dragonfly99

Full Member
10+ Year Member
May 15, 2008
5,089
49
Status (Visible)
  1. Attending Physician
"Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies."
There you have your answer.

Also, keep in mind this is a biased survey. I received it in the mail. The questions were kind of leading, in that they were trying to lead one to say he/she is frustrated w/medicine, and why, etc. Also there is probably a lot of response bias...I didn't send mine in, but docs who are more unhappy are probably more likely to send theirs back.

It wouldn't be THAT hard to get more primary care docs...have to make the lifestyle better, and the reimbursement needs to be closer to that of specialists, so that primary care docs don't have to run a "mill" and see 35 patients/day just to maintain the income they had 5-10 years ago.
 

nontrdgsbuiucmd

Full Member
10+ Year Member
Mar 28, 2008
998
3
my own little world
Status (Visible)
  1. Medical Student
"Dr. Alan Pocinki has been practicing medicine for 17 years. He began his career around the same time insurance companies were turning to the PPO and HMO models. So he was a little shocked when he began spending more time on paperwork than patients and found he was running a small business, instead of a practice. He says it's frustrating.

"I had no business training, as far as how to run a business, or how to evaluate different plans," Pocinki says. "It was a whole brave new world and I had to sort of learn on the fly."

This is interesting in pointing out the changing nature of being an MD in some instances, wait a few years; I'd bet a class or two will become standard in med school regarding "running your practice" or "how to manage staff/accounting/payroll". Conversely, ADP or their competitors may open divisions to handle the business aspects of medical practices, as they now offer services to handle legal aspects related to wrongful discharge & other non-payroll services.

One other small trend - check out today's wall street journal regarding some large employers such as Intel, Pitney Bowes, etc. that are hiring medical staffs including mds to run in-house clinics for their employees in order to reduce time out of work and encourage preventive care.

As Dragonfly said, I'd take this with a grain of salt - ask any professional if they'd consider changing careers if they got a good offer at a firm; would you be surprised if half said they'd consider it?
 
About the Ads

odamae

New Member
10+ Year Member
Jul 29, 2008
8
1
Status (Visible)
  1. Academic Administration
The article also mentioned primary care MDs retiring early or going part time. Also, it mentioned that there were plenty of specialists so the solution is making primary care attractive with an income level comensurate with specialists and easing the patient load. Reducing paperwork would also be important. Otherwise, the gatekeepers are going to be FMGs. Who else is going to want to do it?
 

bipolardoc

Membership Revoked
Removed
10+ Year Member
Jun 24, 2008
203
3
Status (Visible)
  1. Pre-Health (Field Undecided)
The article also mentioned primary care MDs retiring early or going part time. Also, it mentioned that there were plenty of specialists so the solution is making primary care attractive with an income level comensurate with specialists and easing the patient load. Reducing paperwork would also be important. Otherwise, the gatekeepers are going to be FMGs. Who else is going to want to do it?


There is no such thing as a perfect profession. My lawyer friend hates his job, and if he had other options that pay him what he makes he probably would of jumped off ship.

My dentist friend wants to retire by 40 because he found out how he hates dentistry.

80% or so of americans are not satisfied with their degrees.

The beauty of medicine, it is a very versitle degree. You can use it to get a job anywhere around the world. If the US becomes socialized, move to a Middle Eastern Gulf oil rich country that pay the heck out of US trained doctors. Or better yet, start your own business, consult, work for a pharm company, or something of that sort. No one can name me a single degree that is as powerful and versitle as an MD
 

dragonfly99

Full Member
10+ Year Member
May 15, 2008
5,089
49
Status (Visible)
  1. Attending Physician
PA's and nurse practitioners will serve as primary care providers more and more in the future, perhaps. The insurance companies would like it because they can pay them a little bit less than a doc. However, I also predict that many PA's and NP's won't stay in primary care either...they can go work @ a hospital or with a specialist for similar or better pay and not have to deal with the huge amount of paperwork and the hassles of "owning" numerous patients and having to potentially deal with a myriad of problems in one visit.
 

cbrons

Full Member
10+ Year Member
Jul 29, 2007
7,009
4,462
Jungle
Status (Visible)
  1. Attending Physician
The beauty of medicine, it is a very versitle degree. You can use it to get a job anywhere around the world. If the US becomes socialized, move to a Middle Eastern Gulf oil rich country that pay the heck out of US trained doctors. Or better yet, start your own business, consult, work for a pharm company, or something of that sort. No one can name me a single degree that is as powerful and versitle as an MD

Thats what I've always thought, too. If the US becomes even more bogged down by lawyers and bureaucrats, there is always some emerging economy out there that is more promising.

