why has the "golden age" of medicine passed?

[HailToTheThielf]

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can you guys explain to me what is meant by "the golden age of medicine has passed"? Why are docs getting paid less? Why do people say that medicine as a career is going down the drain? Thats its not nearly what you thought it was before you entered med school. More disrespect?? People have said that doctors aren't doctors anymore but health care providers??? And that the future of medicine as a career is NOT like it was and is getting worst and probably will not be worth it in the future? Do you guys think its worth all the school and loans? Do you think doctors get paid enough for the amount of time they put into their education and training? Do you think its worth it for the amount of time you put into becoming an MD?

 

[Daiphon]

can you guys explain to me what is meant by "the golden age of medicine has passed"? Why are docs getting paid less? Why do people say that medicine as a career is going down the drain? Thats its not nearly what you thought it was before you entered med school. More disrespect?? People have said that doctors aren't doctors anymore but health care providers??? And that the future of medicine as a career is NOT like it was and is getting worst and probably will not be worth it in the future? Do you guys think its worth all the school and loans? Do you think doctors get paid enough for the amount of time they put into their education and training? Do you think its worth it for the amount of time you put into becoming an MD?

long story short (and i'm sure to get flamed for this, but what the heck...)... we as doctors have evolved (or de-evolved) from a 'profession' in the strictest sense of the word to nothing more than highly trained technicians/service providers. when medicare/aid came along and started messing with doctors, instead of "circling the wagons," the different specialties defended their own... then the HMO's came along (which IMHO obliterated the doctor-patient relationship and trust), and still we did nothing... then the allied health professions strolled up onto our turf, and still, believe it or not, did nothing. i personally believe we've passed the point of no return in terms of reclaiming our professional boundaries.

plus, we're regulated not by ourselves (which is the defining characteristic of a 'profession' - self regulation), but by a bunch of lawyers who are not necessarily thinking about the full ramifications of the laws they pass and since most doctors are not also JD's, we don't get much input in the legislative process (and again, b/c most specialties look out for their own instead of for the overall profession).

will it get worse? i fully think so... but the golden lining is that I think in getting worse, it will thereby facilitate a swinging of the pendulum back in the 'right' direction.

let the flames begin...

-t

oh, and i know that i should use the shift key; and my sentence structure lacks grace, but i'm post call and quite sleepy.

 

[NinerNiner999]

Well stated - I think we definitely made our own bed. In addition, the word "malpractice" carries with it a bad connotation to the lay public, who don't realize the fact that the average physician will be "sued" 3-4 times in their career. Being a professional carries such a drawback which, in the days of more reasonable judgments and penalties, were not made such high profile issues in the daily news. Case in point - most of what the public hears about physicians today revolves around the current malpractice crisis, where some doctors are labeled as money-grubbing souless providers who leave their home states because they "don't make enough money." In reality, they can no longer support their own practice because the legal climate in which they practice has made premiums too high to continue with reason. 30, 20, even 10 years ago, this scenario would have been unheard of. This, coupled with Daiphon's realistic portrayals of our "profession" have shaped the current opinion of physicians.

 

[Lefty]

How about the patients? The patients have changed over the past several decades. Patients demand perfection. They want to be treated and cured with little or no side effects and they want it now. They want that whether or not they are going to pay anything for it. If they don't get that then its the doctor's fault. Now instead of blaming the disease the doctors get blamed. Even the non-compliant patients are unhappy with doctors quite often. It kind of sours that whole "I want to help my fellow man" idealism that many of us had when we chose to go into medicine.

 

[MD'05]

can you guys explain to me what is meant by "the golden age of medicine has passed"? Why are docs getting paid less? Why do people say that medicine as a career is going down the drain? Thats its not nearly what you thought it was before you entered med school. More disrespect?? People have said that doctors aren't doctors anymore but health care providers??? And that the future of medicine as a career is NOT like it was and is getting worst and probably will not be worth it in the future? Do you guys think its worth all the school and loans? Do you think doctors get paid enough for the amount of time they put into their education and training? Do you think its worth it for the amount of time you put into becoming an MD?

