Obamacare and Primary Care

Discussion in 'Allopathic' started by DermViser, 05.17.14.

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  1. DermViser

    DermViser 5+ Year Member

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    So I was looking up Jonathan Gruber. He is a professor of economics at MIT. He was a key architect in Romneycare and helped in crafting Obamacare. So if anyone should know about the law, it would be him. He's not a partisan (although he is an idealogue). He has a book here: http://www.amazon.com/Health-Care-Reform-Necessary-Works/dp/0809053977/ref=sr_1_1?ie=UTF8&qid=1400374470&sr=8-1&keywords=Jonathan gruber

    So anyways, I watched his lecture which is quite interesting if you have the time to watch, but one segment really came out at me when it came to the question segment of the talk.

    Go http://magazine.wustl.edu/2013/december/Pages/Understanding-the-Affordable-Care-Act.aspx, click on the streaming video and then click to 43:00

    Question from a physician:
    "There's one piece that I think is missing in the dialogue, which is, what about the providers, bc we are caught in a very delicate situation. Insurance companies don't want to give us anything. The medical device companies and pharmaceuticals are increasing their costs for the care we provide for our patients, and so we are caught smack in the middle of this, not being able to provide care for our patients, and it hasn't played out entirely, but do you agree there is a big problem there?"

    So several things, when Gruber answers:

    1) Instead of actually answering the physician's question directly about the costs of pharmaceuticals/medical devices and getting those under control, he diverts instead into an interspecialty salary catfight, which as you can guess he chose the examples of Family Medicine vs. Dermatology (not shocked) in which he believes the solution is for the IPAB (a govt. body) to lower reimbursement in order to "depoliticize" the process :rolleyes:, bc he believes that in America we have overspecialization (not bc he cares about actual patient care, but likely bc of cost). On a tangent, he believes someone with medical school level debt should be happy with $150K-$200K working 60 hrs. a week, on call every other weekend. I'd like to take a guess what his hours and salary are. It's not as if doctors pocket the entire reimbursement from insurance companies. Meanwhile he: http://abcnews.go.com/blogs/politics/2010/01/on-jonathan-gruber-and-disclosure/

    2) He also says this: "We need to change the way we deliver primary care in America. We need to have doctors do less, and physicians assistants and nurse practioners do more." Which he then uses the example of dentists and the dental hygienists. "The doctor in the future needs to spend 1/3 of the day seeing patients, 1/3 of the day on the phone, and a 1/3 of the day answering email. That will allow us to provide much broader coverage and stretch our primary care resources further."

    I think it's very telling that he believes those in primary care (General IM, General Pediatrics, and Family Medicine) should do LESS and be pretty much administrators who only do patient care activities 1/3 of their day. And the rest of the time be business administrators. The only problem is: 1) PA/NPs are staying away from primary care if they can also and 2) NPs are fighting for equal reimbursement as well (the first battle being opening up scope of practice, which they are currently getting) and want to practice independently.

    As far as the college students at a prestigious (or prestigious level charging) university asking questions, I'll hold my tongue on that. I'll just say I think it's funny he pretty much has the full bloated support of these college students (many of whom are probably applying for medical school) since they can be on their parent's health insurance till age 26 and are most likely still supported by their parents esp. at an institution that charges a ridiculously high sticker price for just undergrad.
     
    Last edited: 05.17.14
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  3. WhippleWhileWeWork

    WhippleWhileWeWork 2+ Year Member

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    I'm wondering if he meant those two thirds at the computer and on the phone would be spent answering patients questions which would "expand" care? I hope that's what he meant.
     
  4. DermViser

    DermViser 5+ Year Member

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    I don't see how it would expand care though as most likely those answering emails and phone calls are from patients already seen (med refills, question on a new medication, etc.). You can bet this 1/3 - 1/3 - 1/3 plan comes with an even greater decrease in salary.

    And the goal is for PCPs to only see patients 1/3 of the time, and I guess underlings see patients a full day while being overlooked by the PCP. I know this will shock him, but primary care doctors want to be doctors, first and foremost. That's why they did premed, medical school, and residency. They don't want to have underlings seeing patients, esp. not those whom they have to be responsible for their actions.
     
  5. WhippleWhileWeWork

    WhippleWhileWeWork 2+ Year Member

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    I hear what you're saying. Where I'm coming from on this is a couple of the FM guys I know who will answer texts/emails/phone calls with "No, you're not dying, but come see me tomorrow", "Yes that's an emergency get to the hospital now", "Those red streaks are indeed an infection, I'll call in the prescription". It's 3 less people booking appointments that day, only one of which actually needed to come in and take up his time. If that makes sense....

    However, I don't know if that's what Mr. Squeaky voice had in mind. Esp. because they should be able to bill, somehow, for that response.
     
