3,000 Junior Doctor’s fail to find work

[dave777]

http://uk.altermedia.info/general/3000-junior-doctors-fail-to-find-work_331.html

There is even a story below about nurses not getting work either

http://uk.altermedia.info/general/student-nurses-fail-to-find-work_424.html

 

[ASDIC]

well thats in Britain due to the National Health Service employing only a certan number of doctors to manage costs...wouldnt happen in the US.

 

[astrife]

Are the european nations with national healthcare systems starting to have a decline in the number of people who go to medical school because the reimbursement isn't that great over there?

 

[tigress]

Just to defend national healthcare (I know that's not the topic of this thread), I want to point out that Great Britain's system is different than almost all the others in that it is a true "socialized" system in which the doctors are all government employees and the government runs the hospitals (like we have with the VA system). Americans like myself who promote a national single-payer health insurance do NOT support that sort of system.

In response to the question above, I have no clue, but in the system proposed by PNHP (www.pnhp.org), for example, physician compensation wouldn't change much. The average would remain the same, but there wouldn't be the same disparity between the higher paying specialites and the lower-paying ones.

Sorry for the unsolicited single-payer promotion here. I'll shut up now

 

[dave777]

well thats in Britain due to the National Health Service employing only a certan number of doctors to manage costs...wouldnt happen in the US.

In USA you do not have a Free National Health Service though

UK residents seem to take it for granted

 

[tigress]

In USA you do not have a Free National Health Service though

UK residents seem to take it for granted

Probably most people in the world take it for granted. The US is the only Western(ized) country in the world to NOT have national health coverage (South Africa didn't used to but now they do too, apparently).

Although personally I think the UK's system is one of the worst out there.

 

[aamartin81]

Probably most people in the world take it for granted. The US is the only Western(ized) country in the world to NOT have national health coverage (South Africa didn't used to but now they do too, apparently).

Although personally I think the UK's system is one of the worst out there.

Germany and France (I believe) have a system of mandated private coverage, similar to what we have for car insurance.

 

[tigress]

Germany and France (I believe) have a system of mandated private coverage, similar to what we have for car insurance.

In any case, no matter what they have, they still have national health coverage. Single-payer isn't the only way to reach that goal. Israel also has a multipayer system. I don't know much about France, but in Germany at least there is universal coverage with the government overseeing all insurance efforts. Healthcare in Germany is not part of the market system, as there isn't business competition involved. They aren't the best in terms of GDP spent, but still much better than the US. Mandated coverage with strong government oversight is definitely another option for universal coverage, but not the one I personally support.

Countries like Canada and Australia are much better examples of national health care, in my opinion. But every time I get into this on sdn it just turns into a big fight. I mostly just wanted to mention the single-payer thing to point out that national health coverage doesn't necessarily translate into falling salaries for physicians (except the highest-paid ones who mostly abuse the system right now; of course, they may continue to abuse any single-payer system, since it's mostly Medicare they abuse anyway, but maybe with better oversight this will decrease).

 

[C.P. Jones]

what about italy!!!! ranked 2nd behind france! gooooo italy!

 

[HMSNeuro]

In any case, no matter what they have, they still have national health coverage. Single-payer isn't the only way to reach that goal. Israel also has a multipayer system. I don't know much about France, but in Germany at least there is universal coverage with the government overseeing all insurance efforts. Healthcare in Germany is not part of the market system, as there isn't business competition involved. They aren't the best in terms of GDP spent, but still much better than the US. Mandated coverage with strong government oversight is definitely another option for universal coverage, but not the one I personally support.

Countries like Canada and Australia are much better examples of national health care, in my opinion. But every time I get into this on sdn it just turns into a big fight. I mostly just wanted to mention the single-payer thing to point out that national health coverage doesn't necessarily translate into falling salaries for physicians (except the highest-paid ones who mostly abuse the system right now; of course, they may continue to abuse any single-payer system, since it's mostly Medicare they abuse anyway, but maybe with better oversight this will decrease).