What I am seeing at my cushy little private hospital is that nurses run the show. There are protocols for chest pain, chf, heparin drips, asthma, etc. The decision making is being taken away from doctors and formulated into protocols. This also protects the hospital from being sued and supposedly results in better patient care. What I think it does is set a dangerous precedent. All of a sudden, doctors don't have to think - very similar to what nurses do. Now we have cookbook medicine. Everyone goes on the same amount of beta-blocker, ACEI, ASA, regardless of comorbid conditions such as DM, hx of angioedema, bleeding disorders, etc.

State-of-the industry hospitals are these patient tranforming machines. Patients come in sick and are sent out all better. Behind the scenes are the pharmaceuticals who somehow influence the hospital so that their particular medicines are placed on formulary.

And doctors are at fault too. Greedy specialists hire PAs and NPs to admit patients, round, and discharge patients. The PAs and NPs ridicule these greedy specialists behind their backs to the hospital administration. Undereducated PCPs consult every specialist for every problem a patient may have. You could certainly replace a stupid PCP with a PA or NP.

And resident education is going down the tubes. With more litigation against hospitals, hospitals are allowing residents to do less.

My advice, make sure you do your residency at a university-based hospital, preferably a county hospital with lots of poor patients who have no voice in their patient care. Otherwise, your education will suffer. You may have MD behind your name, but it will be in name only.

 

[allendo]

What I am seeing at my cushy little private hospital is that nurses run the show. There are protocols for chest pain, chf, heparin drips, asthma, etc. The decision making is being taken away from doctors and formulated into protocols. This also protects the hospital from being sued and supposedly results in better patient care. What I think it does is set a dangerous precedent. All of a sudden, doctors don't have to think - very similar to what nurses do. Now we have cookbook medicine. Everyone goes on the same amount of beta-blocker, ACEI, ASA, regardless of comorbid conditions such as DM, hx of angioedema, bleeding disorders, etc.

State-of-the industry hospitals are these patient tranforming machines. Patients come in sick and are sent out all better. Behind the scenes are the pharmaceuticals who somehow influence the hospital so that their particular medicines are placed on formulary.

And doctors are at fault too. Greedy specialists hire PAs and NPs to admit patients, round, and discharge patients. The PAs and NPs ridicule these greedy specialists behind their backs to the hospital administration. Undereducated PCPs consult every specialist for every problem a patient may have. You could certainly replace a stupid PCP with a PA or NP.

And resident education is going down the tubes. With more litigation against hospitals, hospitals are allowing residents to do less.

My advice, make sure you do your residency at a university-based hospital, preferably a county hospital with lots of poor patients who have no voice in their patient care. Otherwise, your education will suffer. You may have MD behind your name, but it will be in name only.

Your a freakin A$$hole talking about PCP's that way, it just shows how ignorant you really are. Really, like there aren't undereducated specialist? Freakin *****, people like you shouldn't be doctors, we are all here for the patients well being. Your not the only person unhappy with the environment in medicine today. The PCP has to consult so he doesn't get sued, the rule now is CYA. So I guess your the type to call ER docs a glorified nurse or PA?

 

[yaah]

During the "Golden Age" the doctor was the most important part of health care, procedures were relatively inexpensive (other than the doctor's fees) and money could go to hospital stays and doctor visits. Now, however, technology and treatments are king and take up most of the costs. Whereas if 50 years ago you went to the doctor for a cough, you could get maybe a culture, chest xray, maybe blood work, now there are thousands of blood tests, different radiology, and a myriad of drugs that all cost $$$. The money is still going into medicine, and even more than before, it's just that it is distributed differently, with a larger percentage going to technology, medications, administration, and of course lawyers.

