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Knicks

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For the last couple of years, I've always been hearing "there's a doctor shortage in this country".

:rolleyes: Then why the hell is EVERY SINGLE RESIDENCY PROGRAM I CONTACT TELLING ME THAT THEIR PROGRAM IS FULL?

What "shortage"? Again, :rolleyes:.
 

Socrates25

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There is no doctor shortage -- its all a scam. Politicians use that lie to open 500 new med schools so they can "stimulate the economy"

The only shortages are in some rural areas. The vast majority of cities have a big oversupply of doctors. Thats why cardiologists stent 40% blockages when ordinarily they wouldnt be touching them -- all the 95% blockages have already been treated and they are competing for patients to try and make $$$$
 
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Dave89

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There is no doctor shortage -- its all a scam. Politicians use that lie to open 500 new med schools so they can "stimulate the economy"

The only shortages are in some rural areas. The vast majority of cities have a big oversupply of doctors. Thats why cardiologists stent 40% blockages when ordinarily they wouldnt be touching them -- all the 95% blockages have already been treated and they are competing for patients to try and make $$$$

Lol. When I was a premed applying to medical school, I really wished they HAD done that :laugh:
 

VisionaryTics

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For the last couple of years, I've always been hearing "there's a doctor shortage in this country".

:rolleyes: Then why the hell is EVERY SINGLE RESIDENCY PROGRAM I CONTACT TELLING ME THAT THEIR PROGRAM IS FULL?

What "shortage"? Again, :rolleyes:.

Because the match was last month.
 
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SoundofSilver

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I think the so-called physician shortage is a projection based on the fact that the baby boomer generation is getting older meaning that the number of sick people is set to grow exponentially over the coming decade or so.
 

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For the last couple of years, I've always been hearing "there's a doctor shortage in this country".

:rolleyes: Then why the hell is EVERY SINGLE RESIDENCY PROGRAM I CONTACT TELLING ME THAT THEIR PROGRAM IS FULL?

What "shortage"? Again, :rolleyes:.

Also, this assumes the number of residency spots in each field is constantly adjusted to meet the needs of the country. It's not.
 

CaptainSSO

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For the last couple of years, I've always been hearing "there's a doctor shortage in this country".

:rolleyes: Then why the hell is EVERY SINGLE RESIDENCY PROGRAM I CONTACT TELLING ME THAT THEIR PROGRAM IS FULL?

What "shortage"? Again, :rolleyes:.

Physician shortage /= resident shortage.
 
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Nomdeplume

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There's a physician maldistribution, by specialty and by practice location

This.

I am sorry that you are having trouble finding a residency position, but your conclusion is wrong.

There is an effective shortage of physicians. However, your problem is a result of the fact that the number of people seeking residencies is greater than the number of residencies available. It's just that the number of residencies is, by some estimates, too low to meet the projected demand for physicians over the next decades.
 

dd128

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It's also more of a predicted shortage. As many of these aging physicians retire in the coming years, there's going to be quite a drastic drop off. And unfortunately the smart people in control of the government realized this and decided it best to up med school enrollment. Unfortunately this does not work without increasing residency spots, which has yet to be done.
 

Ibn Alnafis MD

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For the last couple of years, I've always been hearing "there's a doctor shortage in this country".

:rolleyes: Then why the hell is EVERY SINGLE RESIDENCY PROGRAM I CONTACT TELLING ME THAT THEIR PROGRAM IS FULL?

What "shortage"? Again, :rolleyes:.

I don't understand how you deduced that since every residency program is full, then there's no physician shortage.

The US ranks 53 in term of physician-to-population ratio. There's shortage, but this shortage is usually met by an oversupply of midlevels. I also agree that maldistribution causes the shortage of doctors to be more pronounced in certain parts of the country.

http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people
 

johnnydrama

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I've called states such as Nebraska, Idaho, Wisconsin, the Dakotas, etc,,,, they're full.

I'm sorry you haven't had any luck this cycle, but your current difficulties are more or less irrelevant to the presence or absence of a physician shortage.

