'The Doctor Shortage Is Coming: Whom Should We Blame?'

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Penguin Fan said:
Big pharma already hands out samples for you to give to patients...most major hospitals have inpatient discharge rx services, and honestly the two big chains cvs and wags would never allow it.
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Not true. I run an in-office dispensary and the board of pharmacy has no say in it.
 
Penguin Fan said:
Not really sure how being a CPP is encroaching on your turf? The pharmacist does not have full autonomy and every change in pharmacotherapy has to be approved by the physician.

Here is what California currently permits some pharmacists to do:
http://www.cpha.com/Portals/45/Docs/CEO Message Misc/SB 493 What does it do for me.pdf

And 99% of pharmacists HATE cvs and walgreens
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Why do we need that? Sounds redundant and annoying. I don't have time to check your work. In fact, it's your job to check ours

Basically you want the glory of prescribing medications without any of the responsibility. I understand, it sounds like a sweet gig. But I'm not your babysitter
 
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W19 said:
It is sad to see what greedy 'administrators' are doing to the pharmacy profession...
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http://www.nabp.net/system/rich/rich_files/rich_files/000/001/276/original/naplex-passrates-2015.pdf -> naplex pass rate is dropping

At the moment it's an employers market. More pharmacy students are graduating with higher debt and the chains can pick who they want, suck the life out of them, and move on to the next lot. The only thing chains care about is number of scripts filled. People treat it like its a fast food restaurant.
 
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Psai said:
Why do we need that? Sounds redundant and annoying. I don't have time to check your work. In fact, it's your job to check ours

Basically you want the glory of prescribing medications without any of the responsibility. I understand, it sounds like a sweet gig. But I'm not your babysitter
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At the moment it only depends on which state you're in and whether your practice wants to employ a pharmacist. Here's the protocol in nc where the physician decides what the CPP can diagnose and prescribe:
http://www.ncbop.org/faqs/Pharmacist/CPPAppProtocolReviewFAQsJan2016.pdf
 
Penguin Fan said:
At the moment it only depends on which state you're in and whether your practice wants to employ a pharmacist. Here's the protocol in nc where the physician decides what the CPP can diagnose and prescribe:
http://www.ncbop.org/faqs/Pharmacist/CPPAppProtocolReviewFAQsJan2016.pdf
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How would anyone derive any advantage from that? Take someone who isn't properly trained in diagnosis and treatment, give them prescribing ability then check what they do? And be responsible for all of their mistakes? Because we don't already have people who do that?
 
Penguin Fan said:
http://www.ashpintersections.org/2012/05/is-prescribing-the-next-step-in-the-evolution-of-pharmacy/
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So basically the goal is to increase income by going through some inadequate abbreviated training and then use inflexible protocols designed by physicians to poorly treat the low lying fruit. See easy patients and have the final responsibility fall on the doc anyway. Blah blah shortage of providers. Sounds great, real unique 👍

At least they aren't pretending to want to serve rural populations
 
Psai said:
So basically the goal is to increase income by going through some inadequate abbreviated training and then use inflexible protocols designed by physicians to poorly treat the low lying fruit. See easy patients and have the final responsibility fall on the doc anyway. Blah blah shortage of providers. Sounds great, real unique 👍

At least they aren't pretending to want to serve rural populations
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Everyone's a critic.

This was a letter written by AAFP:
https://www.accp.com/docs/positions/misc/AAFP MTM Letter to CMS^2.pdf
 
So let me get this straight. Pharmacy student is bemoaning the overcrowded, sinking ship that is the pharmacy field, and his solution is to ask med students to let him on board their own already listing ship.

Hey, why not the lawyers too? Their job market is also a mess, so why not bring them into the fold? Surely we can find some way to incorporate lawyers into the process of edging physicians out of their own field. Maybe let the lawyers do the crucial task of pocketing the billings, which would free docs up to work their asses off without the unnecessary distraction of having to think about things like how to spend money or plan vacations. Less money = less problems, amirite?

/sarcasm. Seriously though, we worked extra hard to get to medical school, eschewing lower hanging fruits like law and pharmacy where everyone can get in, and as a result no one can find a job. We didn't put forth all this effort so that we could then just get swamped by rats fleeing sinking ships. Find your own lifeboat, pharmacy brah, this one's full. Maybe the dental forums? Those dentists aren't as facile at prescribing meds as physicians, so there might be greater synergies there for pharmacists.
 