 

[BPD]

During the "Golden Age" the doctor was the most important part of health care, procedures were relatively inexpensive (other than the doctor's fees) and money could go to hospital stays and doctor visits. Now, however, technology and treatments are king and take up most of the costs. Whereas if 50 years ago you went to the doctor for a cough, you could get maybe a culture, chest xray, maybe blood work, now there are thousands of blood tests, different radiology, and a myriad of drugs that all cost $$$. The money is still going into medicine, and even more than before, it's just that it is distributed differently, with a larger percentage going to technology, medications, administration, and of course lawyers.

I for one hate the way the allied health professionals have intruded the field. Working in the NICU for example, the nurses page the respiratory therapist for any issues with the vents, and often the resident/fellow/attending is not even involved. When a patient is coding, a nurse and a respiratory therapist assist the fellow/attending. PICC lines are done by NNPs. The residents aer the ones who lose out. Makes my blood boil.

 

[HailToTheThielf]

This is very good info! So basically, specialities have gone into subspecialties which in turn cut doctor-patient treatment? Its hard to follow because I haven't even gone through med school yet. I thought the main difference was that insurance companies run the show now paying doctors ALOT less. My father gave me an example, saying that he used to get about $1000 for appendectomies and now with medicade patients he does them for about $298 and has to treat the patient for the following 6 weeks. Then he was talking about patients now having to get referrals? So basically, less pay, less doctor-patient treatment, more technology based treatment? And I read alot of posts about doctors recieve less respect. Do you mean less respect in that the nurses are calling all the shots now?

 

[HailToTheThielf]

this stuff is great. I have to write an application essay on the future of health care for a couple of osteopathic schools. If you'll don't mind, please keep posting. Everything helps. Thanks!

 

[Butch]

Three words ...

Third party payer.

 

[xampower]

Where else did we go wrong? We are haunted by lawyers everyday, but we have our own physicians selling us out as expert witnesses. Standard of care is no longer determined by what our specialties dictate but rather what the ***** expert witness says that he/she thinks we should have done. I blame lawyers, but I equally blame our so called colleagues that sell us to the devil!!

 

[MD'05]

Your a freakin A$$hole talking about PCP's that way, it just shows how ignorant you really are. Really, like there aren't undereducated specialist? Freakin *****, people like you shouldn't be doctors, we are all here for the patients well being. Your not the only person unhappy with the environment in medicine today. The PCP has to consult so he doesn't get sued, the rule now is CYA. So I guess your the type to call ER docs a glorified nurse or PA?

Pull your head out of your a=s=s and quit being defensive. If you really think PCPs will be around in another 20 years, you are the ignorant *****. And actually, I can see hospitals replacing ER docs with NPs and PAs also. It's a matter of economics, skippy.

 

[MD'05]

I for one hate the way the allied health professionals have intruded the field. Working in the NICU for example, the nurses page the respiratory therapist for any issues with the vents, and often the resident/fellow/attending is not even involved. When a patient is coding, a nurse and a respiratory therapist assist the fellow/attending. PICC lines are done by NNPs. The residents aer the ones who lose out. Makes my blood boil.

Thank you. This is the trend I see. Now there is something called the rapid response team who can decide if you are not caring for your patient adequately. Hospitals won't need residents in the next 10 years at all.

 

[RADRULES]

I remember a friend (an ER doc) asking me why I picked radiology. I replied "Because it is at the forefront of the future of assembly line medicine." I was kidding at the time, but it has become true. I do not blame my collegues, because it has been taken out of their hands. We have NPs and PAs who order CTs from ER triage, before a MD has even seen the patient. It is not looking good my friends.

 

[sdnetrocks]

I am not sure that allied health workers are displacing MDs. The bottom line, I feel, is that people want to see *doctors*, not doctor-wannabees. Hell, even as an M3, I have a hard time placing absolute faith in the impressions and decisions of seasoned attendings when it comes to MY health care. I couldn't imagine ever trusting an NP or PA or what-have-you.

However, assuming that the allied health folks are in fact taking over, are there any fields that are safe? By the way, radiology is one of those that could very easily get farmed out to India, etc.

 

[allendo]

Pull your head out of your a=s=s and quit being defensive. If you really think PCPs will be around in another 20 years, you are the ignorant *****. And actually, I can see hospitals replacing ER docs with NPs and PAs also. It's a matter of economics, skippy.

