What you need to know about Howard Dean

[Freeeedom!]

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As written in Emergency Physicians Monthly, January 2004 pages 1,8-9,16


The best source for this article is the Print article itself, it cannot be found on the website.
You may write to recieve a copy at [email protected]


Here are some out takes from the article on Howard Dean and his ideas on healthcare:

"1. Federally subsidized insurance would pay for chiropractic treatment without referral or oversight of a physician. 'As President of the United States, I will work towards further integrating chiropractic care into these systems-and into all federal health care programs and systems where chiropractic is excluded or not adequately provided"

"4. Empower pharmacists and other non-physician providers to manage the cases of Medicaid patients"

"7. Work with organized labor to establish home care nursing unions"...the Sopranos meet grandma and the LPN's. Gotta have a smoking break...its in my union bylaws

"11. Encourage and facilitate the sale of prescriptoin durgs on the internet from foreign countries"

"Mr. Dean promises to : Allow Nurse practitioners practice independently; Expand the role and compensation of Nurse Practitioners"

"Governor Dean believes that, as an interist, the majority of people he saw on a first visit could have received excellent care from a competent nurse practtioner, without his direct supervision"


Once again, this article is found in Emergency Physicians' Monthly, January 2004 by Mark L Plaster, MD

 

[ckent]

Yup. I was made aware of this and more and have since withdrawn my vote for him. I hope that he loses by one vote in Maryland now which ends up costing him the election . Physicians in Vermont are now among the lowest paid physicians nationally, his wife only makes 50K per year, and I used to think that she was full time but someone else told me that she was part time. Irrespective, Dean's solution on insuring the uninsured is covering them all under some medicaid program that balances the budget and keeps cost down by decreasing reimbursement for hospitals and doctors. I was reading that health insurance is actually higher in Vermont then other states too, because health insurance payments have to be higher then other states just so that hospitals can continue to stay financially afloat because the state reimburses so many things below cost.

 

[NinerNiner999]

Hmm. doesn't sound too Primary Care-friendly. Does he address medicare reimbursement for emergency services or any other type of Emergency-related issues?

I don't disagree with his position on prescription drugs. It is a shame that our own country's pharmaceutical companies can't make their products affordable to those who are living off of medicare and social security. They should be able to get their prescriptions any way they can - as long as its safe and reliable. Just my opinion, though. Besides, if they can't afford it, they'll just keep getting it the cheapest way for them - a visit to their friendly neighborhood ED (Which in the long run will cost 5-10 times as much).

 

[idq1i]

Awesome!!! Who needs those overpaid physicians! Dean for President!!!!


(of Canada)

 

[DrQuinn]

Looks like Dean has been getting back rubs from all the special interest groups (chiros, ARNPs).

Q, DO

 

[edinOH]

Looks like he is willing to ***** himself out to any special interest that comes along.

I'm not too worried. The only thing we really need to know about him is that he will still be a private citizen come next January.

 

[DocWagner]

I read the article and plan on posting it next to our residency mail boxes.
Sounds like "Dr" Dean really doesn't see the value of the oath he took upon medical school graduation...maybe he would prefer to be a Nurse Practioner that practices chiropractic.

I hope everyone takes the opportunity to read the article and give it to friends.

 

[Finally M3]

Another reason to vote again for Dubya...

I can understand increasing compensation to NPs...but chiropractors?? Why not include Medicare compensation for Voodoo practioners and witch doctors?

 

[DocWagner]

How about increasing compensation for residents AT THE SAME LEVEL as Nurse Practitioners and Physician Assistants.

How about limiting the amount of Nurse Managers by increasing the hourly wage of ICU, floor and EM nurses...at the same time creating financial incentives (by "forgiving" federally subsidised medical school loans up to 30k) for Medical students to enter primary care!

Instead of increasing chiropractic care, INCREASE reimbursement of Osteopathic Manipulation or medicare reimbursement for Physical Therapy, therefore eliminating the NEED for chiropractic reimbursement!

 

[H0mersimps0n]

Originally posted by Finally M3
Another reason to vote again for Dubya...

I can understand increasing compensation to NPs...but chiropractors?? Why not include Medicare compensation for Voodoo practioners and witch doctors?

lol another reason? If you're lucky the ONLY reason.

Guess who picks up the tab for all those senior citizens left in the cold with the MC reform, hospitals. People are going to get care (to an extent) no matter what, it comes down to how much of the burden the government can take off of the hospitals by paying for the uninsured.

Three hospitals where I'm from "WENT OUT OF BUSINESS" and here in Erie I know they've lost one recently and I think another a while ago.

Makes me sick to my stomach to think we have legislators that let this kind of crap happen, I mean just say it out loud: "my local hospital went bankrupt". Doesn't that make you ill? What matters these days anyway?

 

[D.M.D dude]

I think it's time for me to step in and run for president. 😀

 

[tofurious]

If you look at Howard Dean's bio, it seems that he became the Lieutenant Governor 4 years after he graduated from medical school. This may be misinformation as he graduated from college 8 years before he graduated from med school, so it's entirely possible that they meant "finished residency" instead of graduating from med school. Nevertheless, he never really spent much time practicing medicine regardless of when he graduated. This may explain how he could be so ignorant about other health "professionals" and the idiotic plan to buy drugs from Canada (where do you think Canada gets their prescription drugs from? Canadian drug makers that compete with Pfizer and Bayer?).

Plus, he simply lacks personality. Kind of reminds me of our local AMA and AMSA reps though... people who like to get involved ONLY to stuff their resumes.

 

[ERMudPhud]

The article everyone is referring to was printed in an industry rag supported primarily by drug companies and corporate EM groups. Not exactly an unbiased source. It was primarily a collection of short quotes followed by the editor's (clearly not a Dean supporter) rather caustic opinions. No attempt at an opposing view was attempted. Even as a long standing Democrat I can't say I'm sold on Dean but I wouldn't make my decision based on this article. Dean's support for reimbursement to chiropracters drives me nuts but there is more to any candidate than any one specific issue.