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cmcner said:
The big problem is mal distribution of people more than doctors. Some people live in awful places in the middle of nowhere and then expect doctors to move there to take care of them without paying extra to the doctor for their sacrifice in lifestyle. This is what shortages really are.
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Not necessarily. Places with lots of doctors and are generally popular (like major cities) are expensive and have a high cost of living. It's not fair to ask people to live there if they can't afford it.
 
Brahnold Bloodaxe said:
So let me get this straight. Pharmacy student is bemoaning the overcrowded, sinking ship that is the pharmacy field, and his solution is to ask med students to let him on board their own already listing ship.

Hey, why not the lawyers too? Their job market is also a mess, so why not bring them into the fold? Surely we can find some way to incorporate lawyers into the process of edging physicians out of their own field. Maybe let the lawyers do the crucial task of pocketing the billings, which would free docs up to work their asses off without the unnecessary distraction of having to think about things like how to spend money or plan vacations. Less money = less problems, amirite?

/sarcasm. Seriously though, we worked extra hard to get to medical school, eschewing lower hanging fruits like law and pharmacy where everyone can get in, and as a result no one can find a job. We didn't put forth all this effort so that we could then just get swamped by rats fleeing sinking ships. Find your own lifeboat, pharmacy brah, this one's full. Maybe the dental forums? Those dentists aren't as facile at prescribing meds as physicians, so there might be greater synergies there for pharmacists.
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So you acknowledge that the pharmacy field is sinking, so why are you not concerned? Incompetent pharmacists will be managing your patients medications.

At the academic medical center where I work the attendings have a lot of power, does the same not hold true throughout the rest of the country? The AMA could use their influence to intervene.

I'm a millennial, you can either help make changes to make my profession better (not saying that prescribing power is the answer) or let me drown, and the vicious cycle will keep repeating itself.
 
So you acknowledge that the pharmacy field is sinking, so why are you not concerned? Incompetent pharmacists will be managing your patients medications.
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I am concerned. The worst thing we can do for the quality of pharmacists is let the pharmacy schools off the hook by absorbing their sub-par graduates into the medical job market. This will just incentivize further school expansion and the acceptance of even worse dregs into the profession.

At the academic medical center where I work the attendings have a lot of power, does the same not hold true throughout the rest of the country? The AMA could use their influence to intervene.
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The AMA is neither responsive to the concerns of the rank and file physicians (let alone med students) nor does it answer to them. It answers only to itself and the powerful elites with whom its leadership rubs shoulders. Asking us to lobby with the AMA on pharmacists' behalf is like asking chipmunks to lobby the prime minister of Lesotho on the behalf of basaltuous rock formations. It doesn't compute.

I'm a millennial, you can either help make changes to make my profession better (not saying that prescribing power is the answer) or let me drown, and the vicious cycle will keep repeating itself.
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A millennial, eh? I consider myself a human, not a millennial. Insofar as I recognize the existence of such a category as “millennial,” I think of them not as an age group but as their favorite word, a “social construct.” They are the creatures of safe spaces and Bernie Sanders. I don't approve, if you get my drift.

You also attempt to weirdly place responsibility for your professional fate in my lap, as if I am somehow responsible for how it turns out one way or another.

Do you have a hot sister? You can either help me or let me drown.

See how weird that is? My romantic life is not your responsibility regardless of if you have multiple hot sisters, and your professional life is none of my responsibility even if I could somehow be of help. Let's not pretend otherwise.
 
Penguin Fan said:
So you acknowledge that the pharmacy field is sinking, so why are you not concerned? Incompetent pharmacists will be managing your patients medications.

At the academic medical center where I work the attendings have a lot of power, does the same not hold true throughout the rest of the country? The AMA could use their influence to intervene.

I'm a millennial, you can either help make changes to make my profession better (not saying that prescribing power is the answer) or let me drown, and the vicious cycle will keep repeating itself.
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Your problems are not our problem buddy. This whole country is going to hell and no one except lawyers, politicians, and bankers are going to be spared. So like others have suggested, why don't you go pester them. Maybe they'll let you count their money instead of counting meds.
 