If they can replace PCP's then why can't they replace specialist???? PA's do tend to work for specialist and surgeons! Anyways I'm not being defensive, I just wonder why pieces of $hit like you were ever allowed the opportunity to be a physician. Your attitude is totally wrong when you speak down upon people who send you business.

 

[MD'05]

If they can replace PCP's then why can't they replace specialist???? PA's do tend to work for specialist and surgeons! Anyways I'm not being defensive, I just wonder why pieces of $hit like you were ever allowed the opportunity to be a physician. Your attitude is totally wrong when you speak down upon people who send you business.

Are you illiterate??? I wish I was a specialist. I simply report what I see. What are you a freaking premed?

 

[allendo]

Are you illiterate??? I wish I was a specialist. I simply report what I see. What are you a freaking premed?

Nope, not a pre-med! What are you? How have you b/c such an authority on everything in the medical world? Please respond quickly, stupid people make me laugh.

 

[mdblue]

What I am seeing at my cushy little private hospital is that nurses run the show. There are protocols for chest pain, chf, heparin drips, asthma, etc. The decision making is being taken away from doctors and formulated into protocols. This also protects the hospital from being sued and supposedly results in better patient care. What I think it does is set a dangerous precedent. All of a sudden, doctors don't have to think - very similar to what nurses do. Now we have cookbook medicine. Everyone goes on the same amount of beta-blocker, ACEI, ASA, regardless of comorbid conditions such as DM, hx of angioedema, bleeding disorders, etc.

State-of-the industry hospitals are these patient tranforming machines. Patients come in sick and are sent out all better. Behind the scenes are the pharmaceuticals who somehow influence the hospital so that their particular medicines are placed on formulary.

And doctors are at fault too. Greedy specialists hire PAs and NPs to admit patients, round, and discharge patients. The PAs and NPs ridicule these greedy specialists behind their backs to the hospital administration. Undereducated PCPs consult every specialist for every problem a patient may have. You could certainly replace a stupid PCP with a PA or NP.

And resident education is going down the tubes. With more litigation against hospitals, hospitals are allowing residents to do less.

My advice, make sure you do your residency at a university-based hospital, preferably a county hospital with lots of poor patients who have no voice in their patient care. Otherwise, your education will suffer. You may have MD behind your name, but it will be in name only.

👍
This is so true. I work in 3 different places and almost every month they come up w/ a new protocol 😡 .It just makes my job difficult and has nothing to do w/ improving pt care.
Of my top 3 attendings, 2 are FMGs and the third was trained overseas after doing medschool in US.
Also the pt needs to understand that they are coming to a hospital because they're ill and calling them consumers will not change that.

 

[docB]

I am not sure that allied health workers are displacing MDs. The bottom line, I feel, is that people want to see *doctors*, not doctor-wannabees. Hell, even as an M3, I have a hard time placing absolute faith in the impressions and decisions of seasoned attendings when it comes to MY health care. I couldn't imagine ever trusting an NP or PA or what-have-you.

However, assuming that the allied health folks are in fact taking over, are there any fields that are safe? By the way, radiology is one of those that could very easily get farmed out to India, etc.

I agree that people would prefer to see doctors but they also believe that they are entitled to unlimited, free health care. When their insurer gives them the option of paying out of pocket or seeing a midlevel they have and will see the midlevels.

 

[Lemont]

This is why I think it is becoming a waste of time to go to med school if you just want to be a "generalist" physician. More and more their job is being done by allied health people. Heck they're even pushing for psychologists to be able to prescribe medicine---it doesn't take a genius to figure out how psychiatrists will be affected by that. Not to mention the CNA's in anesthesiology.