Originally posted by tofurious
the idiotic plan to buy drugs from Canada (where do you think Canada gets their prescription drugs from? Canadian drug makers that compete with Pfizer and Bayer?).

Exactly! Canadians get many of their drugs from Pfizer, Bayer etc... at prices that Americans can't get because the Canadian government negotiates for cheaper prices on the same drugs from the same companies while our government is looking out more for the interests of the drug companies than the people.

 

[Freeeedom!]

ERMudPhud,

While it is NOT a peer reviewed Journal, this article DID NOT have a slant toward ANY political party as Dean was the ONLY candidate noted.
I am an Independent, and I CERTAINLY think that if quotes that are controversial are noted by ANY politician, it should be noted; regardless of political affiliation.
This article, did NOT offer solutions, nor did it mention the current president, rather only the viewpoints of the writer and his opinion of a candidate that is noted to be a "Doctor".

Important, wouldn't you agree??

As the time approaches when we are still learning about the candidates, all information is helpful.

Write Mr. Dean...ask him yourself if he made these quotes. As there are no clear front runners in the Demo race for the nomination, it only helps if we learn what we can. And this ain't exactly poloroids on a boat called "Monkey Business".

 

[Idiopathic]

I approve of the cheaper scrips. The American government lets the public get ass-reamed over prescriptions, and individual states should be allowed to work some deals out, because it is their responsibility to help the citizens. The feds wont do it.

 

[edinOH]

I think it is important to remember that the drug companies exist to make a profit, first and foremost. That is why they are in the business of making the product they make. If there is no money in it, they won't research it, develop it, or produce it.

The Canadian drug thing is a case of the manufacturers selling their product to what they at the time preceived to be a set, limited market, with a defined need for their drugs. Since the Canadian govt is the financial provider of their citizen's health care, they were able to act like Wal-Mart and get Wal-Mart style volume discounts. I realize this isn't news to most of you.

But. The price breaks given to the citizens of Canada really don't work for the drug companies if they are forced to provide those deep discounts to the rest of their market. I don't know the specific bottom line costs for the drug companies and their individual drugs obviously, but I think it is important to remember this fact when considering how much drugs should and do cost.

On the other hand, I think there is plenty of price-gouging in the pharmaceautical industry. It is a double-edged sword. We want to provide the financial incentive to the drug companies to make the out-lay of millions, if not billions, of dollars for a drug that may or may not ever come to market, so that they are willing to take this risk. This financial incentive is obviously huge profit.

It is a tricky situation. On one hand I think we should regulate the cost of prescription drugs, while allowing for a handsome profit for the drug companies. Then again I wonder if this wouldn't inevitably stifle the financial drive to take the risks associated with development.

I think one way might be to let the drug companies ass-rape the consumer for a couple of years when a new drug comes on the market and then either make it generic immediately after that or tightly regulate the cost.

Ultimately we can't just demand cheaper prescription drugs and continue to expect the level of research and innovation the U.S. drug industry has maintained thus far.

Also, I'm surprised the Canadian govt. isn't fighting hard to disallow the exportation of their drugs from Canada. If this continues it will ultimately cook their golden drug goose.

Don't mean to lecture. I'm just kind of thinking this stuff through as I type.

And judging from the results of the Iowa caucus, Dean is toast.

 

[ckent]

A news article that I read a few months ago raised a few excellent points about importing scripts from Canada. First of all, think about the absurdidity of it all. We are making drugs here in the US, shipping them to Canada who is applying a price fixing system, who is then taking a small profit off and then shipping them back to us. It's like paying someone to go commit a crime because you believe that crimes are unethical. Canada only accounts for a small percentage of the drug companies business, tiny compared to the US drug market. If the drug companies recognize that the US is going to start importing all of it's drugs from Canada, all they have to do is stop sending drugs to Canada or ration drugs. This will get the Canadians who can't get drugs all mad because us Americans are importing them all, and then they will pass laws outlawing the export of them. States are only able to do this because drug companies don't want to seem like the bad guy right now. But if too many states try doing this and push comes to shove, I think that you will see the drug companies get together to intervene and re-negoatiatte their contracts with the Canadian government. If we want to price fix, then we should price fix. The fact is that greed drives discoveries in the pharmaceutical market, that's why there hasn't been a single successful non-profit drug company that discovers new drugs for the "underserved". Don't even get me started on what would happen if the government tried to make their own drugs too. Practically everything the government does can be run out of the private sector for a fraction of the price with better quality. The government even pays a company to ship food around in Iraq, I seriously doubt they (the NIH or any other branch) is capable of embarking on any drug research.

I also wanted to comment on the whole residency match system and artificially keeping residents salaries low (below PA's and NP's, even though we work many more hours and oftentimes do much more). With the whole lawsuit against the nrmp, two "prominent" senators have stepped forward to say that even if the lawsuit is successful, they will intervene by making a law overriding the lawsuit and keeping the match. The two senators who "care" about these issues is Sen Hillary Clinton and Kennedy. They are obsessed with seeing doctors get paid less, they don't actually care about our education or well-being, they only want to make sure that they can continue to get cheap labor. Ironically, these two are the most prominent senators on health care issues in the democratic party. Besides pushing for managed care, decreased medicare reimbursements for hospitals, while dictating where doctors practice, these two fellows care enough about the match system to protect it for us alll. 🙄 I am actually opposed to the lawsuit going underway right now too because I think that the app process would be too chaotic without the match, but I certainly don't have the same motives that these two have.

 

[Finally M3]

Actually, the Michigan State Medical Society is gonna be sponsoring a talk in Febuary with health policy advisors from Dubya, Dean, and other Deomcratic candidates...I'll be sure to ask for clarification...

