Awesome Sauceome

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http://well.blogs.nytimes.com/2013/05/30/for-new-doctors-8-minutes-per-patient/

I am concerned for physicians ability to provide good care. It seems that although the ACA has some benefits, one very negative aspect will be the further shortening of physician-patient interactions due to more patients going to physicians. This article talks about how short the interactions were and this was even before millions more patients were flooding the system.

Do you think there will come a point where patient care becomes so horrible (due to physicians simply not being able to spend time with patients because of cost concerns/time) that the system will undergo a profound change (back to old school practice)? Or do you think that we will simply slowly drift further down the ranks of countries that provide quality healthcare?
 

Mad Jack

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I think primary care will gradually make a shift to direct care, cash only, concierge medicine, whatever you want to call it. It's a sustainable model that cuts out all of the reimbursement BS. It's just you and the patient and that's it. By having a smaller patient base and no pressure to produce X number of visits per day, spending a half hour with one patient to sort out their medications and give them a proper physical is suddenly a possibility again. I read one paper recently that showed direct primary care practices reduced insurance company payments by 80%. It just goes to show that you cannot practice real primary care with 6 minute visits.
 
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Awesome Sauceome

Awesome Sauceome

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Goodness that would be amazing.... What is your take on groups like Kaiser Permanente? And that whole system they got going on? Seems like a pretty old way to practice as well. Pay 12$ a year for your family to have all access (mind you like early 1900s heh) but it would seem more enjoyable as a physician to do either of those routes

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RogueUnicorn

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Sounds like typical "sky is falling" BS that every generation spews about the next. While the nonsense that the EMRs typically add in big hospitals is definitely a problem, you don't really need much more than 8 minutes per patient provided you already know them and they are stable. I also have an issue with this part of the article - "As in earlier studies, the researchers found that current interns spend the majority of their time in activities only indirectly related to patient care, like reading patient charts, writing notes, entering orders, speaking with other team members and transporting patients." Well, if reading the chart, writing notes for other providers to reference, calling consults and entering treatment orders is indirect patient care, what the heck is direct patient care?
 
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Awesome Sauceome

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I mean sure its probably some hype, and naturally news presented is 90% of the time bad news not good news. However, even spending a lot of time with both freshly minted and veteran docs, there definitely seems to be a decent amount of frustration towards basically wanting to spend more time with patients but essentially being forced to see more patients because of lower payments.

Sure at the core every doc has a choice to work less or see less patients, but not necessarily... A lot of people who are a part of small groups and stuff really HAVE to see a ton of patients to "feed the beast" that is their nurses, admin, etc

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RogueUnicorn

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I mean sure its probably some hype, and naturally news presented is 90% of the time bad news not good news. However, even spending a lot of time with both freshly minted and veteran docs, there definitely seems to be a decent amount of frustration towards basically wanting to spend more time with patients but essentially being forced to see more patients because of lower payments.

Sure at the core every doc has a choice to work less or see less patients, but not necessarily... A lot of people who are a part of small groups and stuff really HAVE to see a ton of patients to "feed the beast" that is their nurses, admin, etc

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This is mostly talking about residents and your post seems to refer more to attendings, which are somewhat different, if related, issues. I think almost all docs want to be able to spend time with patients but it is what it is. For the residents, seeing more patients has no financial benefit, only educational (if that).