Physician Surveys and Universal Healthcare

[TAbrown]

This is in regard to the published survey in the Annals of Internal Medicine last month that stated 59% of physicians support universal healthcare.
My question is whether or not a comprehensive survey of all physicians of different specialties was conducted.
I will accept the fact that a majority of general practitioners support Universal Healthcare, but what about specialty physicians who spend several more years training and have greater on-call schedule than general physicians. I find it hard to believe that this group of physicians would be in support of a government-run healthcare program, considering that they would not be compensated as fully for their services.
Everytime I see such sweeping claims for Universal Healthcare, I really wonder who would benefit the most and who would not benefit.
Sure, it's not all about money, but it is common sense to think that less physicians would seek specialty training given that they would not be compensated as fully for more hours and a longer period of training.
Does anyone else have this suspicion about the survey? I would like to see how physicians voted via a specialty breakdown.

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[Jnye33]

The survey does sound a bit suspicious - I would also like to see the breakdown based on geographic location and population of city in which they practice. On a related topic, do you think it would be a good thing to have less specialists and more primary care physicians?

 

[CigarTragic]

It's bad enough with a media slant that this concept of Universal Healthcare is being shoved down our throats. Obviously it's skewed, and they can pretty much concoct any story they want to suit their purposes.

If you think it's bad now, ... wait, JUST wait to see what other health-initiative Marxist garbage spewed out by Fruitopia junkies comes out of the woodwork with Obama as president. A lot of people hate Hillary, so I feel as though her efforts wouldn't be as successful. Option C is to go with what you know... at least with McCain our future will be protected... for the time being.

There's your choice, SDN.

 

[TAbrown]

The survey does sound a bit suspicious - I would also like to see the breakdown based on geographic location and population of city in which they practice. On a related topic, do you think it would be a good thing to have less specialists and more primary care physicians?

As technology increases and medicine becomes more specialized, the need for specialists increases. What good are more primary care physicians if there are no specialists to take their referrals?
However, with that said, there are many sects of the country that are considered medically disadvantaged. I think that they are medically disadvantaged not because the entire pool of physicians is low but because physicians do not want to practice there for various reasons (bad part of the city, etc.).

 

[AwesomO]

Disclaimer in that I'm going into Primary Care and my opinion could be very different if I was going into say Cardiology and was projected to bring home 500K+ a year.

I have no issue compromising with the govt on UHC if it needs to be done. I think it's reasonable to ask for the following
1) Repayment of all my loans
2) A generous pension plan funded by the govt
3) Complete protection of my assets from lawsuits.
4) No property taxes on my primary home.
5) And finally, attending pay and benefits as a RESIDENT.

However if they infringe on any of my personal freedoms ie dictating where I can live and practice then the deal is off.

 

[docB]

Disclaimer in that I'm going into Primary Care and my opinion could be very different if I was going into say Cardiology and was projected to bring home 500K+ a year.

I have no issue compromising with the govt on UHC if it needs to be done. I think it's reasonable to ask for the following
1) Repayment of all my loans
2) A generous pension plan funded by the govt
3) Complete protection of my assets from lawsuits.
4) No property taxes on my primary home.
5) And finally, attending pay and benefits as a RESIDENT.

However if they infringe on any of my personal freedoms ie dictating where I can live and practice then the deal is off.

I'd be cool with #3 alone.

 

[AwesomO]

I'd be cool with #3 alone.

Dude your compromising are bargaining position

 

[kronickm]

. Option C is to go with what you know... at least with McCain our future will be protected... for the time being.

There's your choice, SDN.

How will your future be protected with McCain's "stay the course" policy. It is with this current system that doctor's salaries are plunging while their workload is increasing.

I know of many docs who feel that it is not medicare that is the biggest problem, but private insurance companies. I can fully understand why people would want a "cash based" system, where the consumer pays for services rendered, but such a system will simply not happen, always relegated to a niche. I think many people are wrong in thinking that decresing the dependance on private insurers, thus increasing medicare's role in paying physicians will destroy the practice of medicine. I agree with awesomo though, that one caveat that should be necessary is repayment of student loans for those who accept medicare patients. It is the least the government can do.

 

[docB]

I think many people are wrong in thinking that decresing the dependance on private insurers, thus increasing medicare's role in paying physicians will destroy the practice of medicine.

Nothing will ever "destroy the practice of medicine." Socialism will just serve to make it even more wretched. There will always be doctors, no matter what they pay. The problem is that when wearing the blue vest at WalMart becomes higher paying than wearing the white coat you won't see those board scores staying up there. If that's what people want then whatever. Patients want the smartest doctor they can get without paying anything. And you get what you pay for.

I agree with awesomo though, that one caveat that should be necessary is repayment of student loans for those who accept medicare patients. It is the least the government can do.

The least the government can do is nothing. They could even quit paying for residency altogether. It's conceivable that they could say that residency is schooling and that the student has to pay the costs involved. Don't think there aren't people out there that would still line up to pay for residency. There are.