As for the hospitals closing...dude, I go to Wayne State in downtown Detroit, and our home hospital system, the Detroit Medical Center, is in the middle of 'massive restructuring'. I don't need lessons on how messed up the financing of our medical system is. I see it every day I go to work.



PS Dean ain't toast...if he finishes 3rd in New Hampshire the wheels may start to fall off...

 

[docslytherin]

as a side note, John Kerry is also pushing full practice rights for nurse practitioners. i haven't found anything out for the other candidates though...

 

[tofurious]

It is not in anyone's interest but our own to raise our salaries. To the rest of our society, it does not matter that it takes us many many productive years to acquire the skills necessary to treat their ailments. They want the best at the lowest cost: the American ideal has graduated from earning a fair share based on your hard work to getting more bang than your buck deserves. That is why companies are exporting jobs off-shore. They simply cannot give Americans what they want with the US labor and material costs. If one could demonstrate that shipping doctors in from Asia and South America could sufficiently take care of America's patients without a drastic drop in quality, we'd be in the unemployment lines like the IBM programmers. The only people that can help us maintain or ideally raise our salaries are us. Maintaining that the residency system would be TOO chaotic is a cop-out. No one has ever said that all regulations and guidelines should go out of the door along with the Match. All the lawsuit claims is that the Match violates anti-trust laws, which it does. There are many open market practices with laws governing the participants that allow for free to freer competition without massive chaos. People apply for college, medical school, and jobs all without a Match and without the chaos every Match proponent is afraid of. If there is regulated competition at every other level, why should there not be at the residency level?

Health care reform proposed by politicians is really not about the physicians. Their health care reform is about providing the best care at the lowest cost, including low physician salaries to cut down the "supply" cost. Allowing nurse practitioners to practice independently is one step closer towards achieving that goal. Americans need to realize that the type of medicine they want is not cheap, and the nurse practitioner/nurse anesthetist solution is very similar to the Canadian prescription drug plan. While politicians seek 2-4 year terms, they will never society's long term interests in mind. We really need to form a trade union - the much feared and much discussed doctors' union - that has more power and more foresight than AMA ever did.

 

[DD214_DOC]

Corporates would LOVE to have NPs and PAs with full practice rights. Bye bye overpaid doctors, hello more profit! It will happen one day, so get ready. Physicians had a tradition of almost 100% job security, but not anymore.

 

[H0mersimps0n]

so true, so sad but so true...

It absolutely NOT surprise me to see the US import "cheap docs" like we import cheaply made crap commerse.

America has become quantity not quality and the willingness to pay for public services through taxes has never been lower.

If American's took a second to see how much their taxes already go toward (roads, police, fire, etc) and could think out of the box for a single second of their natural lives to realize that public health should be a public service just like police or fire protection. I'm betting the number one cause of death in the US isn't murder but rather a disease, funny how the public is willing to pay for one type of protection but fail to see the importance of a more daunting critical protection (healthcare).

Thinking out loud is great isn't it?

 

[docslytherin]

my assumption is that even if nurse practitioners and physician assistants get full practice rights without physician oversight, patients will still come to doctors... with the surge of most graduates of medical school into specialties, the NPs and PAs will fill primary care spots that docs (apparently) aren't too keen on anyway. if something is serious, i think patients will still go to a physician. routine checkups and standard cough and cold stuff would probably be seen by NPs or PAs. there aren't going to be oncologist, GI or neuro PA/NPs. the specialist, highly trained fields are still going to be physicians (at least that's my opinion)

perhaps a union is a good idea. they were developed to protect skilled laborers from replacement.

it makes me nervous to have PAs and NPs (and others like PharmDs, and chiropractors) with full practice rights without the depth of education that docs go through.

it's sad that cost is more important than quality of care.

 

[cooldreams]

what are you guys complaining about? Look at a typical FP doc. He may have several nurses or PA's or NP's working for him. The bigger his practice, the more patients seen, the more PA/NP's he can hire. The indepth stuff he sees personally, but the routine cold/shots/physicals will be NP/PA stuff.

This selling out of docs is nothing new, doctors have been doing it themselves for a while now to increase THEIR money. Finally big business has caught on and was a piece of the pie.

that leaves us with the subspecialties:

rads-telerad or just using computers

derm - while in engineering school, i personally assisted a group of people using computer imaging to detect various skin problems much more accurately and quicker than any doc could. this is only the begining people....

anathesia - i dont know a great deal here, but seems that complex calculations done for the correct dosages could be more accuarate and timely on a comp than a doc could do... time is your enemy...

psych - seeing as how we have yet to fully understand how the brain even works, jobs here are pretty safe for a while... 😛

basically you come to things like surgery or related, and a doc has to be there to do stuff right? well... you have many technologies fighting you still. nanobots could theoretically REPAIR tissue on the fly- imagine being able to do that?!?!? then look at a car manufacturing plant. how long has that stuff been around?? just refine the technology and you are seriously getting close to surg being computerized as well.

you guys want to live in a little hole and keep your world the same day to day. life is all about change. its gonna happen. maybe it wont completely effect you now or later... but the change is happening... its definitely out there....

how can you act now? dont resist change. learn what IS changing and then act AHEAD of it to anticipate it.

old architects, maybe 50-70+ yrs old never had to deal with comps when they drafted a building. but now architects that have experience and can run autocad are in much more demand than those that cannot use autocad. its all about seeing the change, and going with it....

good luck out there.........................

 

[ERMudPhud]

Originally posted by Freeeedom!
ERMudPhud,

While it is NOT a peer reviewed Journal, this article DID NOT have a slant toward ANY political party as Dean was the ONLY candidate noted.