There are always fewer residency spots than applicants.

If you were having trouble getting a job after residency, then it would be relevant.
 

SpecterGT260

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could it be that these programs just say they are full as an easy way out of a conversation with a scrambling ms4?
 

SpecterGT260

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:oops:
ok, fine... the "I cant get a spot so the shortage talk must be a conspiracy" was just a little too "tinfoil hat" for me...
 
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johnnydrama

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ok, fine... the "I cant get a spot so the shortage talk must be a conspiracy" was just a little too "tinfoil hat" for me...

Yeah, but at this point all the spots really are full. Some will open up later in the year, but all the spots that didn't disappear in the SOAP would have been filled weeks ago.
 

Marcus Brody

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If you don't do residency, you go work at Wendy's. I don't see any "shortage" of Wendy's cashiers. Interesting how that works. Why is it relatively simple to fulfill one need but not the other? Why can Wendy's hire affordable cashiers but no one except the wealthy can afford basic health care? :confused:

Don't give me the "but you gotta be smrat to do medicine" bullsh*t. Needing penicillin for strep throat is actually not much different from needing any other random ass thing, there's just a monopoly on providing it. Needing lovastatin for cholesterol is no different from any other random ass thing, except only one company is allowed to sell it. Restriction of supply to elevate prices, same goes with residency spots.
 

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If you don't do residency, you go work at Wendy's. I don't see any "shortage" of Wendy's cashiers. Interesting how that works. Why is it relatively simple to fulfill one need but not the other? Why can Wendy's hire affordable cashiers but no one except the wealthy can afford basic health care? :confused:

Don't give me the "but you gotta be smrat to do medicine" bullsh*t. Needing penicillin for strep throat is actually not much different from needing any other random ass thing, there's just a monopoly on providing it. Needing lovastatin for cholesterol is no different from any other random ass thing, except only one company is allowed to sell it. Restriction of supply to elevate prices, same goes with residency spots.

You may have taken the hyperboles a tad far with this one.
 

SpecterGT260

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If you don't do residency, you go work at Wendy's. I don't see any "shortage" of Wendy's cashiers. Interesting how that works. Why is it relatively simple to fulfill one need but not the other? Why can Wendy's hire affordable cashiers but no one except the wealthy can afford basic health care? :confused:

Don't give me the "but you gotta be smrat to do medicine" bullsh*t. Needing penicillin for strep throat is actually not much different from needing any other random ass thing, there's just a monopoly on providing it. Needing lovastatin for cholesterol is no different from any other random ass thing, except only one company is allowed to sell it. Restriction of supply to elevate prices, same goes with residency spots.

I can't tell if you're joking or embodying the "smrat for medicine BS"....
 

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I think the so-called physician shortage is a projection based on the fact that the baby boomer generation is getting older meaning that the number of sick people is set to grow exponentially over the coming decade or so.

No there is a shortage. Its real, its happening right now, and its happening in almost all specalties.

When people say 'there is no shortage' or 'its just maldistribution' generally what they mean is that they have done some kind of regression analysis at a liberal arts university and that concluded that additional physicians in certain specialties would not improve the community's health. By this logic every single cosmetic dermatologist is 'maldistributed', and the only shortage we have is in rural primary care.

When physicians say there IS a shortage, they're refering to the fact that there are way fewer physicians selling their services than there are people willing to buy their services. In this case we have huge shortages of CT surgeons and orthos in the biggest cities, that's why even the crappies ortho has a full practice and can command an insane salary. There's an even bigger shortage of plastic surgeons and cosmetic dermatologists. The shortage is maintained by the protectionism we can medical licensing and residency, which allows us to keep the supply of trained doctors artificially small even when there are legions of students clammoring to train and tons of doctors who would be happy to take their money to train them. Which sucks whether your someone like the OP who wants to train but can't, or a patient paying 10x what your care would cost in a deregulated industry.
 
