Why would anyone go into primary care nowadays?

[tdram]

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that's all semantics to me.....an insurance company not being allowed to recognize my exam produces more educated diagnosis than a nurse is insane.

The libertarian in me is ok with the concept of nurses competing as long as they have to label themselves as nurses and not use the misleading "doctor" from their watered down degree. What's not ok with me at all is the concept that I can't go to an insurance company and convince them my exam/diagnosis is more valuable and get paid more than a nurse. I'm not allowed to say, I'll save you money in needless testing because I actually know what I'm doing and can diagnose at a higher level of skill...and then get paid according to my skill. I'm cool if the insurance company just doesn't buy my argument as long we handle that conversation between us. But the idea that the government steps in and says the insurance company isn't allowed to agree with me drives me nuts. It's akin to oregon saying that the michelin star restaurant isn't allowed to charge more for a hamburger than the mcdonalds because....you know...."them's all burgers anyways"

I'm also a libertarian. Government has no business regulating what private insurance companies pay to anyone. It is absolutely absurd. The insurance company should be free to spend their money as they see fit.

 

[oldbearprofessor]

I can't believe you think that Pediatric residents would want to practice in a PCMH type of setting.

Some might find this article of interest from 2004 explaining the historical development of the pediatric medical home which goes back many decades.

The pediatric residents I talk to are overwhelmingly supportive of the medical home setting. Probably those who aren't won't be likely to be doing community-based pediatrics.

I believe that every child who lives in the United States, regardless of how they got here or what financial resources their family has, deserves good medical care and that it is the responsibility of our society to provide it to them. I can say with some degree of certainty that this is a common perspective amongst pediatricians and pediatric medical trainees. It is part of the perspective that makes the job of being a pediatrician something many of us enjoy and are honored to do.

 

[DermViser]

I believe that every child who lives in the United States, regardless of how they got here or what financial resources their family has, deserves good medical care and that it is the responsibility of our society to provide it to them. I can say with some degree of certainty that this is a common perspective amongst pediatricians and pediatric medical trainees. It is part of the perspective that makes the job of being a pediatrician something many of us enjoy and are honored to do.

🙄 - and let me guess, this also includes children of illegal immigrants, and you plan on paying for that "responsibility of our society" by raising everyone's taxes (including those of the middle class). Wonderful.

I'm pretty sure pediatric subspecialists disagree from those going into general pediatrics.

 

[tdram]

I believe that every child who lives in the United States, regardless of how they got here or what financial resources their family has, deserves good medical care and that it is the responsibility of our society to provide it to them. I can say with some degree of certainty that this is a common perspective amongst pediatricians and pediatric medical trainees. It is part of the perspective that makes the job of being a pediatrician something many of us enjoy and are honored to do.

I don't agree with you. No one deserves good medical care for just existing, just like no one deserves a car or a house for just existing. If you want to have a kid, you'd better be ready to pay for that kid's expenses. If you can't, that's your problem, not all of society's. That doesn't mean we can't help if we feel generous, but the idea that it's everyone's responsibility to ensure every child is taken care of is ridiculous. And raising the taxes on everyone, including the middle class to pay for this is also ridiculous.

 

[PL198]

I feel no responsibility towards random other people or giving them anything. This doesn't mean I wouldn't, but this thought that it's required is essentially 100 % what is screwing over this country economically.

 

[DermViser]

I don't agree with you. No one deserves good medical care for just existing, just like no one deserves a car or a house for just existing. If you want to have a kid, you'd better be ready to pay for that kid's expenses. If you can't, that's your problem, not all of society's. That doesn't mean we can't help if we feel generous, but the idea that it's everyone's responsibility to ensure every child is taken care of is ridiculous. And raising the taxes on everyone, including the middle class to pay for this is also ridiculous.

This is exactly why medical students of today are nowhere in the same position as the doctors of the Baby Boomer generation, and shouldn't be taking advice on financial matters from them, a generation that has gotten the full benefits of Social Security and Medicare, and would be willing to default the nation's budget to pay for their free stuff. So it's any wonder healthcare to them is a "right" (i.e. free) when it's actually a commodity -- that has value and prices, and isn't "free".