Just because an article (or in this case more of an editorial) only mentions one candidate doesn't keep it from being slanted. It might have been more reasonable if the writer had acknowledge his clear rightward ideologic bent. I doubt he would have been happy with any of the current democratic candidates as Dean has a reputation of being one of the more fiscally and socially conservative democrats. The writer actually came out against the idea of coverage for uninsured children because it would take money out of his pocket and force him to work (see these kids in the ER) to get it back. That struck me as a remarkable combination of selfishness and short-sightedness. The cost to him as a taxpayer of covering uninsured kids would be minor compared to the extra income he would realize when previously uninsured kids in his ER now had coverage. The costs would be spread amongst all taxpayers, the benefits would be realized only by children and physicians seeing uninsured kids.

I agree we need to know as much as we can about each candidate but I don't think an attack like this is very useful. Dean still might be the most medicine friendly of the democratic candidates. Kerry's views on health care are at least as liberal. Kucinich even more liberal. Edwards is a tort-lawyer. Clark- who knows. The current debate should be among democrats about who is the best democratic candidate. Unfortunately writers who are clearly so far to the right that they are unlikely to ever vote for a democrat use this time and their platforms to attack whoever the current[or current at the time of the article🙂] front runner so that they will emerge from the primary fray to damaged to be a serious candidate. Articles like this are a lot like push-polling- choose your quotes carefully to offend you specific audience while not allowing counterarguments or comparison to the other side.

 

[ERMudPhud]

Originally posted by edinOH
I think it is important to remember that the drug companies exist to make a profit, first and foremost. That is why they are in the business of making the product they make. If there is no money in it, they won't research it, develop it, or produce it.

The Canadian drug thing is a case of the manufacturers selling their product to what they at the time preceived to be a set, limited market, with a defined need for their drugs. Since the Canadian govt is the financial provider of their citizen's health care, they were able to act like Wal-Mart and get Wal-Mart style volume discounts. I realize this isn't news to most of you.

But. The price breaks given to the citizens of Canada really don't work for the drug companies if they are forced to provide those deep discounts to the rest of their market

So American consumers should continue to pay the highest prices with the blessing of the current administration just so the pharmaceutical companies can sell drugs cheaper (but still at a profit) to the rest of the world? I don't have a problem with free market forces. Bush's medicare drug plan should have encouraged it. Almost every class of drugs we use has multiple members which are really quite similar. Make the drug companies compete for the right to sell their drugs under the plan and only cover the one or two that are the cheapest. You could still have a plan that had one or two ACE inhibitors, one or two quinolones, one or two of everything. At the same time require that drugs sold to the plan can't be more expensive than the price sold to other first world nations. The majority of consumers would benefit and there would still be plenty of room for innovation since if you have the only viagra or only amiodarone you could still price it as high you want for a while since there wouldn't be any competition.

 

[ERMudPhud]

Originally posted by ckent
I also wanted to comment on the whole residency match system and artificially keeping residents salaries low (below PA's and NP's, even though we work many more hours and oftentimes do much more).

The people who make this argument are almost always medical students or residents and I think the miss two important points.

1. The match doesn't prevent free market forces. Unpopular residencies in unpopular places often do pay a premium to attract residents but applicants continue to choose better or more prestigous residencies over better paying ones. I remember even just within New York there was as much as a 30-40% difference between the salaries at different programs when I was there. Even if the match was gone the really good places could continue to pay very little while trading on their reputation.

More importantly

2. Residents are not a financial plus for many hospitals. It is well documented that academic centers are often less efficient and more expensive than similar non-academic hospitals. When I was a resident I often felt taken advantage of and I was convinced the hospital couldn't run without us. Now I work at a non-academic referral center with no residents. The place runs just fine without residents and although we have some NP's and PA's there are no where near as many as there were residents at my old hospital.

 

[docslytherin]

Originally posted by cooldreams
what are you guys complaining about? Look at a typical FP doc. He may have several nurses or PA's or NP's working for him. The bigger his practice, the more patients seen, the more PA/NP's he can hire. The indepth stuff he sees personally, but the routine cold/shots/physicals will be NP/PA stuff.

This selling out of docs is nothing new, doctors have been doing it themselves for a while now to increase THEIR money. Finally big business has caught on and was a piece of the pie.

that leaves us with the subspecialties:

rads-telerad or just using computers

derm - while in engineering school, i personally assisted a group of people using computer imaging to detect various skin problems much more accurately and quicker than any doc could. this is only the begining people....

anathesia - i dont know a great deal here, but seems that complex calculations done for the correct dosages could be more accuarate and timely on a comp than a doc could do... time is your enemy...

psych - seeing as how we have yet to fully understand how the brain even works, jobs here are pretty safe for a while... 😛

basically you come to things like surgery or related, and a doc has to be there to do stuff right? well... you have many technologies fighting you still. nanobots could theoretically REPAIR tissue on the fly- imagine being able to do that?!?!? then look at a car manufacturing plant. how long has that stuff been around?? just refine the technology and you are seriously getting close to surg being computerized as well.

you guys want to live in a little hole and keep your world the same day to day. life is all about change. its gonna happen. maybe it wont completely effect you now or later... but the change is happening... its definitely out there....

how can you act now? dont resist change. learn what IS changing and then act AHEAD of it to anticipate it.

old architects, maybe 50-70+ yrs old never had to deal with comps when they drafted a building. but now architects that have experience and can run autocad are in much more demand than those that cannot use autocad. its all about seeing the change, and going with it....

good luck out there.........................

computers won't (for a long time) replace people. you can't have machines running and diagnosing without a physician verifying results. ekg machines can spit out results but without a physician looking at the leads and validating the report, it's worthless. someone has to be able to check the machine. same thing with lab values for a patient.

those of us resisting PAs and NPs getting full practice rights aren't battling it because it's bad for us, (at least I'm not) we're battling it because it's bad patient care. people who aren't trained to completely treat patients shouldn't completely treat patients. it's pretty much that simple. both PAs and NPs are trained to have their actions and decisions validated by docs.