Hmm, concerning your argument that specialists get paid more (sometimes, much more) than non-specialists... well, yeah. I think you need to consider the amount of training and the risk faced everyday by these doctors. Neurosurgeons train for 7-9 years, come within millimeters of paralyzing people, and do it everyday. They deserve their compensation.

 

[hardy]

Germany and France (I believe) have a system of mandated private coverage, similar to what we have for car insurance.

Which is actually a much better system than a single-payer health insurance. This keeps up competition and gives companies incentives to lower costs when possible. However, these countries also require health insurance companies to insure you, no matter what kind of risk you are (unlike car insurance which does not have to insure you). To solve this problem there is a national fund which equalizes the financial risk that some insurances have with the difference in demographics. That means that an insurance with older customers who cause higher costs will receive money from the fund while an insurance with younger customers will pay into the fund.
This system seems to keep the best of both worlds. Competition is kept up but everybody is given healthcare.

And by the way, the german system does not really follow this. It is much closer to a single payer health insurance which does not seem to work very well.

 

[tigress]

Hmm, concerning your argument that specialists get paid more (sometimes, much more) than non-specialists... well, yeah. I think you need to consider the amount of training and the risk faced everyday by these doctors. Neurosurgeons train for 7-9 years, come within millimeters of paralyzing people, and do it everyday. They deserve their compensation.

Oh no, I'm not talking about specialists in what you quoted. I just mean doctors engaged in the all-too-common practice of insurance fraud, most often with Medicare.
I do think specialists will always be compensated more. Just perhaps not as MUCH more. The gradient is really pretty steep.

 

[tigress]

And by the way, the german system does not really follow this. It is much closer to a single payer health insurance which does not seem to work very well.

Where's the evidence that it doesn't work very well? I'm willing to read whatever you show me.

In any case there's no doubt that the system we have now in the US works horribly. So whatever the solution, there ought to be one.

 

[EctopicFetus]

Where's the evidence that it doesn't work very well? I'm willing to read whatever you show me.

In any case there's no doubt that the system we have now in the US works horribly. So whatever the solution, there ought to be one.

The problem with a single payer system is that that single payer can and will tell you just how much you will make. If there is no free market then you damn well better believe physician pay can/will decrease (while our congress passes pay raises for themselves). There is currently a proposed 4.4% reduction in physician reimbursement being proposed for next yr. The US government pays 50% of all health care costs in this country. The problem is most of these cuts are usually against primary care docs.

As far as free health care for everyone in the US...I would ask you this considering how incredibly unhealthy we are isnt it impressive that we live as long as we do. We are the fattest, unhealthiest, and most sedentary society in the world. Meanwhile we have life expectancies near any other country. Show me where national healthcare does work? The real issue is that the working poor are screwed whereas those who dont work at all get Medicaid. The system is a farce. The patients who get free care usually are non-compliant and dont care for themselves and then end up in worse shape than before. This then of course requires even more expensive care (think diabetic complications). Dont you think these people should take some personal responsibility for their actions? Of course this is the pre-med forum so perhaps you guys havent had the experience to really see whats going on..Well i just wanted to drop my $0.02. This is a tough choice we have to make and while I agree the system is messed up I am not sure free health care for all is the solution. Perhaps we should start with Tort reform!

 

[EctopicFetus]

I cant say I agree with all of this but.. Here is some reading...

http://www.signalhealth.com/node/339

Also keep in mind that governmental centralization has failed in every single program we have ever approved. The reality is politics only screws things up and we will end up wasting a ton of money. I did see something from the group you state and they think that a 7% payroll tax and a 2% income tax would cover the costs. The issue is we currently spend between 14-17% of our GDP on healthcare. Somehow their numbers dont add up. There is a 5-8% discrepancy. Like I said there arent simple solutions to this complex problem. The real issue is the government has shown and continues to show they are incompetent. The free market is the only way to gain efficiencies that are really necessary.

