A Dissident is Here

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Roofie

Roofie

Membership Revoked
Removed
10+ Year Member
What happened to the dissident voices on this forum?

Ex-PCM - Why did he get banned? In my opinion, he's had some of the most insightful threads here. Hope he's here as an alt somewhere.

DarthNeurology? Gone or just taking a break?

As for my namesake, it's a metaphor. I have never adminstered nor taken a roofie.
 
Here's some dissidence for ya....my rant I'm trying to post all over the world...

To all the student docs and residents out there....my rant....

This "belief " and trust in the specialty "Boards" (ABMS) and similar mercenary organizations (ACGME / RRC) is a symptom of the greater ill of the growing bureaucratic control and cost of medicine in general. The medical specialty boards are just another business - another self proclaimed "accreditation" business - a private enterprise - that's found a way to make HUGE profits from leeching off the medical field and driving up costs and making themselves appear as "official" agencies of some credulity - horsepucky - they're just a dang profiteering business who couldn't care less about you and your patients well being. They are driven by greed and controlled by special interests like any bureaucracy. And in fact they are doing more harm than good to the quality and variety of training of medical residents across the country. Many excellent free-standing residency programs with innovative ideas and methods and fresh approaches with regional relevance have been shut down due to the ACGME and the RRC behemoth - and the growth of the "boards" that "certify" physicians - after they've ALREADY proved themselves through State Licensure and many many years of training - both in general medicine and specialty training - and GRADUATED from the programs ready to practice. I got board cert in my first specialty, but I've done 2 residencies and 2 fellowships and I'm tired and sick of test taking - which proves nothing. I know excellent docs who've never boarded, and I know many crappy incompetent docs who are boarded and think the world of themselves - they just know the tricks of taking tests. You know the type. The type that's given us a bad name. Prima Dona University Sophists - on whom we can blame the whole Board scam. No doc took "boards" in the not so distant past - just the academics - because of their dang over-competitiveness and damaged egos. Now we all pay for their folly. Why the need for an ADDITIONAL "Board cert? NO NEED! It was designed by profiteering leeches to prey on those university professor doctors with fragile egos who wanted another sheepskin on the wall to compete with their peers! This has served only to create a generic, controlled and controllable "product" out of previously free-thinking, innovative, and caring physicians of yesterday. And now the very idea of private-practice medicine - like the affordable neighborhood doc who knows his patients personally for a lifetime - is being threatened by socialized government run medicine. I hope all the hospital employed physicians and institutionalized physicians in universities are not falling into this mentality completely. For if they are we will see the rapid decay of the entire field. Perhaps we are already seeing it.
I urge a REVOLT by all the young docs out there - you are becoming a rarity and in demand - as less and less youngsters are going into medicine for these very reasons. Stand up for yourselves - go into private practice - avoid 3rd party payors - do fee for service only - and don't do the dang scam of the specialty boards! You don't need them!
And I would add The Art of Medicine is not yet completely dead. Find an innovative training program that's not yet been shut down by the ACGME / RRC - and join the AAPS (NOT the AMA who own and profit from the CPT coding system!) - and go practice the Art of Medicine for your patients and community - the way it was meant to be practiced. Free market. Good docs will do well, bad profiteering docs will fail. It's as simple as that. And with a lot less overhead, and thus savings for all. The cost of medicine / health care will half overnight if we went back to cash only / fee for service. And I believe the quality would increase exponentially, because you could then afford the time with your patients to figure out whats going on properly. No more rushing to meet your quota and keep under budget - as no more overhead of the overly complex billing and coding system. Pass the word along to the student docs. Private practice is not yet dead. The evil is not the doc - but the bureaucracy trying to control him. You don't need to be an employee. You'll be infinitely happier working for yourself with a new found freedom. Your patients will appreciate it too. People are willing to pay for quality care. I know I am.
 
I agree that there are good/bad docs on both sides of the line and the boards are expensive. And there are definitely 'hoops' to go through that are goofy or redundant. But there is some regulation and competence that needs to be done. For example, I've passed all my boards, a residency and am fully licensed. I technically could hang my name on a shingle and practice in any field of medicine. But I only finished a residency in one field; I shouldn't practice IM since I am not IM trained. There are people who did three years of IM training at 3 different places and never made it past PGY-1 level; technically they did three years of training in IM but it's not the same as finishing a residency and should not be viewed as equal to someone who fulfilled board certification requirements. Could there be some reform/efficiency in the whole LCME/USMLE/ACGME/ABMS pathway? Sure.

Kvetch, the problem with this is that the current healthcare system is too complicated to support a true free market. Also:

1. some practices REQUIRE their docs to be board certified or eligible and state so in the contract. If you let your eligibility pass (often 5 yr limit) without getting boarded, you may find yourself job hunting.
2. Some hospitals are now requiring the same (this is a new shift in some areas).
3. Some managed care organizations require the same. See #5.
4. Patients are increasingly savvy and in general will choose someone boarded over someone who is not if they are made aware that someone is not BC. The ability to check board status online is also becoming more well-known.
5. The majority of the public is unwilling and/or unable to pay-for-service for healthcare (exceptions being plastic surgery and the like). Especially people with insurance that would otherwsie pay for a different provider's service. Only a few specialties can really support a 100% pay for service model.
6. The general public does not have the same insight into physician competence as providers do. Every doctor knows a doctor of whom they would not let treat their worst enemy, but whose patients worship him/her.
 
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