    Last edited: 05.17.14
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  6. DermViser

    DermViser 5+ Year Member

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    Yes and they do this after seeing a full day schedule of patients, not 1/3 of the work day. Even in derm, we do call backs for refills on prescriptions, medication re-education, skin biopsy results, getting in contact with the PCP to notify him/her on what we did, etc. although our scope is obviously more limited than primary care.

    It's any wonder primary care doctors are turning to direct care/concierge care medicine in order to restore the doctor-patient relationship. It seems like the govt. is fully intent on making their jobs harder, give them more responsibility (esp. for OTHER people's actions), all for the dubious good of the collective.

    I'm glad they're being honest about their intentions in forums like this, and I hope medical students coming out choose their specialty accordingly keeping this in mind.
     
    Last edited: 05.17.14
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  7. username456789

    username456789 SDN Bronze Donor Bronze Donor 7+ Year Member

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    As a Dermatology resident I do this every day for anywhere from 30-60 minutes after clinic (and that's usually if I'm lucky enough to answer some of the messages over my lunch break or in between patients).

    And I sure as hell don't get paid any extra for it.
     
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  8. DermViser

    DermViser 5+ Year Member

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    @GuyWhoDoesStuff, imagine how much better it would be if you only got to see patients for 1/3 the time and could do phone calls and emails the rest of the day!! (sarcasm).
     
    Last edited: 05.17.14
  9. Dave89

    Dave89 ACCOUNT ON HOLD Account on Hold 2+ Year Member

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    Total side remark here, and it won't add to the conversation, but I have to say it. I have a younger brother majoring in Economics (and who will definitely be getting a PhD), and the arrogance of those in his field is pretty astonishing. They really do see themselves as the architects of society, and the rest of us as busy little bees.
     
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  10. alpinism

    alpinism Give Em' the Jet Fuel 5+ Year Member

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    Funny thing is most of the the PCPs I've worked with (FM and outpatient IM) already spend less than 1/3 of the time with patients.

    typical day:

    1. see pt for 10min

    2. spend 10min charting and filling out paperwork

    3. spend 10min answering voicemails, emails, EPIC MyChart messages, etc...

    4. repeat all day.

    5. then spend another 2-3hrs after your last appointment catching up on #2 and #3.

    The politically correct term is "healthcare coordinator" which is essentially nothing more than being a business administrator.
     
  11. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    Administrators and pencil pushers believe that administration and pencil pushing is the apex of work and what everyone obviously wants to do in life. Seeing patients? Doing procedures? Who in their right mind would want to do that over letting other people do it while you just collect a paycheck for their work and fill out and just fill out forms all day? Bureaucrats base their entire view of work through the twisted eyes of men and women that believe actually performing work is beneath them. That physicians would prefer to perform billable labor themselves and enjoy doing so is an unfathomable concept to a desk jockey that does nothing but shuffle numbers all day.
     
    Last edited: 05.18.14
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  12. croak

    croak Banned Banned Account on Hold 2+ Year Member

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  13. croak

    croak Banned Banned Account on Hold 2+ Year Member

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    Most of my peers refuse to look at how poorly they're being reimbursed, and the hours of wasted time tinkering with one new protocol or another. At least a few folks stood up to the MOC link to licensure. Oh, you didn't add a few hours to the daily busywork, and hours of aggravation with EMRs. It's really much more wretched than you can imagine. Clearly, allowing the technocrats "in," and giving them—pencil pushing, managerial think tank wizards—control didn't pan out too well. America, a land where medicine is practiced by non-clinical dolts—Witness the grand meat processing system build a better waste of resources. What a mess.
     
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  14. croak

    croak Banned Banned Account on Hold 2+ Year Member

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    How can I fully evaluate a patient in ten minutes? I refuse. If I can't dedicate "as long as it takes" to evaluate a new patient who may or may not be a surgical candidate f*** it. The system is beyond broken, and I don't think anyone knows where medicine is going in the US. If I ever practiced again it sure wouldn't be in the US. I can't imagine non US citizens wanting to come to America to practice. Drive a cab, wait tables, why in the world subject yourselves to this nonsense. The "extenders" and bureaucrats won. Game, set, match.
     
  15. nowanmd

    nowanmd 7+ Year Member

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    When I worked in business the human resources department made sure they were paid well while holding the line on other employee functions.

    This is a similar situation, the imbecile administrators believe they should be well paid for managing the resources (us).

    I'm beginning to think it's inevitable- there will be some kind of national physician job action-sad.
     
    Last edited: 05.18.14
  16. Anastomoses

    Anastomoses secretly an end artery Banned Account on Hold 2+ Year Member

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    So you're basically suggesting we all go wait tables or drive cabs?
     
  17. PL198

    PL198 2+ Year Member

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    Or make an organized stand and don't make as much money as teachers. 10 years tops, it'll happen without that intervention.

    BUT THEY EDUCATE OUR YOUTH!!!!! Insert brilliant Churchill quote here as I can think of at least 5.
     
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