 

[C.P. Jones]

i think tigress is a troll, just taking a really really long time to set herself up as a regular member and then finally hijack a thread to turn it into another healthcare battle

 

[aamartin81]

Where's the evidence that it doesn't work very well? I'm willing to read whatever you show me.

In any case there's no doubt that the system we have now in the US works horribly. So whatever the solution, there ought to be one.

Here are some articles which address the single payer system:

http://www.heritage.org/Research/HealthCare/HL702.cfm

http://www.csmonitor.com/2005/0808/p06s01-woam.html


In short, they state that Canadians, UK citizens, etc... are unhappy with their system of healthcare. Do you remember a few years back when the Prime Minister of Canada came to Cleveland (I think) for private treatment?

A major problem with the US system of healthcare is a lack of standardization among insurance providers. This leads to increasing amounts of time spent on administration in place of patient care. Moreover, Medicare is set to unroll a new series of procedural "G" codes which are not used by any of the private insurers (Blue Cross, Cigna, Aetna, UHC, etc...) to promote efficiency in the workplace - does that make sense at any level?

The US must decide what level of health service (if any) is a right. I wrote about this in another thread, but where the shortcoming of the American health system is now who can afford to pay, the expense of the socialized health system is who can afford to wait. An easy example is the emergency cardiac bypass which can be diagnosed and treated in roughly 3-4 days in the US, but would take ~20+ days to schedule an appointment with a cardiologist and ~15 days to schedule surgery under the Canadian system. The result: patient dies.

In the private model, patients often abuse coverage by paying their yearly deductible and proceeding to demand the highest level of technological tests for everyday problems (MRI's for bruised knees and shoulders). Do you as a physician tell them no? The patient has no incentive to keep costs low. Perhaps limiting an insurance company's exposure to patient expenses over a fixed period of time would increase the chance the patients sought only those tests which were medically necessary. Or maybe that would lead to higher levels of bankruptcy (I don't know).

Other considerations: Should the government use taxes levied on all to support the continued health of those who knowingly abuse their bodies (through smoking, drug use, criminal activity, etc...)? Can you imagine being forced to pay for car insurance for a driver who actively seeks to wreck into others - only to have his car looked at/fixed to do it again?

These are just a few of the issues that I think should be addressed in "fixing" the US system of healthcare.

 

[tigress]

i think tigress is a troll, just taking a really really long time to set herself up as a regular member and then finally hijack a thread to turn it into another healthcare battle

I'm not a troll, I'm an ogre...oh wait, I'm a tigress. ROAR.

thanks for the responses guys. I'm always open to reading other opinions. I think I'll still keep mine at the moment, though

edit: I can't keep myself from responding. I'm so annoying.

Anyway, there are plenty of waits in our current healthcare system. I don't know where you're getting your figures as far as cardiac care, but patients in this country often wait for months for an appointment. At the neurology clinic where I work patients would have to wait for 3-5 months just to get in if it weren't for the doctor demanding to see them within a month and then staying extra just to fit everybody in (she's always booked like 120%). For other doctors patients DO have to wait for 3-5 months. And that's common.

I hate to recommend this book, because I think it's not well written and way too sensationalistic, but Critical Condition has some good info about this in it. Unfortunately it's also tainted by poor use of statistics, not nearly enough actualy data/information, and a polemic tone.

 

[EctopicFetus]

In the private model, patients often abuse coverage by paying their yearly deductible and proceeding to demand the highest level of technological tests for everyday problems (MRI's for bruised knees and shoulders). Do you as a physician tell them no? The patient has no incentive to keep costs low. Perhaps limiting an insurance company's exposure to patient expenses over a fixed period of time would increase the chance the patients sought only those tests which were medically necessary. Or maybe that would lead to higher levels of bankruptcy (I don't know).