Psai said:
There's no doctor shortage, it's a blatant overutilization of medical services
When the gubment is constantly cutting payments for services and doing things like making it illegal for physicians to own medical facilities, not much of an incentive to dedicate your life to this field. Take away the micromanagement
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where is that, "making it illegal to own medical facilities", this is the 1st I heard of that, wow, how low will they stoop...................? I'm sick and tired of micromanagement.. this world is full of terrible people with no idea what they are doing
 
Penguin Fan said:
Everyone's a critic.
This was a letter written by AAFP
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I was told from a friend at the Family Practice clinic they were a resident at, there are pharmacists who see patients specifically as an office visit for medication reconciliation and medication advisement/formulary changes. Afterwards they have to go to the physician and precept the visit and the physician sees the patient again, does an exam, double-checks the pharmacist's recommendations, and then signs off the pharmacists note and write their own.

My only thought from hearing that was, why would we, as physicians want to add that burden to ourselves? So that you guys get to play doctor a bit more? If primary care wasn't already pushed and focused with seeing numerous patients a day and visit times stretched ridiculously thin, it would be a different story, but that's not reality.

Penguin Fan said:
So you acknowledge that the pharmacy field is sinking, so why are you not concerned? Incompetent pharmacists will be managing your patients medications.
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If anything, the pharmacy field will implode upon itself. The end results is over-saturation of the field with graduates all applying for a few available positions across the country. What that makes is a employer's market-- hospitals and retail pharmacies will be able to choose from the cream of the crop to staff themselves, and the end result is we work with the more talented people in the field. Unfortunately that does mean the average and below average, and even possibly the above average graduates will be struggling in debt and difficult to secure a position, but ce la vie.

You guys should have protested that long ago instead of letting pharmacy schools open at every corner due to unchecked greed by your administrative bodies.
 
tatsuchi said:
I was told from a friend at the Family Practice clinic
You guys should have protested that long ago instead of letting pharmacy schools open at every corner due to unchecked greed by your administrative bodies.
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having been a student of the '80's.... if you hear "a giant sucking sound" .. be VERY, VERY concerned.... that might be the only sound it makes...

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I don't know what to make of this, but I followed one patient that saw, IM, hem onc, radiology, pathology, interventional radiology, and pulmonary medicine just to get a diagnosis of some sort of benign lesion in the lung. Is all that really necessary? Do we really need that many specialist?
 
Rejecting competent applications to medical school..


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Penguin Fan said:
This was never about me, I'm just advertising what the pharmacy profession wants. If pharmacists (those who meet a certain level of training) are granted provider status then entry into pharmacy school will become more competitive and acceptance standards will be raised (brighter/more motivated students require better professors which will drive down the current saturation of pharmacy students/new private pharm schools). Raising standards in the pharmacy field could only benefit the medical field.
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What your college professors are telling you pharmacists want (or even pharmacist associations where the majority of practicing pharmacists are not members), is not really what pharmacists want. Pharmacists want provider status so they can directly bill for MTM and stuff like that, the vast majority of pharmacist know we are not trained to diagnose, and not want to diagnose.

One model that is used and works (but on a low scale due to economics) is where the physician does the formal diagnosing, then the pharmacist does medication recommendations and/or dosing. This is most commonly done in hospitals via protocol, but is also done in some out-patient clinics.

Siggy said:
We'll have 4 years of pre-med undergrad, 4 years of medical school, at least 3 years of residency... can we practice just a little bit of pharmacy and bill for it? You know... just the drugs that we're really familiar with we should be able to prescribe and dispense from our office. It'll help patients out in the end by letting them get their prescriptions filled quicker, which should increase compliance. We don't want to take over all of pharmacy... just the bit that we practically do already.
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Ummmmm, this is already legal in most states. It is not commonly done because most doctors don't want to deal with the expense of carrying a pharmacy inventory, paperwork/recordkeeping requirements (and most, if not all states, do not allow the doctor to make a profit on the prescriptions sold, due to "conflict of interest".) That, and the fact that an ever increasing number of doctors are employees of a health system that runs their own pharmacy, so not only would they have no incentive, they would probably be forbidden by their employment contract.
 