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Socrates25

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If you don't do residency, you go work at Wendy's. I don't see any "shortage" of Wendy's cashiers. Interesting how that works. Why is it relatively simple to fulfill one need but not the other? Why can Wendy's hire affordable cashiers but no one except the wealthy can afford basic health care? :confused:

Don't give me the "but you gotta be smrat to do medicine" bullsh*t. Needing penicillin for strep throat is actually not much different from needing any other random ass thing, there's just a monopoly on providing it. Needing lovastatin for cholesterol is no different from any other random ass thing, except only one company is allowed to sell it. Restriction of supply to elevate prices, same goes with residency spots.


sorry, this is wrong.

healthcare is not and will never be a free market. In a "free" market, the cost of the product is inversely proportional to the supply of the provider, i.e. as the number of doctors increases, they compete against each other and drive costs downward. Healthcare is a "supply-induced demand" model where the cost is directly proportional to how many providers there are.

Consider this -- Boston and NYC have the highest concentration of doctors per capita in the world. If healthcare were a free market, all these doctors would be competing against each other, driving down healthcare costs. Yet, the reverse is what is actually happening -- NYC and Boston actually have some of the HIGHEST healthcare costs in the country, despite the fact that there is a doctor on every corner.

When you flood a market with doctors, the docs start looking for "business" in corners that they otherwise would not have looked for. A good example is cardiology. When there was a shortage of cardiologists, they were so busy that they had to stick to placing stents and doing angioplasties on only the worst blockages. As the number of cardioogists increased, the potential patient pool skyrocketed, and now they do caths on people who are barely having any symptoms and whose blockages are modest at best.
 

SoundofSilver

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The shortage is maintained by the protectionism we can medical licensing and residency, which allows us to keep the supply of trained doctors artificially small even when there are legions of students clammoring to train and tons of doctors who would be happy to take their money to train them. Which sucks whether your someone like the OP who wants to train but can't, or a patient paying 10x what your care would cost in a deregulated industry.

I agree with this. But isn't residency funding mostly provided by the federal government as part of the medicare budget? If that's the case, the profession couldn't increase the number of residency slots even if it wanted to. And in the era of "fiscal austerity" and 15 trillion dollar government debt, I don't see anyway that funding will be increased (actually it will most likely be decreased). Also medicare is predicted to run out money in 12 years http://money.cnn.com/2012/04/23/news/economy/social_security_medicare_trustees/?hpt=hp_t2

So basically the shortage will continue to get worse. Huge increase in the number of med school graduates + inevitable decline in the number of residency positions = more and more unemployed U.S. MD graduates during a time when there is a physician shortage. Those who do get a residency will see their reimbursements fall even though demand will be way up and supply will be stagnant. Cool!

I hope I'm wrong.
 

Marcus Brody

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sorry, this is wrong.

healthcare is not and will never be a free market. In a "free" market, the cost of the product is inversely proportional to the supply of the provider, i.e. as the number of doctors increases, they compete against each other and drive costs downward. Healthcare is a "supply-induced demand" model where the cost is directly proportional to how many providers there are.

Consider this -- Boston and NYC have the highest concentration of doctors per capita in the world. If healthcare were a free market, all these doctors would be competing against each other, driving down healthcare costs. Yet, the reverse is what is actually happening -- NYC and Boston actually have some of the HIGHEST healthcare costs in the country, despite the fact that there is a doctor on every corner.

When you flood a market with doctors, the docs start looking for "business" in corners that they otherwise would not have looked for. A good example is cardiology. When there was a shortage of cardiologists, they were so busy that they had to stick to placing stents and doing angioplasties on only the worst blockages. As the number of cardioogists increased, the potential patient pool skyrocketed, and now they do caths on people who are barely having any symptoms and whose blockages are modest at best.