Patients can demand a lot. The fact is physicians have to order an MRI. most patients have no idea what to order or what needs to be ordered. Most of the time they will ask and a decent doc just tells them why they dont need it. Docs have to be held accountable for practicing poor medicine. I just did a month on the MICU and my attending would always complain about being getting transfused blood with hemes of 8. He told the other attending that there is no EBM to support this. He said well "i want it".. He told us it costs $2k for each unit we transfuse. Thats a lot of wasted money. Another example is my FP attending during 3rd yr. We were talking about ordering CT heads. He said he just always orders with and without cause he cant remember which one he needs. Then the Rads guys will read it either way. The cost of doing that is about 1K. I mean think about these numbers we are talking about. This is pure waste. The issue is that there is an outside payer and the amount of money spent has no effect on the doc or the patient and as such there is little incentive to reign in costs.

 

[daviddamoore]

There is a good discussion (from a pro-universal healthcare perspective) here:

http://ezraklein.typepad.com/blog/health_of_nations/index.html

It's especially interesting to see that french physicians make abou $55k a year, yet French healthcare is ranked #1 by the WHO. When that seems very little, bear in mind that to go to med school in England (I'm not sure about France) used to only cost about $3500 a year, covered by below inflation rate loans!

Another thing to throw in the equation is that the GPs in England are getting all pissy at the moment because they are being asked to have their offices open on the weekend...lazy bastards!;-)

 

[EctopicFetus]

Anyway, there are plenty of waits in our current healthcare system. I don't know where you're getting your figures as far as cardiac care, but patients in this country often wait for months for an appointment. At the neurology clinic where I work patients would have to wait for 3-5 months just to get in if it weren't for the doctor demanding to see them within a month and then staying extra just to fit everybody in (she's always booked like 120%). For other doctors patients DO have to wait for 3-5 months. And that's common.

Uh its her clinic. She doesnt need to demand anything. It is her show. She is overbooked, and this leads to the question of allocation of our docs. Sadly, we are people and many (not me) want to live in Cali and other "nice" areas. Also docs tend to want to live near cities, additionally, many docs dont want to work in the inner city due to frustration of patient noncompliance. If you are truly that sick you have the option of going into the ED (my field) and most docs hold spots for people who are really sick. Most people in Neuro are there for long term issues. Having them wait is not essential. There is a ton of evidence out there that people with socialized medicine have significantly longer waits to see docs. Tigress, I assume you arent arguing vs that. I havent known too many people who have to wait to see a doc for 3-5 months. I have NEVER heard of a wait this long. The only exception is if one of the docs is so great that people WANT to wait for them. Otherwise there are other docs out there who can help you. I would say for things like Derm and other non-essentials the wait can typically be 4-6 weeks. I have rarely heard of longer waits and like i said if you are really sick there are other options.

 

[EctopicFetus]

Actually one final thing. One of the interesting things brought up on a previous thread was that the majority of people who are pro-universal healthcare are either older docs and those who are still not in med school. Just something interesting to consider.

 

[titoincali]

I'm not a troll, I'm an ogre...oh wait, I'm a tigress. ROAR.

thanks for the responses guys. I'm always open to reading other opinions. I think I'll still keep mine at the moment, though

edit: I can't keep myself from responding. I'm so annoying.

Anyway, there are plenty of waits in our current healthcare system. I don't know where you're getting your figures as far as cardiac care, but patients in this country often wait for months for an appointment. At the neurology clinic where I work patients would have to wait for 3-5 months just to get in if it weren't for the doctor demanding to see them within a month and then staying extra just to fit everybody in (she's always booked like 120%). For other doctors patients DO have to wait for 3-5 months. And that's common.

I hate to recommend this book, because I think it's not well written and way too sensationalistic, but Critical Condition has some good info about this in it. Unfortunately it's also tainted by poor use of statistics, not nearly enough actualy data/information, and a polemic tone.

tigress, I would also recommend Health care Meltdown by LeBow. Fantastic overview for implementing the single payer system in the US.