omn said:
where is that, "making it illegal to own medical facilities", this is the 1st I heard of that, wow, how low will they stoop...................? I'm sick and tired of micromanagement.. this world is full of terrible people with no idea what they are doing
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This probably varies from state to state, I don't think its actually illegal for doctors to own their own medical facilities (and by this, its referring to hospitals, laboratories, etc.), or the more likely scenario of having a controlling interest in a non-profit, its that its illegal for doctors to make a profit off these, because its considered a "conflict of interest", so therefore there is little economic reason for the doctor to want to own a medical facility. The theory being that if a doctor owns a controlling interest in a lab, then the doctor will be ordering unnecessary labwork for all their patients. It is micromanaging, but the government justifies it since they are paying for a good portion of it (Medicaid/Medicare.)
 
BidingMyTime said:
This probably varies from state to state, I don't think its actually illegal for doctors to own their own medical facilities (and by this, its referring to hospitals, laboratories, etc.), or the more likely scenario of having a controlling interest in a non-profit, its that its illegal for doctors to make a profit off these, because its considered a "conflict of interest", so therefore there is little economic reason for the doctor to want to own a medical facility. The theory being that if a doctor owns a controlling interest in a lab, then the doctor will be ordering unnecessary labwork for all their patients. It is micromanaging, but the government justifies it since they are paying for a good portion of it (Medicaid/Medicare.)
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I'd still like to know what this could be referring2, partnerships are not 501c3 corporations ... Who made it so that a doctor can't own their office?

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omn said:
I'd still like to know what this could be referring2, partnerships are not 501c3 corporations ... Who made it so that a doctor can't own their office?

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Our own offices, we can. Hospitals/surgery centers not so much.
 
Penguin Fan said:
PLEASE don't try to fix the issue by admitting lower tier students. Better yet, lobby for pharmacists to have provider status, so they can bill for their services. Clinical pharmacists (are over-trained) can become mid level practitioners, so physicians can specialize and focus on more complex health issues.

Then there's the whole NP issue.
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Let's lobby for technicians, janitors, administrators, and food-service specialists to become providers too. Then, they can all practice under the umbrella of "alnternopatho-astrologogogurt medicalishiousness provider" witch-doctors in underserved areas.

We should blame legislators for barring all these folks from being providers. In fact, Jimmy who hangs out in the alley by my house should also be considered an untapped resource for the health of other people - he definitely dispenses a lot of products on his own, we should get him some papers that allow him to practice pharmacy. There are rural areas where Jimmy could help the community like he is helping my community now.
 
*Sarcasm de-intensifies*

LONG POST AHEAD.... TL;DR: Mid-level creep is expected, and economics predicts it.

From a purely economic standpoint, mid-level creep makes a lot of sense. It also makes a lot of sense why policy makers, news folk and propaganda-masters are making a lot of stink right now.

There are a few major economic factors behind "mid-level creep" assuming a near free-market system: (a) a quasi-monopoly on a resource with high demand and (b) consumer surplus. Any economist, policy maker, and provider will tell you that there is money in health care, (a) plays a large role in the legislation that has passed and will continue to pass in the future and (b) is why Doctors will still be fine .

To follow up with (a), MD's had a monopoly-like hold on a lucrative business.

monopoly_graph.jpg

This means that because there were a set quantity of medical doctors graduating at any given year, and legislation in place to secure their practice and profits, the effect was an artificial rise in the price of the good (healthcare) due to a push to the left on the graph of supply (see above). Anytime someone has a status like this in a lucrative business, there is incentive to find ways to increase competition (i.e. supply). This clearly leads to the eventual rise of mid-levels, which pushes the "profit maximizing monopoly qty" in the graph line to the right over time. In the model, prices will equalize at the meeting point of supply and demand eventually if an identical service or good is provided by all competitors. This will never happen in real life because MD's and DO's are not identical to NP's or other mid-levels, but eventually all shared procedures will drop in price/compensation. This may matter at first, but it won't really change the bottom line in the long-term because of (b). This leads us to the second point, (b) consumer surplus.

consumer-surplus-1.jpg

If there is a business with a set demand and supply, then there is incentive to get as much money as someone is willing to pay for any particular good or service. In a "dystopian" future where MD's, DO's, and NP's, all compete with the same service (would never happen); there will be incentive to build into the structure of service a way to take more for the same product, or otherwise find a way to differentiate the service/good to make more money. For example, if you want a soda, a company used to sell X and was paid Y. They increased profits by establishing a new system. They are now happy to sell you a medium (baseline price/product X), but offers a large (2X) or a small (X/2) the beauty of this, is that they can sell X/2 to people that wouldn't have every bought X and make more money, and can sell 2X to people who are willing to pay more for almost the same product/service.