It is becoming more and more necessary to specialize and subspecialize and carve out your own niche. Either that or do a specialty that is too difficult for allied health people to encroach on too much because they just don't have the years of training and knowledge to do it competently. Sure PAs may be able to do some of the basic procedures in cardiac surgery, but they will never replace a real cardiac surgeon and be able to do the entire case. Let's see them try to perform pediatric cardiac surgery from start to finish. Or a heart transplant or complex valve operation. Or do what a trauma surgeon, neurosurgeon, etc does. It's becoming all about being a specialist more and more.

 

[Daiphon]

I agree that people would prefer to see doctors but they also believe that they are entitled to unlimited, free health care. When their insurer gives them the option of paying out of pocket or seeing a midlevel they have and will see the midlevels.

this is true... methinks another issue with why the 'golden age' has gone kaput is the insurance issue. for example, when you take your car in for routine maintenance (oil change, fill up with gas, etc.), do you file a claim with the auto insurance company? no... but, when you see your doctor for routine maintenance (annual CHA, med refill, etc.) not only are claims filed, but the patient often complains about the copay... "i'm paying for insurance, this should be free."

most of the general public either doesn't know or doesn't care that their abuses of insurance are one of the key factors (IMHO) that has brought about both our devolution from profession to technician and our "malpractice crisis." (which maybe, just maybe, if people had an accurate idea of what things REALLY cost, and not just their copays, perhaps they wouldn't feel that suing the doctor is the best get rich quick scheme ever invented.)

just my $.02... a little more organized this time.

-t

 

[MD'05]

Nope, not a pre-med! What are you? How have you b/c such an authority on everything in the medical world? Please respond quickly, stupid people make me laugh.

Yeah, stupid people make me laugh, too. I guess that is why you are so funny. Ha. Ha.

 

[Daiphon]

This is why I think it is becoming a waste of time to go to med school if you just want to be a "generalist" physician. More and more their job is being done by allied health people. Heck they're even pushing for psychologists to be able to prescribe medicine---it doesn't take a genius to figure out how psychiatrists will be affected by that. Not to mention the CNA's in anesthesiology.

It is becoming more and more necessary to specialize and subspecialize and carve out your own niche. Either that or do a specialty that is too difficult for allied health people to encroach on too much because they just don't have the years of training and knowledge to do it competently. Sure PAs may be able to do some of the basic procedures in cardiac surgery, but they will never replace a real cardiac surgeon and be able to do the entire case. Let's see them try to perform pediatric cardiac surgery from start to finish. Or a heart transplant or complex valve operation. Or do what a trauma surgeon, neurosurgeon, etc does. It's becoming all about being a specialist more and more.

it doesn't matter if one chooses a "specialty that is too difficult for allied health people to encroach on too much because they just don't have the years of training and knowledge to do it competently," because as technology improves, these complicated cases are going to become easier to do by less-trained individuals. sure, these less-trained individuals won't be able to 'improvise' if something outside the norm occurs, but that's why you have the one oversight doctor (think CRNA's and anesthesiologists) for several mid-level providers... we doctors are still going to get hosed.

thus, one might argue that it is actually less about becoming a ultra-narrow specialist and carving out smaller and smaller niches (think about Muller's Ratchet & evolution), and more about strengthening the profession of medicine. i'm not saying let's get rid of our cardiologists (or the subspecialties of EP or interventional), i'm just saying that we should remember we are PHYSICIANS first, and [fill in name of your chosen specialty] last.

$.02 more,
-t

 

[Lonestar]

Daiphon,

you hit the nail on the head. I am a 2nd yr anesthesia resident and I totally agree with you. However, try explaining this to some of the "good specialties", b/c evidentally logic dictates that they will lose out. its kinda like giving up a little of your blessings for the good of the profession. And my friend thats not happening anytime soon. People in general will look out for themselves first and their neighbours next. Just the way the world works. if you want to change it back, the way to do it to make sure that some of these so called "allied health professionals" do not get the same right as you. Woops too late, it already happened in my field. Where was the rest of "medicine" when anesthesiologists were fighting for supervision. Point is people will take shortcuts wherever possible. Just a fact of life. Now, granted i will easily find a job, it still bothers me that a person could circumvent around going to med school, do some of the most intricate/complicated cases without the proper education (more that most doctors are accustomed to), make more than most docs, then bitch and whine to state legislatures that "see we don't really need a doctor to supervise us." Unfortunately, my friend money talks and BS walks. If you want to have a voice, lend money to the AMA. I will do the same with the AMA and ASA. The business part of medicine is not going away (period).