Who ever said it was a free market? I'm saying the exact opposite- it is an extremely un-free market. When there are licensing laws, and device and drug patents, competition is severely restricted, no matter how many cardiologists with which you "flood the market." This is something few people seem to understand. Healthcare is not a competitive industry. The most "competitive" specialties are in reality the least competitive, because they rely the most on a government grant and enforcement of monopolistic privilege to restrict supply and protect them from potential competitors. Example: dermatologists. If I spent a year learning derm and set up an acne clinic, I would obviously be shut down and hauled to jail, regardless of my level of true expertise or the quality of the service I provide. God forbid someone should do what dermatologists do at a lower cost. :rolleyes:
 
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SpecterGT260

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Who ever said it was a free market? I'm saying the exact opposite- it is an extremely un-free market. When there are licensing laws, and device and drug patents, competition is severely restricted, no matter how many cardiologists with which you "flood the market." This is something few people seem to understand. Healthcare is not a competitive industry. The most "competitive" specialties are in reality the least competitive, because they rely the most on a government grant and enforcement of monopolistic privilege to restrict supply and protect them from potential competitors. Example: dermatologists. If I spent a year learning derm and set up an acne clinic, I would obviously be shut down and hauled to jail, regardless of my level of true expertise or the quality of the service I provide. God forbid someone should do what dermatologists do at a lower cost. :rolleyes:

and when you generate an army of mutant babies by ignorantly throwing accutane at every patient who comes in the door you will either 1) cackle maniacally and proclaim that your evil plan is coming to fruition or 2) realize why these practices are restricted to people with the proper training - even if there are certain aspects that could be done by a trained monkey...
 

Marcus Brody

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and when you generate an army of mutant babies by ignorantly throwing accutane at every patient who comes in the door you will either 1) cackle maniacally and proclaim that your evil plan is coming to fruition or 2) realize why these practices are restricted to people with the proper training - even if there are certain aspects that could be done by a trained monkey...

1) you are fear mongering 2) who are you to, as a third party, step in and restrict the free interaction between a consumer and provider?

The situation also can't be looked at as a snapshot of time, without taking into account how it came to be like this and how continuing it affects the situation in the future. IE: "what would happen if Joe-the-Plumber suddenly was allowed, this afternoon, to do surgery? omg it would be awful!!1 LOL!"

This conveniently ignores the accumulated effects of the type of intervention you want to continue, as well as its anticipated future effects. Competition isn't just what is actively happening now, it's also potential. For example, if we had strictly enforced cantaloupe selling licenses (meaning anyone selling cantaloupes without a license gets shot by the FCA [the "Fruit and Cantaloupe Administration"]), no one is going to bother learning anything about selling cantaloupes unless they are planning on getting the license. They are assessing the world around them and anticipating the grant of monopolistic privilege. It has pervasive and under-appreciated effects on how the market works. The long term effect is that as the knowledge and skills of an industry become more specialized and advanced, it can justify its monopoly with circular logic pointing to how scary it would be without it (as you just did). But the fact remains that a) we go to this situation by very unethical means and b) it is logically invalid- it's a solution that perpetuates the problem it supposedly solves.
 

QQm

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1) you are fear mongering 2) who are you to, as a third party, step in and restrict the free interaction between a consumer and provider?

The situation also can't be looked at as a snapshot of time, without taking into account how it came to be like this and how continuing it affects the situation in the future. IE: "what would happen if Joe-the-Plumber suddenly was allowed, this afternoon, to do surgery? omg it would be awful!!1 LOL!"

This conveniently ignores the accumulated effects of the type of intervention you want to continue, as well as its anticipated future effects. Competition isn't just what is actively happening now, it's also potential. For example, if we had strictly enforced cantaloupe selling licenses (meaning anyone selling cantaloupes without a license gets shot by the FCA [the "Fruit and Cantaloupe Administration"]), no one is going to bother learning anything about selling cantaloupes unless they are planning on getting the license. They are assessing the world around them and anticipating the grant of monopolistic privilege. It has pervasive and under-appreciated effects on how the market works. The long term effect is that as the knowledge and skills of an industry become more specialized and advanced, it can justify its monopoly with circular logic pointing to how scary it would be without it (as you just did). But the fact remains that a) we go to this situation by very unethical means and b) it is logically invalid- it's a solution that perpetuates the problem it supposedly solves.