Any wonder Medicare spending has gotten ridiculously out of control.

 

[el_duderino]

No one deserves good medical care for just existing

This is horrific.

 

[DermViser]

This is horrific.

Remember that when you're an attending. If you aren't willing to give basic healthcare services to your patients for free, then you are hypocrite.

 

[tdram]

This is horrific.

It's absolutely not. It's the truth. Medical care is not free, it costs money and people's time. No one is entitled to another human being's time. In fact, that is the definition of slavery.

 

[el_duderino]

Remember that when you're an attending. If you aren't willing to give basic healthcare services to your patients for free, then you are hypocrite.

This makes absolutely no sense.

 

[tdram]

This makes absolutely no sense.

Why don't you go ahead and provide your time for free to everyone since you believe that every person deserves the best medical care whether or not they can or are willing to pay for it. Let's see how well that works out for you.

 

[el_duderino]

It's absolutely not. It's the truth. Medical care is not free, it costs money and people's time. No one is entitled to another human being's time. In fact, that is the definition of slavery.

Oh god, slavery. Really? Come on man.

The idea that America as a society somehow can't make sure everyone gets halfway decent medical care, when there are a bunch of countries that can, is idiotic. Yes, it will cost more money and no, there aren't really any ideal ways to accomplish that.

But I'm just not comfortable with the idea that we CAN'T do this. I'm not comfortable with the idea that it's OK to let people suffer and die because they can't afford basic medical care.

 

[DermViser]

This makes absolutely no sense.

Read your statement that you were so "horrified" at. If you're unwilling to let your actions speak in that regard, that makes you a hypocrite.

 

[el_duderino]

Why don't you go ahead and provide your time for free to everyone since you believe that every person deserves the best medical care whether or not they can or are willing to pay for it. Let's see how well that works out for you.

I already provide a portion of my time for free to provide things to people. That's what taxes are - a portion of the money I make goes towards things like police protection, fire protection, road construction and maintenance, public housing, food stamps, national defense, etc.

 

[tdram]

Oh god, slavery. Really? Come on man.

The idea that America as a society somehow can't make sure everyone gets halfway decent medical care, when there are a bunch of countries that can, is idiotic. Yes, it will cost more money and no, there aren't really any ideal ways to accomplish that.

But I'm just not comfortable with the idea that we CAN'T do this. I'm not comfortable with the idea that it's OK to let people suffer and die because they can't afford basic medical care.

We can certainly do it. The point is that we shouldn't be forcing people to participate if they don't want to. People who are generous and have enough to spare can help the suffering all they want. I would help too.

 

[el_duderino]

Read your statement that you were so "horrified" at. If you're unwilling to let your actions speak in that regard, that makes you a hypocrite.

Why would I have to personally provide the medical care for free to people? Do I also need to personally fight in wars, put out fires, and sanitize the water supply? Of course not. I'd expect you to be familiar with the concept of taxation and social services, but maybe not. Perhaps medicine is the only life experience you really have.

 

[DermViser]

Oh god, slavery. Really? Come on man.

The idea that America as a society somehow can't make sure everyone gets halfway decent medical care, when there are a bunch of countries that can, is idiotic. Yes, it will cost more money and no, there aren't really any ideal ways to accomplish that.

But I'm just not comfortable with the idea that we CAN'T do this. I'm not comfortable with the idea that it's OK to let people suffer and die because they can't afford basic medical care.

What part of healthcare services is a commodity with actual prices is difficult to understand? Do you think doctors, nurses, medical equipment, etc. just come out of thin air? Do you even know how those other "bunch of countries" health systems work and how much rationing occurs there?

 

[tdram]

I already provide a portion of my time for free to provide things to people. That's what taxes are - a portion of the money I make goes towards things like police protection, fire protection, road construction and maintenance, public housing, food stamps, national defense, etc.

If you didn't know already, taxation is theft: http://mises.org/etexts/taxrob.asp

 

[el_duderino]

We can certainly do it. The point is that we shouldn't be forcing people to participate if they don't want to. People who are generous and have enough to spare can help the suffering all they want. I would help too.

That hasn't been working out too well for us, has it?