PA's and nurse practitioners will serve as primary care providers more and more in the future, perhaps. The insurance companies would like it because they can pay them a little bit less than a doc. However, I also predict that many PA's and NP's won't stay in primary care either...they can go work @ a hospital or with a specialist for similar or better pay and not have to deal with the huge amount of paperwork and the hassles of "owning" numerous patients and having to potentially deal with a myriad of problems in one visit.

If this does happen, doesn't a doctor still need to supervise them or provide some level of oversight? I don't know how this works but I do know that in the rural town I'm in, with many family practices, the NPs are under direct supervision of physicians who own the practice themselves. Also, would malpractice issues get even worse... with legitimate mistakes and also with legal maneuvering by people who feel the NP/PA was not qualified to give them care and were wrong about XYZ (something an MD or DO would have done too) and sue over not getting a referral?
 

bipolardoc

Membership Revoked
Removed
10+ Year Member
Jun 24, 2008
203
3
Status (Visible)
  1. Pre-Health (Field Undecided)
Thats what I've always thought, too. If the US becomes even more bogged down by lawyers and bureaucrats, there is always some emerging economy out there that is more promising.



If this does happen, doesn't a doctor still need to supervise them or provide some level of oversight? I don't know how this works but I do know that in the rural town I'm in, with many family practices, the NPs are under direct supervision of physicians who own the practice themselves. Also, would malpractice issues get even worse... with legitimate mistakes and also with legal maneuvering by people who feel the NP/PA was not qualified to give them care and were wrong about XYZ (something an MD or DO would have done too) and sue over not getting a referral?
NPs can open their own thing without any/much supervision at all. Some states gives alot more indpendence to PAs as well. Mid-levels will NEVER pose a threat to doctors, never did before, never will. Trust me on that. Look how many mid-levels you got for Anes. for example, got CRNAs and Master of Science in Anes. Assistant, Anes. docs still make 3 times as their mid-level counterparts in this position. Plus docs can always bounce into a sub-specialty, open their own practice, or consult, teach, or live overseas with writing their resume on a napkin. Anyone who argues otherwise doesnt know what they are talking about. One con, you have to grey, work your butt off, invest 12+ years or your life, have no life at times, be too old or too messed up after med school to have a normal non hectic life. Is it really stressful, and can lead to really high substance abuse. And sometimes it can be overwhelming, first one talks about a resident in anes. who got fired for failing asleep during surgery:eek:
http://www.local6.com/health/13759745/detail.html
This one about the drugged up Harvard Plastic Surgeon
http://www.boston.com/news/local/massachusetts/articles/2008/07/25/doctor_with_drug_past_suspended/

And these a sample the 100000000 of other related stuff you can find on this issue.
http://www.nytimes.com/2008/05/07/nyregion/07doctors.html
http://www.washingtonpost.com/wp-dyn/articles/A39677-2005Apr9.html
 

Crelal

So close, yet so far away...
10+ Year Member
7+ Year Member
Sep 24, 2008
241
0
Status (Visible)
  1. Attending Physician
And in reviewing many of my client's bills, there are at least some insurance companies charging the same amount for the same service provided by an MD/DO or an NP/PA. But yet the NP/PA makes less.

Let's hope the insurance executives are forced to utilize the system they have created.
 

dragonfly99

Full Member
10+ Year Member
May 15, 2008
5,089
49
Status (Visible)
  1. Attending Physician
cbrons,
depending on what state you are in, NP's and PA's can operate with little or no supervision. It really depends on which state you live in. Many times they do work with other docs and midlevels, with the MD or DO providing advice PRN, and/or just signing off on some charts but not seeing the patient. Sometimes the "supervising" MD is off site and just signs off on some charts occasionally.

Liability risk is real...it would be the MD or DO that would be sued, in general...if he/she was the "supervising doc". Of course midlevels can be sued for malpractice (so can RN's, etc.) but in general if you are the supervising doc then you would be considered responsible for things like misdiagnosis, as far as I know. Also the doc would probably be seen as the "deep pockets" or the best person to sue.

I'm not feeling threatened by midlevels. I think a lot of them are quite good at what they do and provide important services.

I was just pointing out that from an insurance company point of view, midlevels taking over much of primary care would probably be a good thing because they usually can reimburse them less for providing a particular service. But from midlevels I have known, etc. many of them will do the same thing many docs do - work in primary care and/or a clinic for the underserved, but then burn out (or complete their required years to get gov't loan repayment on their student loans) and then move on to greener pastures in either a less indigent area and/or working in a specialty area like derm or orthopedic surgery. If the powers that be want there to be an adequate supply of folks providing primary care, then they have to make the job better. Patients are a part of this equation too - many don't put much value on primary care and have more respect for specialists, and as their insurance companies are paying for most doctor visits, patients often don't value the economy of seeing one doc for multiple complaints.
 
About the Ads
This thread is more than 12 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.