Not that I disagree, because you make a good point, but it seems your argument would apply equally well in the case for allowing midlevels to continue to expand their scopes to cover primary care. And then who would want to go though medical school to become a primary care physician?
 

Perrotfish

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I agree with this. But isn't residency funding mostly provided by the federal government as part of the medicare budget? If that's the case, the profession couldn't increase the number of residency slots even if it wanted to. And in the era of "fiscal austerity" and 15 trillion dollar government debt, I don't see anyway that funding will be increased (actually it will most likely be decreased). Also medicare is predicted to run out money in 12 years

There is no earthly reason why you should need federal funding to train physicians in the first place, except that the top heavy academic institutions that are residency programs are necessary to meet the incredibly burdensome residency acccrediation process that we created. The funding doesn't compensate for the intrinsic costs of a residency, but rather the costs of dealing with the clusterf**k that is the residency accrediation process

My solution:

1) Remove residency funding. Make Internship years universal, one size fits all programs that are part of medical schools. You pay tuition for Internship.

2) After Internship is over, train residents the way we train engineers: everyone gets a provisional license that allows them to practice only under the supervision of someone who is fully licensed until they've worked in the field for a certain number of years and pased several standardized tests. Until your licenced your supervisor assumes your liability, which is all the incentive they need to stay on top of you. Pay during this journeyman period would be dictated by the free market: if you're joining a family practice group and you make it clear that you're more skilled and valuable than a PA you might be able to negotiate a real physicians salary and work hours even though you're still technically in training. If you make it clear that you're working on the level of a student, or you're trying to break into a competitive/difficult field, you might end up paying tuition. You don't need to staywith the same group for your entire training, if they're unwilling to renegotiate your salary to reflect your growing utility you shouldn't lose your progress towards your license by jumping to another practice group.

This isn't quite removing medical licensing or accrediation entirely, but it does mean that the number of physicians we would make would be limited by the number of medical school spots rather than the number of residency spots, and we've seen medical school spots are much easier to grow.
 
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Perrotfish

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Not that I disagree, because you make a good point, but it seems your argument would apply equally well in the case for allowing midlevels to continue to expand their scopes to cover primary care. And then who would want to go though medical school to become a primary care physician?

The expansion of cheaper, more effficient training models is a necessary correllary to believing in the free market. The only reason we don't want midlevels to take over primary care (and a lot of specialty care) is that its bad for us, and we would rather legally shut them out than adapt by streamling our own training. There's no evidence that a lot of midlevels is worse than a few doctors. Actually there's a lot of evidence from countries like Cuba, China, and Singapore than putting a lot of cheap, basically trained primary care physicians into the country is much better for everyone's health than having better trained but less accessible physicians.

Midlevels should take over primary care, and if we want to compete we need to get cheaper, rather than trying to force them out of the market with legal road blocks.
 

KnuxNole

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lol....I don't think anyone ACTUALLY thinks medicine is that easy for someone to do a derm's job by learning it in one year, or that penicillin for strep throat is that simple.

That kinda stuff is why people are scared that PAs want the same rights as actual doctors >.>
 

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There's a physician maldistribution, by specialty and by practice location

It's not just a maldistribution: try cold-calling some rheumatology, cardiology, and dermatology offices in a saturated suburb, I think you'll be shocked at how long you'll have to wait to be seen by a specialist
 

SpecterGT260

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1) you are fear mongering 2) who are you to, as a third party, step in and restrict the free interaction between a consumer and provider?

The situation also can't be looked at as a snapshot of time, without taking into account how it came to be like this and how continuing it affects the situation in the future. IE: "what would happen if Joe-the-Plumber suddenly was allowed, this afternoon, to do surgery? omg it would be awful!!1 LOL!"