 

[cooldreams]

Originally posted by docslytherin
computers won't (for a long time) replace people. you can't have machines running and diagnosing without a physician verifying results. ekg machines can spit out results but without a physician looking at the leads and validating the report, it's worthless. someone has to be able to check the machine. same thing with lab values for a patient.

while this may be true right now, it doesnt mean that it wont change. additionally, for the near future what this means is that one doc can do the work of say, 3 docs. there you just reduced the need of that type of doc by a factor of almost 3.

Originally posted by docslytherin
those of us resisting PAs and NPs getting full practice rights aren't battling it because it's bad for us, (at least I'm not) we're battling it because it's bad patient care. people who aren't trained to completely treat patients shouldn't completely treat patients. it's pretty much that simple. both PAs and NPs are trained to have their actions and decisions validated by docs.

they are trained to have a doc tell them what to do because as of right now that is all the more they can aspire to be doing. they are people just like us, and some of them are even brighter than us. what they are not is a COMPLETE doc, but in complete do you mean about to diagnose and perform surgery, etc?? i dont know many docs who are COMPLETE docs. you get into your routine and you lose a lot of what you learned because you never use it. how much would you trust a psych to perform open heart on you?? for what the pa&np are trained to do, they do it well. that is the only reason they are still here and are catching on so well.

furthermore, you all say that the american public will not stand for anyone but a real doc to take care of them, ask a dad who lost his job a few months ago and has a sick child with the flu or something. wait in the er for a day or two to get 2 seconds from an er doc who then agrees with what a np suggested and then the np helps the kid, or go to a NP that has just recently been licensed by the government to be able to do the things that a FP would normally do ??

 

[Freeeedom!]

The sky is falling the sky is falling!!!!!!


Come on guys, the world is not falling apart. Midlevel practice is decided first by the people who hire them, secondly by the hospitals in which they practice, third the state boards that govern them...and finally by those who sue them and those who pay them.
If PA's and NP's were to get sued, and they are independent...do you think that perhaps the risk management for the hospital may keep a closer eye on them. True I don't think litigation is the best way to gain practice rights, education is. But we do have a say in this...if you don't like what is going on...write letters, contact your congressperson...organize...make your feelings known.


ER MudPhud...remember, the title of the article was called "Will there be a Doctor in the White House"...the article was written as a direct response to a former physician who is now running for president. That is REASON ENOUGH to write an article in Physicians Monthly paper isn't it?? There is no political slant to the article, it certainly is NOT pro-Dean...but there is no party slant. Wait next month, maybe there will be some other candidate info.
Regardless, it is aPOSITIVE thing that physicians are rallying in the political world, speaking for what we believe is right. We can no longer afford to remain quiet.

 

[docslytherin]

Originally posted by cooldreams
while this may be true right now, it doesnt mean that it wont change. additionally, for the near future what this means is that one doc can do the work of say, 3 docs. there you just reduced the need of that type of doc by a factor of almost 3.



they are trained to have a doc tell them what to do because as of right now that is all the more they can aspire to be doing. they are people just like us, and some of them are even brighter than us. what they are not is a COMPLETE doc, but in complete do you mean about to diagnose and perform surgery, etc?? i dont know many docs who are COMPLETE docs. you get into your routine and you lose a lot of what you learned because you never use it. how much would you trust a psych to perform open heart on you?? for what the pa&np are trained to do, they do it well. that is the only reason they are still here and are catching on so well.

furthermore, you all say that the american public will not stand for anyone but a real doc to take care of them, ask a dad who lost his job a few months ago and has a sick child with the flu or something. wait in the er for a day or two to get 2 seconds from an er doc who then agrees with what a np suggested and then the np helps the kid, or go to a NP that has just recently been licensed by the government to be able to do the things that a FP would normally do ??

i don't know how much clinical experience you have, but what i'll tell you from mine is that patients will ALWAYS want to see people instead of machines. can you imagine an office where people went in sat down in a BP chair that weighed them and took vitals, then went to a room where another machine listened to breath and heart sounds and performed the rest of the exams and finally gave them whatever drugs they might need?? patients would have a fit. that's why physician training has so much emphasis on bedside manner. patients judge physicians on how they interact with them more than anything else. i worked in an oncology clinic saw a lot of dying patients come through. the physician who was most liked was the one who spent 20 minutes in each room versus the other docs who spent 5. the interaction is part of the healing process (at least in my opinion). so while financially it might be a good idea to replace 3 docs with 1 and some machines, i think patients would soon find another doc.

with regard to complete doc, i mean that while they understand treatment of disease, PAs and NPs as a general rule do not learn the etiology of disease. they're not taught that in their schooling in the depth or detail that we, as physicians, are. that's how they get through training so much more quickly (2 yr PA vs. 4 yr+residency for a doc). my problem with them having full practice rights is that very little in my clinical experiences has ever been a cut and dry case for treatment. without the "complete" (relatively) understanding of the disease your treatment is a cookie-cutter approach that ultimately is going to fail someone. i certainly wouldn't want that failure to come at my wife or children's expense. that's what i mean by complete... not the ability to do and treat everything (including surgery).

NPs and PAs are not trained to treat on their own. their training requires the oversight of a physician for validation... to give them full practice rights is to undermine the existence of the checks and balances system set up for that profession.

i will grant you that PAs and NPs are excellent additions to an office staff, but they are assistants. i can't believe that a physician (or someone who will become one) would want to sit and just watch this happen. allowing PAs and NPs to take over practice rights from fully-trained physicians is ridiculous. if you give them full practice rights you'll have fewer physicians that you already do. 2 yrs at PA school is a LOT cheaper than 4 yrs of med school.