 

[toughlife]

Daiphon,

you hit the nail on the head. I am a 2nd yr anesthesia resident and I totally agree with you. However, try explaining this to some of the "good specialties", b/c evidentally logic dictates that they will lose out. its kinda like giving up a little of your blessings for the good of the profession. And my friend thats not happening anytime soon. People in general will look out for themselves first and their neighbours next. Just the way the world works. if you want to change it back, the way to do it to make sure that some of these so called "allied health professionals" do not get the same right as you. Woops too late, it already happened in my field. Where was the rest of "medicine" when anesthesiologists were fighting for supervision. Point is people will take shortcuts wherever possible. Just a fact of life. Now, granted i will easily find a job, it still bothers me that a person could circumvent around going to med school, do some of the most intricate/complicated cases without the proper education (more that most doctors are accustomed to), make more than most docs, then bitch and whine to state legislatures that "see we don't really need a doctor to supervise us." Unfortunately, my friend money talks and BS walks. If you want to have a voice, lend money to the AMA. I will do the same with the AMA and ASA. The business part of medicine is not going away (period).

I agree with you entirely but what I still don't understand is why so many anesthesiologists still choose to hire CRNAs in their group. It is hypocrytical to hear them criticize CRNAs and yet have many anesthesia groups dying to pay them big bucks just to joinn their groups. Why? Because they are greedy. So why not make it illegal for any anesthesiologist to hire CRNAs in their group or risk losing their license? That's how you would stop that in a second. Ahh but believe me, many anesthesiologists would fight tooth and nail if that law was ever passed. Like you said, the mighty dollar is always king.

 

[Lemont]

it doesn't matter if one chooses a "specialty that is too difficult for allied health people to encroach on too much because they just don't have the years of training and knowledge to do it competently," because as technology improves, these complicated cases are going to become easier to do by less-trained individuals. sure, these less-trained individuals won't be able to 'improvise' if something outside the norm occurs, but that's why you have the one oversight doctor (think CRNA's and anesthesiologists) for several mid-level providers... we doctors are still going to get hosed.

thus, one might argue that it is actually less about becoming a ultra-narrow specialist and carving out smaller and smaller niches (think about Muller's Ratchet & evolution), and more about strengthening the profession of medicine. i'm not saying let's get rid of our cardiologists (or the subspecialties of EP or interventional), i'm just saying that we should remember we are PHYSICIANS first, and [fill in name of your chosen specialty] last.

$.02 more,
-t

There is no way anybody except a qualified pediatric heart surgeon will ever be able to do something as complex as congenital heart surgery from start to finish with acceptable results. The surgical PA may be able to do some of the basic stuff, like they do now in adult heart surgery, but even then congenital heart surgery is too complex---despite any technological advances. Same thing goes with other difficult fields---you're not going to get any amateurs clipping a cerebrovascular aneurysm, doing reconstructive surgery, etc just by being supervised by a surgeon. But they will be able to encroach on fields like anesthesiology and family medicine because those fields are not as complex nor require as much training. I don't mean to diss anesthesiologists, but this is why a CNA can run an anesthesia case from start to finish.

 

[Lonestar]

toughlife,

you bring up a good point. there will always be some (in any field) that greed will be a part of the equation. BUT more often than not many groups utilize nurses out of necessity and not GREED. By that i mean, the way healthcare has been going (insurances cutting reimbursements, hospitals going for assembly line surgeries) having one doctor do one case at a time is simply unfeasable at today's pace (unfeasable for the hospital and the doc). And that my friend is only going to get worse. Medicine is not medicine anymore; it is a business. In business, quality will always be sacrificed by quantity in the interest of profit. Everyone who wants it gets it; Previously, everyone who NEEDED it, got it. Healthcare is a priviledge and not a right. Medicare, Medicaid, and HMOs only worsen the situation. If I had to personally change the situation, i would relieve the frustration built up during the "training years". The costs of medical education in this country are spiraling more than the cost of healthcare itself. Changing that and streamlining it would be a good start. Oh wait, that would involve effort and no one on capitol hill wants to untangle the mess that is medical education of today. So to make a long story short, if you want to protect your profession nowdays, be ready to fight it out politically.