In health care, doctors are seen as "higher quality" (like 2X) so can take more money for some of the same products or services. Doctors provide a higher level of service to pay who are willing to pay for it, so they will continue to take this consumer surplus to the left of the equilibrium point in the graph (make more $$$ than or mid-levels).

As long as the quality remains, and even if the eventual competition destroys the monopoly, Doctors will still be fine. Don't people still buy porches when Toyotas will get you from A->B just as well? Take pride in becoming future Porches in the health care system, MD and DO students. Eventually, all shared services between MDs/DOs and mid-levels will be given up by MDs/DOs or they will have to find ways to subdivide the service/good even more to make more money. Since MDs/DOs are the highest quality provider, they will still always make the most money, even if they eventually lose cash on shared procedures.
 
mistafab said:
*Sarcasm de-intensifies*

LONG POST AHEAD.... TL;DR: Mid-level creep is expected, and economics predicts it.

From a purely economic standpoint, mid-level creep makes a lot of sense. It also makes a lot of sense why policy makers, news folk and propaganda-masters are making a lot of stink right now.

There are a few major economic factors behind "mid-level creep" assuming a near free-market system: (a) a quasi-monopoly on a resource with high demand and (b) consumer surplus. Any economist, policy maker, and provider will tell you that there is money in health care, (a) plays a large role in the legislation that has passed and will continue to pass in the future and (b) is why Doctors will still be fine .

To follow up with (a), MD's had a monopoly-like hold on a lucrative business.

monopoly_graph.jpg

This means that because there were a set quantity of medical doctors graduating at any given year, and legislation in place to secure their practice and profits, the effect was an artificial rise in the price of the good (healthcare) due to a push to the left on the graph of supply (see above). Anytime someone has a status like this in a lucrative business, there is incentive to find ways to increase competition (i.e. supply). This clearly leads to the eventual rise of mid-levels, which pushes the "profit maximizing monopoly qty" in the graph line to the right over time. In the model, prices will equalize at the meeting point of supply and demand eventually if an identical service or good is provided by all competitors. This will never happen in real life because MD's and DO's are not identical to NP's or other mid-levels, but eventually all shared procedures will drop in price/compensation. This may matter at first, but it won't really change the bottom line in the long-term because of (b). This leads us to the second point, (b) consumer surplus.

consumer-surplus-1.jpg

If there is a business with a set demand and supply, then there is incentive to get as much money as someone is willing to pay for any particular good or service. In a "dystopian" future where MD's, DO's, and NP's, all compete with the same service (would never happen); there will be incentive to build into the structure of service a way to take more for the same product, or otherwise find a way to differentiate the service/good to make more money. For example, if you want a soda, a company used to sell X and was paid Y. They increased profits by establishing a new system. They are now happy to sell you a medium (baseline price/product X), but offers a large (2X) or a small (X/2) the beauty of this, is that they can sell X/2 to people that wouldn't have every bought X and make more money, and can sell 2X to people who are willing to pay more for almost the same product/service.

In health care, doctors are seen as "higher quality" (like 2X) so can take more money for some of the same products or services. Doctors provide a higher level of service to pay who are willing to pay for it, so they will continue to take this consumer surplus to the left of the equilibrium point in the graph (make more $$$ than or mid-levels).

As long as the quality remains, and even if the eventual competition destroys the monopoly, Doctors will still be fine. Don't people still buy porches when Toyotas will get you from A->B just as well? Take pride in becoming future Porches in the health care system, MD and DO students. Eventually, all shared services between MDs/DOs and mid-levels will be given up by MDs/DOs or they will have to find ways to subdivide the service/good even more to make more money. Since MDs/DOs are the highest quality provider, they will still always make the most money, even if they eventually lose cash on shared procedures.
Click to expand...