Originally posted by cooldreams

furthermore, you all say that the american public will not stand for anyone but a real doc to take care of them, ask a dad who lost his job a few months ago and has a sick child with the flu or something. wait in the er for a day or two to get 2 seconds from an er doc who then agrees with what a np suggested and then the np helps the kid, or go to a NP that has just recently been licensed by the government to be able to do the things that a FP would normally do ??

and what if the doc found something the NP didn't know about or understand? would you take your child to someone whose education was, by definition, less exhaustive than that of a doc? i see no problem letting NPs and PAs practice within the scope of their abilities and that is under a doc's supervision. if they were qualified to make the same decisions, they would have graduated from medical school.

 

[cooldreams]

i agree with you on your posts. i would definitely choose a doc over a machine or a pa/np.

my point is, is that the way usa works, it seems so evident to me that big business/insurance companies/government are all pushing to take something away from us as doctors.

i am not completely sure where we will end up, but i do think there are a number of possibilities that have surfaced - many of which are our(our meaning medical community as a whole) own fault .....

 

[docslytherin]

Originally posted by cooldreams
my point is, is that the way usa works, it seems so evident to me that big business/insurance companies/government are all pushing to take something away from us as doctors.

and this is exactly why we have to be active and diligent to prevent politicians and insurance companies from running the health care system.

by the way... the candidates are only advocating full practice rights with federally insured patients (medicare/medicaid and VA) right now, but allowing this will only facilitate the small step to full practice rights for privately insured individuals as well.

 

[ERMudPhud]

Originally posted by Freeeedom!
There is no political slant to the article, it certainly is NOT pro-Dean...but there is no party slant. Wait next month, maybe there will be some other candidate info.

Alright, then I won't call them and ask them to stop mailing me their rag and I'll look for an article criticizing W's medicare drug plan or a story on how budget cuts have forced many states to cut back medicaid coverage for children. I suspect what I'll see instead is criticism of Kerry's health policies or Edward's past as a tort lawyer or something like that .

P.S. I agree with you on the whole worry about midlevels. Maybe some people feel threatened by them but I never have.

 

[Adapt]

I believe that as future physicians, it would be in our best interest to vote for Bush or a republican for that matter as president. The reasons are the following.

1. Republicans support putting caps on malpractice lawsuits. In Bush's state of the Union address, he is quoted as saying "...To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits..." Democrats have always been on the side of lawyers fighting for no caps.

2. Republicans supported the medicare bill which the AMA lobbied for heavily. Thousands of doctors supported the bill. The bill prevented major cuts in physicians' salaries and gave incentives for physicians to practice in underserved areas. Most Democrats were against this.

3. The opinion of Howard Dean is one similar to most Democrats. The simple idea of having nursing practitioners given the same power as primary care physicians is a threat to physicians in our country.

4. On a ligher note, the democrats are in favor of repealing Bush's tax cuts which will undoubtedly affect physicians as a group since they do make more. This basically means more money out of your income that you worked hard for.

Now I know that republicans have their negatives and democrats are good in many other ways over republicans particularly in the economy. However, as future physicians, we must recognize that republicans are on the physicians' side in the issues that are important to us.

 

[H0mersimps0n]

1.) Bush is 90% talk

2.) When you refer to "bills" that go through congress make sure you understand that a 1600 page bill has a little bit more to it than "prevented major cuts in physicians' salaries and gave incentives for physicians to practice in underserved areas". If you've been keeping up with the sleeze that is the current administration you'd understand that the republicans and Bush are notorous for slipping in haneous crap in with these bills so when the dems vote against the "help children in Somalia" bill it's not because they hate children it's because the Republicans slipped in, somewhere around page 1589 something about using oil companies and tons of tax dollars to drill in somalia as well (as an example) Most dems can read, I have my doubts about the repub.

3.) I'm not fond of dean either, hopefully Kerry will be there for us.

4.) That "fear all taxes" mantanality is sickening. Massive tax cuts do nothing except keep public services from getting paid for and throw this country into massive debt. American's are so short sighted about taxes and what public services they provide that all that matters is getting that money back. Ever hear a Canadian complain about the 4 different taxes they have? nope, cause they love the fact that they can see a doc without receiving a $1200 Bill in the mail the next day. Look past your nose.

 

[jalabert]

Homer, do you actually know any Canadians? I have heard many Canadians complain about their level of taxation. Most Canadians (actually this is a bit of a generalization, because I don't know most Canadians, nor have I seen any polls lately, but let's say, "most Canadians I know") do appreciate the fact that they are covered for medical expenses, but there is another side to that coin. Due to the tremendous strain the health care system has put on the government, there have been large cut back in facilities and personnel. These cutbacks have compromised the availability of many services that Americans take for granted. Therefore, although many Canadians are happy they are covered, they complain about the lack of access, and the excruciating wait for many important procedures.

 

[H0mersimps0n]

J- you're absolutely right, health care is a priviledge for the Rich not a right for everyone. (note sarcasm)

I still think the "lesser of two evils" argument is totally valid, and stand by my opinion that covering everyone (which suffer's from quality control problems) is far better than superior (OVERUSED) technology (leaving 42.1 million without insurance plus the few extra million out of work since Bush has been in office)... Of course it's not that simple but I'd like to think it is.

To each his own but I bet if something happened to you and you couldn't finish your medical education or continue to practice, had no insurance or coverage (i.e. shoe on the other foot) you'd see things much differently. Until then I guess you're just one of the lucky priviledged healthy weathly...

 

[DD214_DOC]

You guys made the incorrect assumption that, even if medicine becomes dominated by robots, doctors would still be needed to verify results. Wrong. You don't need an MD/DO to do that. PAs/NPs diagnose all the time without the doctorate.

 

[DocWagner]

JKDmed, I think he meant the "correct" diagnosis.
JKDmed, not really sure why you are already so jaded, but dude/dudette; after 3 years of intense residency and exposure to all fields of medicine as well as the 4 years of medical school...I still feel like I have a TON to learn. It baffles me why others (perhaps even you) think that "less is more". Question JKDMed, are you a medical student or a resident? Your slant on information is a bit odd...perhaps uninformed? I am not sure where you get the "conspiracy theories" but it obviously plays on the insecurities of others.
Are you a troll?
I enjoy learning, I certainly feel that standards for ALL professionals need to be raised, I feel as though the standards of care will only change if you choose to let them...whether that be positive or negative.