BTW, good luck on your interviews.

 

[MDgirl76]

I for one hate the way the allied health professionals have intruded the field. Working in the NICU for example, the nurses page the respiratory therapist for any issues with the vents, and often the resident/fellow/attending is not even involved. When a patient is coding, a nurse and a respiratory therapist assist the fellow/attending. PICC lines are done by NNPs. The residents aer the ones who lose out. Makes my blood boil.

i think alot has to do with very inefficient training for doctors -- whos fault is it if allied health happends to be better in handling certain situations (eg running codes etc - this is based on stuff i have seen) versus a resident -- being an md by name means nothing if the profession is not efficiently trained

 

[Daiphon]

...Medicine is not medicine anymore; it is a business. In business, quality will always be sacrificed by quantity in the interest of profit.

Everyone who wants it gets it; Previously, everyone who NEEDED it, got it.

Healthcare is a priviledge and not a right.

to lonestar:
b-i-ngo, b-i-ngo, b-i-ngo and bingo was his name-o... with one caveat. i think a basic level of health care is indeed a right; but if you want more, you pay more (see British Health System). I fully agree with the medicine=business comment, and anyone who doesn't think so might need to have their head examined (stated jovially. d=) )

to lemont:
i don't disagree that the congenital pediatric cardiac cases will likely always require a physician to treat... but this speaks against my earlier comment that one should, <i>a priori</i>, focus on the role of the PHYSICIAN in health care instead of the role of the "ultra-narrow specialist" (which, pediatric cardiac surgery certainly entails... that said, one of my best friends is going to be a peds cards surgeon, and i have nothing against her and she would agree with my earlier statements --> she was a frequent sounding board for them in med school).

to MDgirl:
well, yes, oftentimes allied health will be better at, for example, running codes... but, keep in mind that allied health often has a much narrower base of training, less responsibility, and the ability to focus on certain aspects of care. does allied health know how to do the ABC's, assess rhythm, and push drugs? sure... but do they know what the rhythm implies pathophysiologically? do they know how the drug works (and how it might interact with the other drugs the patient's on)? DO THEY HAVE THE ULTIMATE LIABILITY IF SOMEONE F*CKS UP?!?! the answers - maybe, maybe, HELL NO. if all i had to do all day was, to again use your example, run codes (which as an EM doc, is pretty much my bread & butter), then you'd better believe i'd be more adept at doing so compared to some resident physician... anyone can learn algorithms; it's understanding them that's the issue.

sorry to rant... but, 'nuff said.

-t

 

[Solideliquid]

Reading all this has got me worried about going into psych. I'm applying for this upcoming match.

During rotations in outpatient psych patients are always asking to see the doctor when he is too busy and the nurse makes them see a masters level counselor. That made me feel better but after reading the above post I'm getting a little anxious again. Where do you think Psychiatry is going to be in 20 years?

 

[toughlife]

toughlife,

you bring up a good point. there will always be some (in any field) that greed will be a part of the equation. BUT more often than not many groups utilize nurses out of necessity and not GREED. By that i mean, the way healthcare has been going (insurances cutting reimbursements, hospitals going for assembly line surgeries) having one doctor do one case at a time is simply unfeasable at today's pace (unfeasable for the hospital and the doc). And that my friend is only going to get worse. Medicine is not medicine anymore; it is a business. In business, quality will always be sacrificed by quantity in the interest of profit. Everyone who wants it gets it; Previously, everyone who NEEDED it, got it. Healthcare is a priviledge and not a right. Medicare, Medicaid, and HMOs only worsen the situation. If I had to personally change the situation, i would relieve the frustration built up during the "training years". The costs of medical education in this country are spiraling more than the cost of healthcare itself. Changing that and streamlining it would be a good start. Oh wait, that would involve effort and no one on capitol hill wants to untangle the mess that is medical education of today. So to make a long story short, if you want to protect your profession nowdays, be ready to fight it out politically.

