doctors warn U.S primary care may collapse

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skypilot

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    Medicare will pay tens of thousands of dollars ... for a limb amputation on a diabetic patient, but virtually nothing to the primary care physician for keeping the patient's diabetes under control,"

    This is the problem. Everyone wants to do the procedures and make the $$$. Nobody wants to provide the prevention and care.
     

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      skypilot said:
      Medicare will pay tens of thousands of dollars ... for a limb amputation on a diabetic patient, but virtually nothing to the primary care physician for keeping the patient's diabetes under control,"

      This is the problem. Everyone wants to do the procedures and make the $$$. Nobody wants to provide the prevention and care.

      I found that quote particularly striking, too, and I know it's true. It's so much better for everyone (except I guess surgeons, etc.) if chronic diseases like diabetes can be properly managed before you reach those really dire complications. It's too bad that our system doesn't reward prevention. This is where my insurance is actually good because it covers 100% of preventative treatment other than prescriptions. Of course, the treatment has to be approved, and I have to pay the difference between what my doctor charges and what the insurance company says she should charge.
       

      CambieMD

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        The medical system as it now stands should be on the verge of collapse. Physicians have been victimized for years. Insurance companies are set up to screw doctors over. So now they are saying that soon the insurance companies will not have enough pcps to screw over. This is merely the open market doing what it does. Physicians speak with their feet. Being buried in paper work and having to see an increasing number of patients becomes frustrating. I am suprised when the occasional med student mentions the desire to pursue a primary care specialty. They are usually clueless as to what they are getting into.

        Primary care will get better only when patients start to get harmed because there is a dire shortage of providers.

        A plumber came to my house on Christmas Eve. I had no choice but to seek out a plumbermy toilet was overflowing when the washing machine was turned on. The plumber was this young dude with piercings and earrings.
        He spent at max 1.5 hrs at my house and drove into the night with a check for $600. He did not file a claim. I wrote a check and received a receipt.
        The present system is set up to rob doctors. I have never heard of an insurance company that was in financial trouble. Physicians especially pcps have been working harder to make up for declining reimbursement.
        They say that crime doesn't pay. That is not true. Talk the guys defending those liers from Enron. Insurance companies do not pay and a physician has little recourse if any. I am hoping the market forces will cause major changes in the healthcare sector. And please do not say that we need socialized medicine. Has the government done anything right.

        CambieMD
         

        gungho

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          CambieMD said:
          The medical system as it now stands should be on the verge of collapse. Physicians have been victimized for years. Insurance companies are set up to screw doctors over. So now they are saying that soon the insurance companies will not have enough pcps to screw over. This is merely the open market doing what it does. Physicians speak with their feet. Being buried in paper work and having to see an increasing number of patients becomes frustrating. I am suprised when the occasional med student mentions the desire to pursue a primary care specialty. They are usually clueless as to what they are getting into.

          Primary care will get better only when patients start to get harmed because there is a dire shortage of providers.

          A plumber came to my house on Christmas Eve. I had no choice but to seek out a plumbermy toilet was overflowing when the washing machine was turned on. The plumber was this young dude with piercings and earrings.
          He spent at max 1.5 hrs at my house and drove into the night with a check for $600. He did not file a claim. I wrote a check and received a receipt.
          The present system is set up to rob doctors. I have never heard of an insurance company that was in financial trouble. Physicians especially pcps have been working harder to make up for declining reimbursement.
          They say that crime doesn't pay. That is not true. Talk the guys defending those liers from Enron. Insurance companies do not pay and a physician has little recourse if any. I am hoping the market forces will cause major changes in the healthcare sector. And please do not say that we need socialized medicine. Has the government done anything right.