The sky is NOT falling.

 

[jalabert]

Homer,

I wasn't saying that the current U.S. system was better or worse than the Canadian system. I was addressing your comment, "Ever hear a Canadian complain about the 4 different taxes they have? nope, cause they love the fact that they can see a doc without receiving a $1200 Bill in the mail the next day. Look past your nose." The grass is always greener. I have been hearing for years, especially back when Big Hill was going to revamp the health care system, that the Canadian system was all that, and that Canadians were as happy as a pig in slop. Canadians will be happy when a Canadian team wins the cup again, but other than that, they're just like Americans, in that, they bi%$# and moan about their taxes, and complain about lack of services. It is nice not to worry about big bills if something catastrophic happens, but I bet most would be willing to pay some out of pocket to get better basic services, and some do. Those with the mula, drive down to the U.S. and get a service pronto that they would have to wait months for in the Great White North.

"Until then I guess you're just one of the lucky priviledged healthy weathly..." My wife would get a kick out of that one. Come on,.. you know that you don't have to be rich (to rule my world or) to have coverage. You just have to have a job. That is a problem right now, that will be rectified to a certain extent when the economy is raging faster than Bill Clinton chasing interns around the oval office. Of course everyone deserves health care, and there probably should be some sort of catastrophic coverage for everyone. Sure I have good coverage now, but there was a stretch where I was rolling the dice, and luckily I didn't have to become a burden on the state. A big part of that is because I take responsibility for my own health, and try to maintain it. I would have been up the crick if I had a catastrophic problem though. So, to wrap this soliloquy up, things need to be fixed in the U.S. system, but higher taxes and a single payer universal coverage model are not the ways to fix it.

 

[Eidolon6]

The VA hospital system has been employing more and more PAs and NPs over the past few years. From what I have seen, they grossly order too many tests, consult like mad and have very cursory understanding of the drugs that they prescribe. I've seen many sit on obvious diagnoses for 2-3 visits before "getting it". Frankly, some of them are downright dangerous, not because they lack intelligence, but because they lack proper training. Plus, the unnecessary tests and consults almost nulls any financial gain made by employing them for less than fully trained physicians.

Emancipating NPs and PAs won't solve any problems, but it will get the Trial Lawyers' Lobby licking their chops as malpractice claims will spiral even more out of control and physicians will be managing the blunders of the PAs and NPs.

BTW, the Association for Trial Lawyers is one largest donors of money to the Democratic party....I don't think Dean, Kerry, Edwards (a malpractice attorney who made millions off of malpractice suits), etc. will ignore their gifts. Despite their liberal hooks and bleeding heart rhetoric, they still make deals with devils.

 

[docslytherin]

Originally posted by Eidolon6
BTW, the Association for Trial Lawyers is one largest donors of money to the Democratic party....I don't think Dean, Kerry, Edwards (a malpractice attorney who made millions off of malpractice suits), etc. will ignore their gifts. Despite their liberal hooks and bleeding heart rhetoric, they still make deals with devils.

You should read Edwards stance on malpractice premiums.

Here's a quote from the website: (http://www.johnedwards2004.com/healthcare-costs.asp)

REDUCE MALPRACTICE PREMIUMS BY CRACKING DOWN ON ABUSIVE INSURERS, LAWYERS, AND DOCTORS
The rising cost of malpractice insurance for doctors is getting in the way of good health care. In rural areas, some specialists can no longer afford to practice and patients can't get the care they need. To free doctors from crippling insurance costs, without preventing severely injured victims from receiving compensation, Edwards would:

Crack Down on Insurance Price-Gouging: Some insurance companies use slow and burdensome processes to discourage legitimate claims. Worse still, they set their rates based on a trade-group loss calculation that they know other companies will follow. An obscure 1945 law gives insurance companies a broad antitrust exemption. Congress has even blocked the Federal Trade Commission from investigating insurance company rip-offs. These special privileges must go.

Prevent and Punish Frivolous Lawsuits: Most lawyers are responsible advocates for their clients, but the few who aren't hurt the real victims, undercut the credibility of the legal system, and clog our courts. Before a lawyer can bring a medical malpractice case to court, Edwards will require that he or she swear that an expert doctor is ready to testify that real malpractice has occurred. Lawyers who file frivolous cases should face tough, mandatory sanctions. Lawyers who file three frivolous cases should be forbidden from bringing another suit for the next 10 years ? in other words, three strikes and you're out.

Reduce Malpractice and Medical Errors: The Institute of Medicine found that at least 98,000 people die from preventable medical errors every year. In medicine, as in law, a few people cause the most problems: Only 5 percent of doctors have paid malpractice claims more than once since 1990. This same 5 percent is responsible for over half of all claims paid. Edwards will provide resources and incentives for boards to adopt real standards on the ?three strikes? model. At the same time, he will encourage doctors to report more medical errors voluntarily so we can learn more about systemic problems.

Offer Direct Aid for Doctors Being Driven From Practice: The three-part plan above will sharply reduce malpractice premiums. To the extent some doctors are still driven from practice in shortage areas by high premiums, Edwards will offer direct aid to keep doctors in business. " (end quote)

I think it's unfair to lump him in with those who are benefiting from malpractice litigation when a founding element of his campaign is malpractice reform and the empowering of physicians.

 

[tofurious]

One thing I find odd is why today's physicians don't pass the high insurance premium onto their patients. It seems perfectly acceptable that when the oil prices go up, airlines add $5 to $50 of "fuel surcharge". Even if consumers complain about it as they're paying the extra, they always blame it on the Middle East rather than the airlines. SO, if malpractice suits are forcing us to pay higher premiums and take home less of what we earned, isn't it reasonable to add an insurance premium surcharge for each patient we see, unless they sign a liability waiver? It is not to say that we are going to be any less professional in the absence of a surcharge, but since the increasing premium is driven by (disgruntled) consumers, it's only fair that the cost gets passed back onto the consumers...