 

[tigress]

It's not her clinic, it's the University clinic. So she does have to demand things. And having the patients wait is incredibly essential if they have ALS (they do), and they can potentially deteriorate significantly in the space of a few months.

Personally I've had to wait 3 months to get into a new rheumatology practice in a new city. I assume if I said it was an emergency they might have made it sooner, but even so it's a long time to wait. Granted, rheumatology isn't like cardiology or something, but 3 months is enough time for a disease to get pretty damaging.

No, I don't think that we have waits as long as in Canada. On the other hand, EVERY Canadian I know is extremely proud of their health system. Of course there are problems with it. I don't think we need to go and adopt the Canadian model. But it still works better than ours by all measures of healthcare outcomes. That's why the WHO lists us at like 30-something for average number of healthy years expected, way below any of the other "first world" countries. And our life expectancies really aren't as good as other countries. I understand all of the confounding variables that people will point out about our population being less healthy to begin with, but I think that's also partially a failure of the health system. Another very important thing to realize is that Canada has far less in the way of health infrastructure than we do. If we went to a single-payer system, adequately funded, our infrastructure (MRIs, etc.) wouldn't suddenly disappear. We would make the system so that we wouldn't have to face the same waits as in Canada. But did you know that countries like Italy have more MRIs per capita than the US? Many countries with a national health coverage have an even better infrastructure than we do, spend way less of their GDP on healthcare, and don't have the same problems with waits as Canada does. That doesn't mean there aren't problems. I'm sure every system has problems. But there has to be something better than what we have now.

I do agree that it's screwed up that the working poor don't get covered. And of course people should take responsibility for their own health. On the other hand, I don't think diabetics and others, for the most part, are noncompliant by choice. It's not just that they're lazy. Granted I dont have as much exposure as you do, but I have some, and in my experience in a significant percentage of these cases it's a lack of patient education. People just don't understand how to take care of themselves, nor do they understand the consequences of not taking care of themselves. I'm sure there are people who are just lazy and don't care, but I'd suggest that they are in the minority.

btw, Medicare operates on a 2.5-5% overhead, compared to 15-30% for private insurers. Not to mention the duplication of effort that goes into multiple billing codes, multiple billing departments, each insurer having to employ people to do the same jobs as the others. We could provide good insurance to everybody at or below our current level of spending by just reducing all of this crazy overhead. Even something incredibly simple like making all billing codes the same would have an impact! Of course this falls on the individual doctor who has to hire enough staff to cover billing and insurance. We'd all be better off with a more streamlined system.

Of course I don't have the answers. Based on what I've read and heard and experienced I believe single-payer to be the best solution. I'm active in groups who are fighting to make it happen. But I can change my mind if I see a better suggestion. So far I just haven't.

 

[tigress]

Actually one final thing. One of the interesting things brought up on a previous thread was that the majority of people who are pro-universal healthcare are either older docs and those who are still not in med school. Just something interesting to consider.

That's just not true. The membership of PNHP is doctors of all ages. In my local chapter we have med students, young physicians, middle-aged physicians, and older physicians. One of the leaders here in Philadelphia is Walter Tsou, who is probably in his 40s I'd guess, and of the other very active members there is one young doc (early30s? or younger even) and one older (60s?). Then in the lay-person group there are tons of nurses of all ages, as well as other non-medical people (teachers, etc.) of all ages.

Also, I think you are pro-universal healthcare. Just not via a single-payer system But how many people don't think everybody should be able to get healthcare? Even free market capitalist people would love for everybody to be able to afford it, right?

 

[tigress]

tigress, I would also recommend Health care Meltdown by LeBow. Fantastic overview for implementing the single payer system in the US.

yup, I have that one out from the library right now! thanks
I heard one of the authors of Critical Condition speak last Monday night. He wasn't too impressive. It's always a shame when somebody finally gets your cause out there in the open but their treatment of it sort of sucks.

