rotations residency and HMOs

[seethrew]

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hey yall....

do any of you have any experience or opinions on whether 3rd/4th year rotation education may be compromised in an HMO environment? residencies? this is a vague segway from my former thread, where i was debating attending tulane. i had heard that tulane university hospital was sold to HMO and a cardio fellow had told me that before the exchange the hospital was in better shape.

curious....

 

[docB]

On the contrary I think having some HMO exposure is very beneficial. The HMO environment is not the same as the private environment and again is definitely not the same as the county/academic environment. The difference is most felt by the primary care and primary admitting specialties (ie. medicine) but it ripples to everyone. If you come out understanding something about HMOs it will help you.

Now, that being said, I don't know how doing a residency where you primarily work for an HMO and don't get experience in other environments would be. I'd say that a varied experience is best.

 

[OldPsychDoc]

hey yall....

do any of you have any experience or opinions on whether 3rd/4th year rotation education may be compromised in an HMO environment? residencies? this is a vague segway from my former thread, where i was debating attending tulane. i had heard that tulane university hospital was sold to HMO and a cardio fellow had told me that before the exchange the hospital was in better shape.

curious....

Managed care in some form is a fact of life wherever you are. Your education is going to be compromised if it DOESN'T include working in an environment where you are accountable to the payors (whether the patient, the government, traditional indemnity insurance, or capitated managed care) for the meds you choose, the number of days you hospitalize, and the level of service you bill for. Get used to it. SOMEONE is paying the bill.

 

[timebomb]

you're misinformed about Tulane. The hospital is private, owned by HCA, but is not an HMO. It is a full academic teaching hospital except for the ER (no residency program, contracted physician staff).

 

[seethrew]

you're misinformed about Tulane. The hospital is private, owned by HCA, but is not an HMO. It is a full academic teaching hospital except for the ER (no residency program, contracted physician staff).

maybe i just didnt understand what the fellow was telling me. what is hca - i dont know. hmmm, is it unusual for the er to be set up that way in a teaching hospital?

 

[timebomb]

HCA = Healthcare Corporation of America (aka Columbia/HCA), the largest hospital company in the country. As far as the ER goes, keep in mind 2 things: 1 is that there are multiple hospitals in which to rotate, including Charity/University which has a full (and very good) ER residency program, as well as the VA, which is often staffed by medicine fellows, and even attendings and a few 3rd year residents. Also, remember that as a med student, who staffs the ER doesn't matter you...you do H&Ps for admitted patients regardless of who in the ER calls your resident to evaluate the patient. (But, to answer your question, that's basically standard ER setup in a private/community hospital.)

 

[raptor5]

HCA = Healthcare Corporation of America (aka Columbia/HCA), the largest hospital company in the country. As far as the ER goes, keep in mind 2 things: 1 is that there are multiple hospitals in which to rotate, including Charity/University which has a full (and very good) ER residency program, as well as the VA, which is often staffed by medicine fellows, and even attendings and a few 3rd year residents. Also, remember that as a med student, who staffs the ER doesn't matter you...you do H&Ps for admitted patients regardless of who in the ER calls your resident to evaluate the patient. (But, to answer your question, that's basically standard ER setup in a private/community hospital.)

When I hear HCA I think Senator Bill Frist, the Senate majority leader, and republican presidential canidate hopeful for 2008. I do not know whether his ties to HCA are good thing or a bad thing.

 

[OldPsychDoc]

When I hear HCA I think Senator Bill Frist, the Senate majority leader, and republican presidential canidate hopeful for 2008. I do not know whether his ties to HCA are good thing or a bad thing.

It may LOOK like a good thing now, but when he is elevated to Chancellor and begins imposing his will on the galaxy with his army of clone warriors, led by his disciple Darth DeLay, then we will all fear the power of the Dark Side...

To join the Rebel Alliance, check out http://www.pnhp.org/

 

[Miklos]

It may LOOK like a good thing now, but when he is elevated to Chancellor and begins imposing his will on the galaxy with his army of clone warriors, led by his disciple Darth DeLay, then we will all fear the power of the Dark Side...

To join the Rebel Alliance, check out http://www.pnhp.org/

Having done rotations in several countries with (underfunded) socialized systems, I'm highly skeptical that this is 'the' solution to our under/uninsured problem.

In addition, I have a problem with this quote:

"Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right."-Cardinal Joseph Bernardin

I prefer:

"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages."-Adam Smith

Miklos

 

[OldPsychDoc]

Having done rotations in several countries with (underfunded) socialized systems, I'm highly skeptical that this is 'the' solution to our under/uninsured problem.

In addition, I have a problem with this quote:

"Health care is an essential safeguard of human life and dignity, and there is an obligation for society to ensure that every person be able to realize this right."-Cardinal Joseph Bernardin

I prefer:

"It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest. We address ourselves, not to their humanity but to their self-love, and never talk to them of our own necessities but of their advantages."-Adam Smith

Miklos

That's fine, if you wish to "commoditize" health care to the level of your bread, beer, and burger--but I think that most of us have at least SOME element of concern for human life and dignity that motivates our practice of medicine. The main problem with your quote is that it fails to recognize that our current highly bureaucratized health system is "neither fish nor fowl"--it is as far from being a free market enterprise driven by the labor of self-interested producers as it is from being a benevolently humanitarian single payer system.

Anyway, I wasn't proposing a single payer plan as a solution to all ills--just engaging in some satirical speculation about the doctor/senator having higher ambitions. PNHP seemed a appropriate analogy to the nobler instincts involved. That's all...

 

[Miklos]

That's fine, if you wish to "commoditize" health care to the level of your bread, beer, and burger--but I think that most of us have at least SOME element of concern for human life and dignity that motivates our practice of medicine. The main problem with your quote is that it fails to recognize that our current highly bureaucratized health system is "neither fish nor fowl"--it is as far from being a free market enterprise driven by the labor of self-interested producers as it is from being a benevolently humanitarian single payer system.

Good point.

You are correct in pointing out that the present 'system' is far from the free-market and bureacracy (at a number of levels) is at the root of the problem. However, having seen the bureacracies inherent in socialized systems first-hand, I am convinced that the proposed cure in this case (a benevolent 'humanitarian' single payer system) is worse than the disease.