BTW, good luck on your interviews.

I agree with you wholeheartedly with medicine being a business today. One of the downsides of capitalism is that everything is done for monetary value and the intangibles of a profession like medicine(respect, appreciation for the knowledge, etc) take a back seat.

One thing that physicians still have though is bargaining power. Problem is that to utilize it, we all have to have a common voice, and knowing how individualistic physicians are, it would be hard to accomplish that goal.

 

[mdblue]

Reading all this has got me worried about going into psych. I'm applying for this upcoming match.

During rotations in outpatient psych patients are always asking to see the doctor when he is too busy and the nurse makes them see a masters level counselor. That made me feel better but after reading the above post I'm getting a little anxious again. Where do you think Psychiatry is going to be in 20 years?

there has been a discussion about this in the psych forum. Essentially,it's following other fields. But if your concern is making $, don't worry-you'll have your share of pie.
And some things may indirectly affect the market e.g. black box on antidep has cut down SSRI prescribing, so a fallout can be pts will be seeing real psychs(w/ a 3 mo waiting time) as opposed to PCPs/NP/peds/med psychs ergo your pt base may increase. 😀

 

[MacGyver]

Where else did we go wrong? We are haunted by lawyers everyday, but we have our own physicians selling us out as expert witnesses. Standard of care is no longer determined by what our specialties dictate but rather what the ***** expert witness says that he/she thinks we should have done. I blame lawyers, but I equally blame our so called colleagues that sell us to the devil!!

Amen brother, preach it!

The bottom line is that these "expert witnesses" are money ******. They figure its a lot better to make $1000 per hour as a lawyer ***** rather than $200 per hour as a clinical doctor so they sell out to the lawyers and say whatever the lawyer wants them to say

 

[Daiphon]

Amen brother, preach it!

The bottom line is that these "expert witnesses" are money ******. They figure its a lot better to make $1000 per hour as a lawyer ***** rather than $200 per hour as a clinical doctor so they sell out to the lawyers and say whatever the lawyer wants them to say

don't forget that in many jurisdictions, the "expert witness" doesn't even need to be BC/BE in the field in question... in other words, doctors who haven't seen OB since medical school, or who trained back when bloodletting was accepted standard of care can testify in neurosurgical cases...

illinois just passed a malpractice reform bill that, hopefully, will combat this (if it resists the claims of being "unconstitutional" by the trial lawyers)... we now get to see the name/specialty of the person filing the affidavit of merit, and expert witnesses have to be in the field in question. small victories, but hey, baby steps. d=)

-t

ps - there was a classmate of mine from M1 year who had been a practicing lawyer (specializing in class action suits), whose stated reason for coming to medical school was both to become an expert witness and to "better understand my enemy [doctors] in malpractice/class action suits." scary, no? how did this guy get past AdCom? i'm pretty sure he didn't graduate...

 

[Aislin]

there was a classmate of mine from M1 year who had been a practicing lawyer (specializing in class action suits), whose stated reason for coming to medical school was both to become an expert witness and to "better understand my enemy [doctors] in malpractice/class action suits." scary, no? how did this guy get past AdCom? i'm pretty sure he didn't graduate...

Really scary.
I had to mention that patients/consumers are to blame, too. My friend is a Plastic surgeon and his wife (no profession), after witnessing a lot of his procedures (dunno why he let her) decided she could do a lot of things as well as he and started botox applications for friends at home. I doubt he knows about it, but if people submit themselves to this kind of thing because they can save a couple bucks, so I say they deserve the consequences. I would deny help if I could in case something goes wrong - as my grannies says ' what you reap is what you sow'.