This conveniently ignores the accumulated effects of the type of intervention you want to continue, as well as its anticipated future effects. Competition isn't just what is actively happening now, it's also potential. For example, if we had strictly enforced cantaloupe selling licenses (meaning anyone selling cantaloupes without a license gets shot by the FCA [the "Fruit and Cantaloupe Administration"]), no one is going to bother learning anything about selling cantaloupes unless they are planning on getting the license. They are assessing the world around them and anticipating the grant of monopolistic privilege. It has pervasive and under-appreciated effects on how the market works. The long term effect is that as the knowledge and skills of an industry become more specialized and advanced, it can justify its monopoly with circular logic pointing to how scary it would be without it (as you just did). But the fact remains that a) we go to this situation by very unethical means and b) it is logically invalid- it's a solution that perpetuates the problem it supposedly solves.

using a little hyperbole to highlight that you inappropriately simplified a profession is not fear mongering. It was only intended to illustrate that you are neglecting components of the job that are beyond the skill level of certain people.

by your argument there should be no restriction on arms sales either. On a theoretical level I agree with you, however. But only on a theoretical level. For your argument to hold validity you must accept 1) that "greater good" is not a valid counter point in any form 2)that opening the restrictions will only be carried out in a beneficial and not harmful way and 3)... there is no 3... I just hate leaving numbered lists at 2 :laugh:
 

johnnydrama

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and when you generate an army of mutant babies by ignorantly throwing accutane at every patient who comes in the door you will either 1) cackle maniacally and proclaim that your evil plan is coming to fruition or 2) realize why these practices are restricted to people with the proper training - even if there are certain aspects that could be done by a trained monkey...

Um, it doesn't take much to prescribe OCPs and require a pregnancy test prior to starting Accutane. (Need to monitor LFTs too.)

The only tricky part about derm is learning the difference between an ointment and a cream.
 

SpecterGT260

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Um, it doesn't take much to prescribe OCPs and require a pregnancy test prior to starting Accutane. (Need to monitor LFTs too.)

The only tricky part about derm is learning the difference between an ointment and a cream.

my point was that you want reasonable assurance in the abilities and competence of your provider. With the "free market" system described above it is not unforeseeable that practitioners will pop up who are dangerously incompetent and the only measure of this will be death.
 

johnnydrama

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my point was that you want reasonable assurance in the abilities and competence of your provider. With the "free market" system described above it is not unforeseeable that practitioners will pop up who are dangerously incompetent and the only measure of this will be death.

Eh, there are plenty of things people can take over the counter that could kill them. A lot of prescription drugs shouldn't require prescriptions. If people misuse them, so be it.

Tylenol kills more people than Accutane.
 

SpecterGT260

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Eh, there are plenty of things people can take over the counter that could kill them. A lot of prescription drugs shouldn't require prescriptions. If people misuse them, so be it.

Tylenol kills more people than Accutane.

I don't believe you really think it is appropriate to open the medical profession and let the consumer decide who provides care. This is a complete parallel to opening arms sales. Many things can be used or misused. The question is where do we draw the line in terms of how severe consequences of misuse are.
 

VisionaryTics

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I don't believe you really think it is appropriate to open the medical profession and let the consumer decide who provides care. This is a complete parallel to opening arms sales. Many things can be used or misused. The question is where do we draw the line in terms of how severe consequences of misuse are.

You know, in the United States, nearly all medications were completely legal for any person to buy before the Controlled Substances Act of 1970.

Prescription privilege is a minor part of a physician's value, and I have no problem with mid-levels having prescription privilege as long as they are legally culpable.
 

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You know, in the United States, nearly all medications were completely legal for any person to buy before the Controlled Substances Act of 1970.

Prescription privilege is a minor part of a physician's value, and I have no problem with mid-levels having prescription privilege as long as they are legally culpable.

Seconded. I'd love to know what malpractice insurance for a midlevel with independent prescription privilege would run. If I were an insurance company exec I wouldn't touch that with a 10 foot pole.
 

Shnurek

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Seconded. I'd love to know what malpractice insurance for a midlevel with independent prescription privilege would run. If I were an insurance company exec I wouldn't touch that with a 10 foot pole.

About $500 a year for ODs for $1 million/$3 million malpractice coverage. One OD missed glaucoma, didn't have insurance and got his butt batted with an aluminium baseball bat by the lawyers.
 
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