 

[Eidolon6]

John Edward's actions are more powerful than his (or his advisors) words. He "won" millions of dollars in malpractice and personal injury trials including a 25 million dollar award in 1997, NC's largest. The cause and effect relationship of increased damage claims is the passing of the buck to the doctor's themselves. I hardly think, despite the moving rhetoric, that Edwards plans to abandon his flock to "stamp out abusive insurers, lawyers and doctors" But hey...I call it as I see it...just my opinion.

 

[Finally M3]

Apparently it's due to the fact that individual physicians or group practices create contracts with individual insurance carriers or by participiating in Medicaid, the government. I think the contracts prohibit physicians from 'adding on' fees such as the one you suggest.

http://money.cnn.com/best/magazine_archive/2003/05/MAL-01.html

Glad I'm not going into OB

Originally posted by tofurious
One thing I find odd is why today's physicians don't pass the high insurance premium onto their patients. It seems perfectly acceptable that when the oil prices go up, airlines add $5 to $50 of "fuel surcharge". Even if consumers complain about it as they're paying the extra, they always blame it on the Middle East rather than the airlines. SO, if malpractice suits are forcing us to pay higher premiums and take home less of what we earned, isn't it reasonable to add an insurance premium surcharge for each patient we see, unless they sign a liability waiver? It is not to say that we are going to be any less professional in the absence of a surcharge, but since the increasing premium is driven by (disgruntled) consumers, it's only fair that the cost gets passed back onto the consumers...

 

[jwin]

Originally posted by docslytherin

I think it's unfair to lump him in with those who are benefiting from malpractice litigation when a founding element of his campaign is malpractice reform and the empowering of physicians.

i am uncertain on exactly how to interpret this statement, but methinks that you believe that edwards would do good things for malpractice reform and physicians.

HAHAHAHAHAHAHAHAHAHA!!!!! if my interpretation is correct, this is one of the funniest things i have read all week.

come on now, that is like believing that bush cares about the environment. doctors will enter a world of legislative pain if the charming southerner ever gets to the oval office.

 

[Adapt]

The following is a link to an article on how Senate democrats successfully blocked an act that would have set malpractice caps nationally.

http://www.premierinc.com/frames/index.jsp?pagelocation=/all/newsroom/insurance/03-jul/senate-democrats-object.htm

"...Like the House-passed bill, the legislation Senate Republicans now are seeking to bring to the floor would place a federal cap of $250,000 on noneconomic damages in health care lawsuits. Both provide for unlimited economic damages and both cap punitive damages at the greater of $250,000 or twice the amount of economic damages awarded to a plaintiff..."

"...Senate Democrats said the solution contemplated by Republicans would punish victims harmed by medical malpractice. Also, they said the Republican bill failed to address the root cause of rising medical malpractice premiums by focusing on changes in tort law and ignoring the practices of insurers..."

"...The AMA has been lobbying heavily for the medical liability legislation. The AMA has designated 18 states as medical liability "crisis" states because of physician shortages in various high-risk specialties that are said to result from rising medical malpractice insurance premiums. In a June 27 press release expressing support for the Senate bill, AMA President Donald J. Palmisano said that the "current jackpot-justice lottery system does not identify negligence, and it has forced good physicians out of medicine, and caused trauma centers and maternity wards to close across the country..."

"...Durbin acknowledged that rising medical malpractice premiums are causing serious health care access problems in the states, but he said that the Senate Republican bill would harm victims of heinous cases of medical malpractice by placing arbitrary limits on their recoveries. "I don't come to the floor today as a doctor-basher," Durbin said. Moreover, Durbin said, the Republican legislation would not do anything to address health care quality deficiencies in the current system..."

 

[Adapt]

Here is a link that talks about Bush's plan on malpractice lawsuits.

http://www.local6.com/health/1913334/detail.html

"...President George W. Bush wants to put a cap on medical malpractice jury awards, and he told Pennsylvania residents Thursday that he will work with Congress to make it happen.
Bush wants to limit "pain-and-suffering" awards to $250,000. He also wants to hold punitive damages in malpractice cases to no more than twice a patient's actual financial loss..."

"...When a doc can't pay the premiums and can't practice, somebody's going without health care," Bush said. "There are too many lawsuits in America, and there are too many lawsuits filed against doctors and hospitals without merit," Bush said. "Excessive jury award will continue to drive up insurance costs and put good doctors out of business." However, Bush said that patients who suffer at the hands of a "lousy" doctor must be protected.
"If they prove damages, they should be able to recover the cost of their care, recovery, lost wages, and economic losses for the rest of their lives," he said. "That's fair. That's reasonable."

Seeing as how John Kerry looks like he's going to be the next democratic nominee, the following link details his plan for health care. Much of what he said is good, but he goes about the issue of malpractice lawsuits in a different way.

http://www.johnkerry.com/pdf/kerry_health_plan.pdf

"...John Kerry believes that improvements can and should be made to our medical liability system -improvements that can substantially reduce meritless claims and defenses, enhance opportunitiesto resolve claims fairly without protracted litigation and make the system fairer for doctors andpatients alike. John Kerry, however, strongly opposes capping damages in medical malpractice lawsuits. Capping damages will neither reduce premium costs for doctors, nor lower the cost of health care for Americans...."

 

[Seaglass]

The following is a link to an article on how Senate democrats successfully blocked an act that would have set malpractice caps nationally.

Actually, that bill had nothing to do with malpractice caps, just caps on jury awards. I seriously doubt that they would have voted against malpractice caps, or that Republicans would support them.

Casey