          CambieMD
          well said.
           

          lateness

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            A plumber came to my house on Christmas Eve. I had no choice but to seek out a plumbermy toilet was overflowing when the washing machine was turned on. The plumber was this young dude with piercings and earrings.
            He spent at max 1.5 hrs at my house and drove into the night with a check for $600. He did not file a claim. I wrote a check and received a receipt.
            The present system is set up to rob doctors. I have never heard of an insurance company that was in financial trouble. Physicians especially pcps have been working harder to make up for declining reimbursement.
            They say that crime doesn't pay. That is not true. Talk the guys defending those liers from Enron. Insurance companies do not pay and a physician has little recourse if any. I am hoping the market forces will cause major changes in the healthcare sector. And please do not say that we need socialized medicine. Has the government done anything right.


            I agree. I went to the mechanic to pick up my car. Had to pay, otherwise getting not getting my car. If you want a service done for your house, electricity, plumbing, roofing, anything, you have to PAY. Primary care, is the only job that a person can come in, or call and get services and not pay a cent. Especially when they allow their insurance to take over..
            Its a sad state., but hopefully something will have to change for the better, there is no other way..
            yes





            CambieMD[/QUOTE]
             

            SigPi

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              bafootchi said:
              I agree. I went to the mechanic to pick up my car. Had to pay, otherwise getting not getting my car. If you want a service done for your house, electricity, plumbing, roofing, anything, you have to PAY. Primary care, is the only job that a person can come in, or call and get services and not pay a cent. Especially when they allow their insurance to take over..
              Its a sad state., but hopefully something will have to change for the better, there is no other way..
              yes
              CambieMD
              [/QUOTE]


              This leads us to the question we all preped for during med school interviews: Does everyone have the right to healthcare, regardless of ability to pay? If you answered yes, then realistically SOME form of a national health system (like Praetorian mentioned would ruin medicine) must be part of your explanation. It's not that i dont agree that billing can suck, or that I believe in socialized medicine --I'm just playing devil's advocate. WE are the ones that will have to advocate for change because WE are going to be the ones wading through this $hit for the next 30 years.
               

              iatrosB

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                SigPi said:
                This leads us to the question we all preped for during med school interviews: Does everyone have the right to healthcare, regardless of ability to pay? If you answered yes, then realistically SOME form of a national health system (like Praetorian mentioned would ruin medicine) must be part of your explanation. It's not that i dont agree that billing can suck, or that I believe in socialized medicine --I'm just playing devil's advocate. WE are the ones that will have to advocate for change because WE are going to be the ones wading through this $hit for the next 30 years.

                No doubt man. It is easy to complain, but hard to propose alternative solutions. :thumbup:
                 

                Atlas

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                  CambieMD said:
                  The medical system as it now stands should be on the verge of collapse. Physicians have been victimized for years. Insurance companies are set up to screw doctors over. So now they are saying that soon the insurance companies will not have enough pcps to screw over. This is merely the open market doing what it does. Physicians speak with their feet. Being buried in paper work and having to see an increasing number of patients becomes frustrating. I am suprised when the occasional med student mentions the desire to pursue a primary care specialty. They are usually clueless as to what they are getting into.

                  Primary care will get better only when patients start to get harmed because there is a dire shortage of providers.

                  A plumber came to my house on Christmas Eve. I had no choice but to seek out a plumbermy toilet was overflowing when the washing machine was turned on. The plumber was this young dude with piercings and earrings.
                  He spent at max 1.5 hrs at my house and drove into the night with a check for $600. He did not file a claim. I wrote a check and received a receipt.
                  The present system is set up to rob doctors. I have never heard of an insurance company that was in financial trouble. Physicians especially pcps have been working harder to make up for declining reimbursement.
                  They say that crime doesn't pay. That is not true. Talk the guys defending those liers from Enron. Insurance companies do not pay and a physician has little recourse if any. I am hoping the market forces will cause major changes in the healthcare sector. And please do not say that we need socialized medicine. Has the government done anything right.