Be careful looking to the government for load forgiveness. They have always required a quid pro quo. They don't think of see their CMS patients as a punishment the way we do. They think it's a privilege. If they start forgiving loans expect that they'll own you for many years.

 

[Faebinder]

Dude your compromising are bargaining position

dats right. DocB sit back and lets the man bargain okay?

 

[docB]

dats right. DocB sit back and lets the man bargain okay?

The thing I always hate about bargaining with CMS is having to sign in blood and the way the contract always disappears in a cloud of smoke and sulfur. The maniacal wailing of a thousand demons during the negotiations doesn't help either.

 

[southerndoc]

The thing I always hate about bargaining with CMS is having to sign in blood and the way the contract always disappears in a cloud of smoke and sulfur. The maniacal wailing of a thousand demons during the negotiations doesn't help either.

And it doesn't help that private companies are now auditing charts trying to find screwups with documentation just so they can get a percentage of money that CMS collects as overpayments. Tell me there isn't an incentive to slant the documentation scores in their favor so they can increase profits!

Don't document enough, bill too much, and off to jail the physician goes.

 

[Faebinder]

And it doesn't help that private companies are now auditing charts trying to find screwups with documentation just so they can get a percentage of money that CMS collects as overpayments. Tell me there isn't an incentive to slant the documentation scores in their favor so they can increase profits!

Don't document enough, bill too much, and off to jail the physician goes.

This is our fault as physicians. We complain about pay and reimburisement yet we wont audit our own financial records of reimburisement and are unwilling to refuse patients based on insurance because we care about them.

I understand southerndoc and DocB are in the EM so this doesn't apply to you guys because the hospitals have you held by the balls IMO, but private companies that audit non-EM physicians should be shot down with a bazooka. We should be approving/denying them.. not the other way around.

 

[Luxian]

Sure, it's not all about money, but it is common sense to think that less physicians would seek specialty training given that they would not be compensated as fully for more hours and a longer period of training.

Um, isn't this the goal? Right now, too many people are headed to specialties and not enough to primary care. This is in large part do to the crazy amount of debt and the crazy rate of malpractice insurance. Wouldn't it be "better" if people were not externally pushed to specialties for monetary reasons?

What good are more primary care physicians if there are no specialists to take their referrals?

I think the idea is that we need an arbitrarily high number of specialists if there are no primary care physicians around. If you don't have PCPs, every disease progresses to its extreme state and we run around spending all our time putting out fires. I'd much rather have a PCP help patients deal with diabetes, infections, and other non-emergencies rather than wait until it calls for desperate measures.

Am I way off here?

 

[TAbrown]

Um, isn't this the goal? Right now, too many people are headed to specialties and not enough to primary care. This is in large part do to the crazy amount of debt and the crazy rate of malpractice insurance. Wouldn't it be "better" if people were not externally pushed to specialties for monetary reasons?



I think the idea is that we need an arbitrarily high number of specialists if there are no primary care physicians around. If you don't have PCPs, every disease progresses to its extreme state and we run around spending all our time putting out fires. I'd much rather have a PCP help patients deal with diabetes, infections, and other non-emergencies rather than wait until it calls for desperate measures.

Am I way off here?

Utopia

 

[Luxian]

Utopia

Hey, I just think it's silly to work on secondary problems when you could work on primary ones.

The OP says universal healthcare will drive reimbursements down and decrease salaries for specialists. (Frankly, I think it will disproportionately decrease salaries for PCPs who don't do "procedures", but this is a salient point of arguement.) In any case, the OP then says if specialists earn less money, they won't do it. (Though, once again, I hardly believe that specialists will ever earn LESS than primary care doctors, so the incentive will always be there.)

Why do specialists need a lot of money? Is it because of the medical school expenses? The years of opportunity cost during residency? Is it just because they're "better"? Well if it's the first two, then we should be lobbying to stop the massive inflation of tuitions and increase the pay for residents. Or increase overtime pay. Or do something. Just throwing up your hands and saying "well, heaven's, we couldn't possibly ask for THAT" seems a little silly to me.

Call me naive.

 

[Miami_med]

With no free market to determine the value of specialists, there is no way to determine what they are, "worth." Before the government decided to take over medicine, the most people were generalists. The government doesn't need to do more to reverse the current trend, it needs to do less. The Family Doctor used to do just fine when half of his money wasn't spent paying office staff and half of his time used to defend chart audits.

 

[southerndoc]

I understand southerndoc and DocB are in the EM so this doesn't apply to you guys because the hospitals have you held by the balls IMO, but private companies that audit non-EM physicians should be shot down with a bazooka. We should be approving/denying them.. not the other way around.

Not sure where you got your information, but ALL specialties are audited, including EM.

 

[Faebinder]

Not sure where you got your information, but ALL specialties are audited, including EM.

I ment.. in EM you wont go to the patients accounts and audit the insurance company's reimburisement to you and decide to later deny for example anyone in the ER with Atena or United cause their reimburisement sucks.

More of that needs to happen by non-EM specialties. Like I said, we should be denying them.. not them denying us!