 

[EctopicFetus]

Also, I think you are pro-universal healthcare. Just not via a single-payer system But how many people don't think everybody should be able to get healthcare? Even free market capitalist people would love for everybody to be able to afford it, right?

Heck I think it would be great. My issue is who is gonna pay for this? I also wish everyone could have a mansion and a maid and a Bentley if they wanted one but I dont think its feasible unless we find a ton of oil. Then we too could live like Oil Barons! I am not mocking your beliefs as I think there are many valid points. I guess it comes down to the discussion of healthcare as a right vs a priviledge.

Lastly, you mention the patients with Diabetes who may be poorly educated about the disease, I think this is true in some cases.. How about the smokers? i think EVERY person in this country and MOST in the world know about the dangers of smoking. Yet 25% of people in the US smoke. This then leads to COPD and a ton of diagnostic tests and a long list of meds that they go on before they die. It just seems reckless IMO to pay for people to knowingly and willingly harm themselves and then pass the bill on to society.

 

[hardy]

Where's the evidence that it doesn't work very well? I'm willing to read whatever you show me.

http://www.diw.de/deutsch/produkte/publikationen/wochenberichte/docs/03-07-1.html

Maybe you can find information about it in English but since I know German I prefer to go to the source.

 

[EctopicFetus]

you can translate that web page by going to www.systranbox.com

 

[hardy]

Heck I think it would be great. My issue is who is gonna pay for this?

That's why you need to keep up competition and make patients pay an amount respective to their income. The problem is not that we couldn't afford healthcare for everbody, the problem is that people like to abuse free services. If the doctor visit is completely free, people do not think about whether they really need to go for a simple cold.

 

[EctopicFetus]

Obviously tigress you wont change my view and I wont change yours. The discussion truly rests on our core beliefs and they are difficult to change. Good luck in your future studies.

 

[tigress]

You might change mine. You never know

 

[tigress]

That's why you need to keep up competition and make patients pay an amount respective to their income. The problem is not that we couldn't afford healthcare for everbody, the problem is that people like to abuse free services. If the doctor visit is completely free, people do not think about whether they really need to go for a simple cold.

I'm curious about statistics on abuse in countries with a national health system. From what I've read, most people don't abuse it, and with oversight those who do can be handled (I read in one place of an idea of increasing copays for basic clinic visits unrelated to ongoing treatment, or something like that). Anyway, I really don't know too much about this particular issue, but it's certainly an important one.

I really should go do the laundry and clean the apartment. I'm such a lazy bumb. And an sdn addict

 

[hardy]

I'm curious about statistics on abuse in countries with a national health system. From what I've read, most people don't abuse it, and with oversight those who do can be handled (I read in one place of an idea of increasing copays for basic clinic visits unrelated to ongoing treatment, or something like that). Anyway, I really don't know too much about this particular issue, but it's certainly an important one.

well, I should work too, so I can't really spend all the time to look for the statistics right now
But here a little anecdote for which you should be able to find plenty of sources online. Germany introduced a kind of copay for clinic visits two years ago. The reason was that there were simply too many unnecessary visits. Unfortunately, it has not helped much since it is a once per quarter fee of 10 euros, which is a joke. After a reduction in unnecessary visits at the beginning they simply rebounded.

I never understand the polarization on any kind of issue. People always think that one of two extremes (in this case a total socialist system or only private coverage) is the only solution and act like it. But usually the most practical solution is found somewhere in the middle.

 

[EctopicFetus]

I am all for nothing but disaster insurance and health care spending accounts. I think that could help. As far as having people pay based on their income this already happening. The rich pay more in taxes and pay a greater % of their income in taxes.

practical solution is found somewhere in the middle

Ahh yes aristotle's golden rule. Let me say I am 100% all for health care spending accounts. It would be much more beneficial in ways too numerous to count.

 

[medworm]

Looks like a 3 person conversation, but I'm enjoying it! Lots of good "left, right, and center" points. Keep up the discourse (while I do some research myself ).