                  CambieMD

                  agreed. well said.
                   

                  cooldreams

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                    im interested in the later part of the story where a solution IS suggested, where the pcp (no not pneumocystis - although now pjp haha) has actual control over the preventative side of stuff for the patient, and directs the patient how to proceed. notice the lack of a hmo directing??? notice the lack of patient looking through insurance manuals?? or of the government interacting?? this is how it SHOULD be.

                    also im wondering - does everyone have the right to plumbing??
                     

                    iatrosB

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                      cooldreams said:
                      im interested in the later part of the story where a solution IS suggested, where the pcp (no not pneumocystis - although now pjp haha) has actual control over the preventative side of stuff for the patient, and directs the patient how to proceed. notice the lack of a hmo directing??? notice the lack of patient looking through insurance manuals?? or of the government interacting?? this is how it SHOULD be.

                      also im wondering - does everyone have the right to plumbing??

                      Yo cool,

                      You shooting for FP or neurosurg. Did the neuro block burn you out on neuro, it sure has me!
                       
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                      cooldreams

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                        ask me on an even number day and ill say neuro :/

                        i have no idea man... just working for God you know?

                        i did manage to get the chance to do some ns research this summer, so thats pretty cool... i dunno man...
                         

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                          bafootchi said:
                          A plumber came to my house on Christmas Eve...He spent at max 1.5 hrs at my house and drove into the night with a check for $600.

                          Heh. Reminds me of that old joke:

                          A pipe burst in a doctor's house. He called a plumber. The plumber arrived, unpacked his tools, did mysterious plumber-type things for a while, and handed the doctor a bill for $600.

                          The doctor exclaimed, "This is ridiculous! I don't even make that much as a doctor!"

                          The plumber quietly answered, "Neither did I when I was a doctor."

                          ;)
                           

                          cooldreams

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                            KentW said:
                            Heh. Reminds me of that old joke:

                            A pipe burst in a doctor's house. He called a plumber. The plumber arrived, unpacked his tools, did mysterious plumber-type things for a while, and handed the doctor a bill for $600.

                            The doctor exclaimed, "This is ridiculous! I don't even make that much as a doctor!"

                            The plumber quietly answered, "Neither did I when I was a doctor."

                            ;)


                            ouch

                            man, ive done some research on the whole plumber-bit. call around, the high prices are charged by union guys. find a nonunion plumbershop and the cost is less than half. also those union guys really dont get all of that check, it goes back to the company, and they get paid through the union which also then takes their own cut....

                            personal case in point, call union "X" plumber for pipe tree in garage to be replaced. comes out gives estimate for 2500 for just that section. i say no thanks, charged 50 for the estimate :eek: ... i call nonunion "Y" plumber about same job, they estimate 600 for that tree plus concrete repair and entire stack all done plus a cleaning of pipes that will stay... all 600. huge huge huge difference. this was like a major plumbing redo here... 600. they were there for 3.5 hrs.....
                             

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                              cooldreams said:
                              ouch

                              man, ive done some research on the whole plumber-bit. call around, the high prices are charged by union guys. find a nonunion plumbershop and the cost is less than half. also those union guys really dont get all of that check, it goes back to the company, and they get paid through the union which also then takes their own cut....

                              personal case in point, call union "X" plumber for pipe tree in garage to be replaced. comes out gives estimate for 2500 for just that section. i say no thanks, charged 50 for the estimate :eek: ... i call nonunion "Y" plumber about same job, they estimate 600 for that tree plus concrete repair and entire stack all done plus a cleaning of pipes that will stay... all 600. huge huge huge difference. this was like a major plumbing redo here... 600. they were there for 3.5 hrs.....

                              Great logic. Soon you will be paying the union guy $2500 anyway when your pipes explode because the non-union guy had inadequate training and generally doesn't give a damn about his work.
                               

                              cooldreams

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                                DrRobert said:
                                Great logic. Soon you will be paying the union guy $2500 anyway when your pipes explode because the non-union guy had inadequate training and generally doesn't give a damn about his work.

                                idunno... both garanteed their work for a year, its been working ok for 3 yrs? dood i did electrical engineering work AT an electrical union shop. i have done estimates, i KNOW unions bill more, and the work is generally better, but not MUCH better... the BEST things from the owners stand point about unions is the quick availability of the labor... with nonunions, you never know if you have enough ppl... but when you got them they work it fine mostly... maybe 50 yrs ago, unions were FAR and AWAY the best quality labor, but today it just is not so... they are still better, but not MUCH better like they were... nonunions picked up the pace....
                                 