You do know that your intro to microeconomics level understanding is not how it works in medicine at all, correct?

Assuming we have a free market with a quasi monopoly? Makes no sense
 
tatsuchi said:
You guys should have protested that long ago instead of letting pharmacy schools open at every corner due to unchecked greed by your administrative bodies.
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Let's learn a lesson here, my fellow med students. Do not fall for the doctor shortage scam proffered in the media, nor the fictitious residency shortage pushed on us by the AAMC as if we were total *****s. Our unfortunate pharmacy colleagues were in the same exact situation nary a decade ago, and look what happened to them. They went from an imaginary "pharmacist shortage" to a glut of pharmacists in less time than it takes to say "boonies or the welfare office."
 
Psai said:
You do know that your intro to microeconomics level understanding is not how it works in medicine at all, correct?

Assuming we have a free market with a quasi monopoly? Makes no sense
Click to expand...

It is how it works. It makes perfect sense in describing a phenomenon - models always have to make assumptions to make predictions. That is how they work.
 
medic86 said:
Well, the presumption is that NPs have had direct patient contact for a number of years. Your average pharmacist does not.
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They certainly can tailor their curriculum a little bit to that end.... A pathology class + 500 hospital hours...:boom:
 
mistafab said:
It is how it works. It makes perfect sense in describing a phenomenon - models always have to make assumptions to make predictions. That is how they work.
Click to expand...

Please learn how physician billing works because you don't know what you are talking about. You cannot have a monopoly in a free market because you need some sort of barrier to entry to have a monopoly
 
mistafab said:
*Sarcasm de-intensifies*

LONG POST AHEAD.... TL;DR: Mid-level creep is expected, and economics predicts it.

From a purely economic standpoint, mid-level creep makes a lot of sense. It also makes a lot of sense why policy makers, news folk and propaganda-masters are making a lot of stink right now.

There are a few major economic factors behind "mid-level creep" assuming a near free-market system: (a) a quasi-monopoly on a resource with high demand and (b) consumer surplus. Any economist, policy maker, and provider will tell you that there is money in health care, (a) plays a large role in the legislation that has passed and will continue to pass in the future and (b) is why Doctors will still be fine .

To follow up with (a), MD's had a monopoly-like hold on a lucrative business.

monopoly_graph.jpg

This means that because there were a set quantity of medical doctors graduating at any given year, and legislation in place to secure their practice and profits, the effect was an artificial rise in the price of the good (healthcare) due to a push to the left on the graph of supply (see above). Anytime someone has a status like this in a lucrative business, there is incentive to find ways to increase competition (i.e. supply). This clearly leads to the eventual rise of mid-levels, which pushes the "profit maximizing monopoly qty" in the graph line to the right over time. In the model, prices will equalize at the meeting point of supply and demand eventually if an identical service or good is provided by all competitors. This will never happen in real life because MD's and DO's are not identical to NP's or other mid-levels, but eventually all shared procedures will drop in price/compensation. This may matter at first, but it won't really change the bottom line in the long-term because of (b). This leads us to the second point, (b) consumer surplus.

consumer-surplus-1.jpg

If there is a business with a set demand and supply, then there is incentive to get as much money as someone is willing to pay for any particular good or service. In a "dystopian" future where MD's, DO's, and NP's, all compete with the same service (would never happen); there will be incentive to build into the structure of service a way to take more for the same product, or otherwise find a way to differentiate the service/good to make more money. For example, if you want a soda, a company used to sell X and was paid Y. They increased profits by establishing a new system. They are now happy to sell you a medium (baseline price/product X), but offers a large (2X) or a small (X/2) the beauty of this, is that they can sell X/2 to people that wouldn't have every bought X and make more money, and can sell 2X to people who are willing to pay more for almost the same product/service.

In health care, doctors are seen as "higher quality" (like 2X) so can take more money for some of the same products or services. Doctors provide a higher level of service to pay who are willing to pay for it, so they will continue to take this consumer surplus to the left of the equilibrium point in the graph (make more $$$ than or mid-levels).

