every person to a primary care physician, reduce cost of health care, increase quality of healthcare. wtf?!

What the hell is he going to do for the physicians who have to work their asses off and come out of school in major debt. All I see is less quality, more patients, and lowered salaries with an even BIGGER shortage of PCP's. If anyone knows what Obama will do for physicians, please educate me because I would like to know.
 
link2swim06 said:
So hire someone to do the paper work. Or buy a tape recorder and have some type your thoughts.
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Easier said than done. It is hard to find good help. You want to hire someone intelligent and hard-working, who actually cares whether the job gets done well/efficiently/thoroughly/quickly to do your crap work? Good luck. Adding more people adds more drama/complication/expense, especially if they aren't very professional or effective. The responsibility (and complaints) always come back to you.
 
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