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                                  DrRobert said:
                                  Great logic. Soon you will be paying the union guy $2500 anyway when your pipes explode because the non-union guy had inadequate training and generally doesn't give a damn about his work.
                                  I don't think that's always true. It's like saying a doc who isn't a member of the AMA isn't good doc for that reason.
                                   

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                                    DrRobert said:
                                    Great logic. Soon you will be paying the union guy $2500 anyway when your pipes explode because the non-union guy had inadequate training and generally doesn't give a damn about his work.

                                    Even worse logic. Having worked in a union outside of the healthcare industry I can tell you people will sometimes care less because it is next to impossible to get fired and when times get rough layoffs are in order of seniority.
                                     

                                    DrRobert

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                                      raptor5 said:
                                      Even worse logic. Having worked in a union outside of the healthcare industry I can tell you people will sometimes care less because it is next to impossible to get fired and when times get rough layoffs are in order of seniority.

                                      Having grown up in a blue collar family - everyone from parents to grandparents to aunts/uncles to cousins and family friends, I will say for certain that this is rare. I'd be willing to bet my future that 95% of union workers do professional work, take pride in their work, and work their asses off. The same cannot be said of non-union workers.
                                       

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                                        I think the same can be said for non-union workers. Most take a great deal of pride in their work. It's just that they choose not to bend to the demands of a larger group when it comes to their work schedule or pay scale. BTW I come from a family full of union members and this is an attitude that comes from talking with an uncle of mine who is an union electrician.
                                         

                                        cooldreams

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                                          i actually talked with one of the recent pres of the electrical brothers union and he gave presentations to the point that about 10-15% of the union workers SHINE, another maybe 60 or so % are average, and about 10-15% are below average, making working conditions dangerous, and giving customers a bad reminder of union workers. about 50 yrs ago, electrical union workers ruled the electrical work with 1000's upon 1000's of contracted firms doing business, today it is something like 1200 or so in the country. its bad. there is a presentation out right now that really details the numbers. when they were showing it in kansas city, few members actually showed up to see it, so my company was planning on mandating that part of hiring was seeing that video, and encouraging those already hired to do so as well. ... i left for med sko shortly after that though so i didnt see it come to fruition.....

                                          as a business we are constantly fighting for work with the non-unions. most of the work we did was commercial/industrial. we did nearly no residential - basically it all went to non-unions.
                                           
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                                            DrRobert said:
                                            Having grown up in a blue collar family - everyone from parents to grandparents to aunts/uncles to cousins and family friends, I will say for certain that this is rare. I'd be willing to bet my future that 95% of union workers do professional work, take pride in their work, and work their asses off. The same cannot be said of non-union workers.

                                            I said sometimes and also generalized unions just as you have. I can only comment on the several IBEW and CWA locals I was involved with years ago plus a few Steelworker locals. Others may be much different I suppose. I can say I loved my time as union card holder but I am no longer pro-union. The reason for this will turn into a debate that is useless. Its like trying to convince a republican to turn democrat.
                                            Labor Unions
                                             

                                            CambieMD

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                                              Hi,

                                              I used the example of the plumber just to illustrate the difference in how the way that we are compensated 4 our services makes so little sense. Do not become preoccupied with how much the plumber takes home and the ins and outs of that profession.

                                              Understand how u wil be compensated as a physician.
                                              Understand how contracts work. Make sure that u do not want to perform procedures that could b considered outside of the scope of whatever specialty u may decide on.

                                              I think that increasing costs and a potential shortage of pcps will result in a shifting of responsibilities to pts. Pts may have to become more proactive in their care. I do not c more money being pumped into primary care. Providers and patients will have to do more with less.

                                              Primary care and FM will never go away. They will just have 2 change to suit the times.