As long as the quality remains, and even if the eventual competition destroys the monopoly, Doctors will still be fine. Don't people still buy porches when Toyotas will get you from A->B just as well? Take pride in becoming future Porches in the health care system, MD and DO students. Eventually, all shared services between MDs/DOs and mid-levels will be given up by MDs/DOs or they will have to find ways to subdivide the service/good even more to make more money. Since MDs/DOs are the highest quality provider, they will still always make the most money, even if they eventually lose cash on shared procedures.
Click to expand...
Unfortunately, a free market requires complete information, completely interchangeable goods and services, no market power, no non-economic barriers to entry. Plus, healthcare expenditure is not very elastic, which adds another very complicated element to hc econ.
 
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VA Hopeful Dr said:
Our own offices, we can. Hospitals/surgery centers not so much.
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So, the future is a mega corporate like HCA, a mega nonprofit like MedCenter.edu, or, if Bernie gets his way... all hospitals become governmental entities...?

This reminds me of the mega hospital merger boom (what an incredible economic and business concept that was) in the 1980s... which subsequently ended with numerous, even larger, bankrupt "health care providers"... anyone remember that?

BTW, you know there really are alot of STUPID people Tom Brokaw's age... and alot of very stupid business and economic ideas that we had to suffer through from HIS Great Generation....

You know the only " for profit", "nonregulated" industry in this whole frickin' country will be corporate media.. with CNN being near the top (would have been bankrupt if AOL and subsequently TimeWarner didn't buy them out). Does anyone anywhere think David Letterman is the most INTELLIGENT person in the world.. and wonder how many radio stations would "make him happy" .. or just how GREAT Ted Turner is, or how many satellites would make Ted Turner happy....

I can almost remember how frickin' clever they all thought they were in, say, 1980...

(a bunch of stupid people 55+ in this world, I can tell you that)

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I'm getting N&V just remembering it all...

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Maldistribution and shortage, but mainly maldistribution. Medicine is a very unique field in that you need doctors EVERYWHERE, but unlike what most of society believes, doctors are still human beings, and most do want to live in a decent city, and thats where distribution issues occur. Compare this to other fields where the best jobs are mostly all located in or near decent cities. (Think of tech companies, are they (google, fb, apple, amazon, Microsoft, etc) in rural areas??; Business- are the big banks in rural areas??). The only ways to fix maldistribution issues with doctors is to produce an oversupply of doctors, so some doctors are FORCED to go to rural areas, or be jobless. Or drastically increase pay in rural areas (highly doubt government will do this) . The other option is having more midlevels take over in those areas.

I live in a major city and I can literally without much difficulty get same day appointments with internist.
 
anbuitachi said:
Maldistribution and shortage, but mainly maldistribution. Medicine is a very unique field in that you need doctors EVERYWHERE, but unlike what most of society believes, doctors are still human beings, and most do want to live in a decent city, and thats where distribution issues occur. Compare this to other fields where the best jobs are mostly all located in or near decent cities. (Think of tech companies, are they (google, fb, apple, amazon, Microsoft, etc) in rural areas??; Business- are the big banks in rural areas??). The only ways to fix maldistribution issues with doctors is to produce an oversupply of doctors, so some doctors are FORCED to go to rural areas, or be jobless. Or drastically increase pay in rural areas (highly doubt government will do this) . The other option is having more midlevels take over in those areas.

I live in a major city and I can literally without much difficulty get same day appointments with internist.
Click to expand...
Ah yes because flooding the market with more physicians than necessary in order to deliberately drive down compensation and keep docs desperate for work even in malignant, low-pay positions will definitely keep the best and brightest coming into the profession and keep the midlevels away from the practice of medicine.

How about instead decreasing regulatory burdens and legal liability for physicians working in areas of need for starters before trying things that would harm medicine.
 
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anbuitachi said:
Maldistribution and shortage, but mainly maldistribution. Medicine is a very unique field in that you need doctors EVERYWHERE, but unlike what most of society believes, doctors are still human beings, and most do want to live in a decent city, and thats where distribution issues occur. Compare this to other fields where the best jobs are mostly all located in or near decent cities. (Think of tech companies, are they (google, fb, apple, amazon, Microsoft, etc) in rural areas??; Business- are the big banks in rural areas??). The only ways to fix maldistribution issues with doctors is to produce an oversupply of doctors, so some doctors are FORCED to go to rural areas, or be jobless. Or drastically increase pay in rural areas (highly doubt government will do this) . The other option is having more midlevels take over in those areas.