                                              CambieMD
                                               

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                                                This leads us to the question we all preped for during med school interviews: Does everyone have the right to healthcare, regardless of ability to pay? If you answered yes, then realistically SOME form of a national health system (like Praetorian mentioned would ruin medicine) must be part of your explanation. It's not that i dont agree that billing can suck, or that I believe in socialized medicine --I'm just playing devil's advocate. WE are the ones that will have to advocate for change because WE are going to be the ones wading through this $hit for the next 30 years.[/QUOTE]

                                                Health care paid for by another is either a privilege or a charity, not a right.

                                                Prior to medicare (the mid-60's) people still got sick. They still got treatment. Even those who were destitute were able to get first rate medical care, through either county, or charity hospitals. If they could repay they did, otherwise the hospital and physicians sucked it up.

                                                Not too different than now, except for the government inflicting a premium of 50-90% over actual costs of services for compliance, regulation, etc.
                                                 

                                                flighterdoc

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                                                  DrRobert said:
                                                  Having grown up in a blue collar family - everyone from parents to grandparents to aunts/uncles to cousins and family friends, I will say for certain that this is rare. I'd be willing to bet my future that 95% of union workers do professional work, take pride in their work, and work their asses off. The same cannot be said of non-union workers.

                                                  You'd lose. I'd say that you've got the ratio inverted.
                                                   

                                                  lateness

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                                                    flighterdoc said:
                                                    This leads us to the question we all preped for during med school interviews: Does everyone have the right to healthcare, regardless of ability to pay? If you answered yes, then realistically SOME form of a national health system (like Praetorian mentioned would ruin medicine) must be part of your explanation. It's not that i dont agree that billing can suck, or that I believe in socialized medicine --I'm just playing devil's advocate. WE are the ones that will have to advocate for change because WE are going to be the ones wading through this $hit for the next 30 years.

                                                    Health care paid for by another is either a privilege or a charity, not a right.

                                                    Prior to medicare (the mid-60's) people still got sick. They still got treatment. Even those who were destitute were able to get first rate medical care, through either county, or charity hospitals. If they could repay they did, otherwise the hospital and physicians sucked it up.

                                                    Not too different than now, except for the government inflicting a premium of 50-90% over actual costs of services for compliance, regulation, etc.[/QUOTE]

                                                    interesting quote you have of GW bush, could really comment ont hat, since I lived in some of those countries you mentioned, it woudl be nice if it was as simple as that. Anyways this is not the forum for politics. I have a questionf or you flight erdoc.
                                                     

                                                    lateness

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                                                      flighterdoc said:
                                                      This leads us to the question we all preped for during med school interviews: Does everyone have the right to healthcare, regardless of ability to pay? If you answered yes, then realistically SOME form of a national health system (like Praetorian mentioned would ruin medicine) must be part of your explanation. It's not that i dont agree that billing can suck, or that I believe in socialized medicine --I'm just playing devil's advocate. WE are the ones that will have to advocate for change because WE are going to be the ones wading through this $hit for the next 30 years.

                                                      Health care paid for by another is either a privilege or a charity, not a right.

                                                      Prior to medicare (the mid-60's) people still got sick. They still got treatment. Even those who were destitute were able to get first rate medical care, through either county, or charity hospitals. If they could repay they did, otherwise the hospital and physicians sucked it up.

                                                      Not too different than now, except for the government inflicting a premium of 50-90% over actual costs of services for compliance, regulation, etc.[/QUOTE]

                                                      interesting quote you have of GW bush, could really comment ont hat, since I lived in some of those countries you mentioned, it would be nice if it was as simple as that; Anyways this is not the forum for politics or is it?' :rolleyes: . I have a questionf or you flight erdoc. so do you fly and are the main doc on board, and if so, how does one get to specialize in that? that sound like an exciting way to practice.
                                                       

                                                      DrRobert

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                                                        cooldreams said:
                                                        obviously because you just argued better. :rolleyes:

                                                        No. It's because I have more firsthand experience/evidence. If you want me to name all of the commercial construction projects that have gone wrong in my city with non-union labor vs. union labor I can do that after graduation. The list is exhaustive.
                                                         
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