I live in a major city and I can literally without much difficulty get same day appointments with internist.
Click to expand...


Allow me to clarify for you. Midlevel take over in "rural" areas is already the plan in most states. The problem is that they are not restricted from practicing in "non-rural" areas. So they end up in the city too, peddling nonsense healthcare because they have no clue what they are talking about. And patients end up very confused. I am convinced that reasonable 3rd year medical students could provide better care than a team of NPs. We need laws strictly prohibiting them from practicing unsupervised within X miles of real providers, otherwise we open a lot of patients up to a lot of harm, all so NPs can line their pockets.
 
Is there a true shortage of physicians even in rural areas? What I'm saying is, let's take the case of people who live in a small settlement in Southwestern Texas which only exists to service a gas station for travelers to Big Bend National Park. The settlement has 20 people and the next settlement of any size is the city of Odessa 100 miles away. So if someone in that "town" wants access to a physician, they must drive 100 miles to get it.

Does this constitute an example of a physician shortage/lack of access to care? Should this town of 20 people have its own dedicated hospital complete with 24hr neurosurgeon coverage?

The reality is, 85% of the United States population lives in an urban area. The United States covers a huge territory, so the 15% who don't live in an urban area are stretched thin over a landmass much larger than the entirety of Western and Central Europe. No shiznits not all of them have a spine surgeon within walking distance. They can't have one. There isn't enough patient density to justify having a physician in much of the rural United States. You can mint doctors till half of them are unemployed, but the good people of Piedmont, Arizona will still have to drive to the nearest city to get their hip replaced.

This isn't rocket science. Just like Mark Zuckerberg isn't so stupid to actually believe there is a "STEM shortage" in the US, so the people pushing the "physician shortage" scam are not that stupid, either. Mark Zuckerberg wants cheap H1B visa workers so he can pay his employees less. Take three guesses what the physician shortage scammers want...
 
anbuitachi said:
. The only ways to fix maldistribution issues with doctors is to produce an oversupply of doctors, so some doctors are FORCED to go to rural areas, or be jobless. Or drastically increase pay in rural areas (highly doubt government will do this) . The other option is having more midlevels take over in those areas.
Click to expand...

You can produce 2x as many doctors and STILL have problems with maldistribution because some physicians will opt to remain jobless than go to some rural areas. Even midlevels dont wanna live in those areas.

You cant live 300 miles away from the nearest post office and expect a sushi restaurant across the street. Cuz the people making sushi dont wanna live there either.

The only way to get docs in those areas is to pay them a PREMIUM.. twice to three times what they would normally make in the big sitay.
 
...the Benthamian Moral Calculus leads us to neither socialized medicine nor more doctors... problematically, the corrupted Pavlovian white slavers want to keep on ringing the bell and expect us to still come running...... well it's not going to happen.... there'd be a reason why 20 years after doubling the number of Olympiad competitions, no one is interested in going to the Olympics anymore...... case in point

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Perspective (and experience) ....
http://www.newyorker.com/magazine/2014/11/24/drool

(waiting for, "I find it insulting that you compare the leadership of today's medical establishment to "white slavers" " (to have the level of your discourse insulted) )
 
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GUH said:
Ah yes because flooding the market with more physicians than necessary in order to deliberately drive down compensation and keep docs desperate for work even in malignant, low-pay positions will definitely keep the best and brightest coming into the profession and keep the midlevels away from the practice of medicine.

How about instead decreasing regulatory burdens and legal liability for physicians working in areas of need for starters before trying things that would harm medicine.
Click to expand...


Medicine is increasingly becoming a business. i can definitely see the government do this to 'fix' the problem. it's all about getting the bang for the buck to the administrators.
 
... and BTW, hahaha
cats is inside the baggie ... Don't suffocate (!).

1462877347751.jpg


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I just really love that in the title of the article is "who do we blame?" not "how do we fix it". Unfortunately, resting the blame on someone else's shoulders and sitting back to watch the titanic sink with the sense of security in knowing "it's not my fault" is the new American way. 🙁
 
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