 

[oldbearprofessor]

🙄 - and let me guess, this also includes children of illegal immigrants

Of course it does, in the delivery room, am I supposed to check on the parent's citizenship status before intubating their apneic newborn?

 

[el_duderino]

If you didn't know already, taxation is theft: http://mises.org/etexts/taxrob.asp

Oh lord.

 

[DermViser]

Why would I have to personally provide the medical care for free to people? Do I also need to personally fight in wars, put out fires, and sanitize the water supply? Of course not. I'd expect you to be familiar with the concept of taxation and social services, but maybe not. Perhaps medicine is the only life experience you really have.

Right, you're just being a typical liberal hypocrite and expect OTHER people to provide that medical care for free. Par for the course.

 

[tdram]

That hasn't been working out too well for us, has it?

It actually works a lot better than letting corrupt politicians handle it.

 

[el_duderino]

Right, you're just being a typical liberal hypocrite and expect OTHER people to provide that medical care for free. Par for the course.

I don't expect anyone to provide anything for free. Reading isn't really your strong suit, I see. I guess that's why so many of your arguments end with the equivalent of "you're a premed/student/resident/whatever and therefore wrong" 😉

 

[DermViser]

Of course it does, in the delivery room, am I supposed to check on the parent's citizenship status before intubating their apneic newborn?

And tell me who is supposed to pay for those services? You realize intubation tools cost money right? You realize that healthcare services and all they entail -- salaries, equipment, etc. all cost money right?

 

[el_duderino]

This would be funny if it weren't so pathetically sad.

 

[oldbearprofessor]

I feel no responsibility towards random other people or giving them anything.

okay, that's your perspective, but the title of this thread is about what motivates primary care physicians, in this case the subgroup of pediatricians. Providing good care to all children, regardless of financial status is one of the motivating factors for many people in my field, including pedi subspecialists like me. I have been posting this information to specifically explain the answer to the title of the thread and encouraging med students interested in pediatrics to get their information about what motivates pediatricians directly from pediatricians, not the internet.

 

[el_duderino]

And tell me who is supposed to pay for those services? You realize intubation tools cost money right? You realize that healthcare services and all they entail -- salaries, equipment, etc. all cost money right?

You know Medicaid already exists, right? I don't think any physicians are being forced into slavery to work for free to provide care to Medicaid recipients. Maybe they are and I just don't know.

But I'm pretty sure Medicaid was funded by taxes, which means that pretty much EVERYONE is working a portion of their time for free to provide those services. Just as we're all working a portion of our time for free to pay the police force. So since I have a job now, I'm ALREADY working for free to provide public services for people.

 

[oldbearprofessor]

And tell me who is supposed to pay for those services? You realize intubation tools cost money right? You realize that healthcare services and all they entail -- salaries, equipment, etc. all cost money right?

We all are. I'm fairly knowledgeable about the cost of neonatal care and that doesn't change my view.

 

[tdram]

This would be funny if it weren't so pathetically sad.

Why don't you do us all a favor and work for a pittance in an underserved area, so you can take care of everyone for free. The rest of us will continue to be the greedy bastards you think we are.

 

[DermViser]

That hasn't been working out too well for us, has it?

Yup, so the solution is to govt. mandate it, raise everyone's taxes (including those of the middle class who are already struggling), so that people who have no business buying comprehensive plans get kicked off their insurance to buy more expensive plans (that they can't afford) to subsidize those who didn't have insurance. Yup, great plan.

 

[el_duderino]

Yup, so the solution is to govt. mandate it, raise everyone's taxes (including those of the middle class who are already struggling), so that people who have no business buying comprehensive plans get kicked off their insurance to buy more expensive plans (that they can't afford) to subsidize those who didn't have insurance. Yup, great plan.

That is one thing we can do. It sucks, but to me it sucks a lot less than leaving people uninsured. That's simply not acceptable.

We can't have everything be awesome all the time forever. As a society we need to make sacrifices. I'm to a large degree comfortable with the idea of sacrificing certain things to make sure we have a bare minimum of societal services. Clean water, decent roads, police and fire protection, and some basic level of medical care are part of that IMO. Whether we accomplish that with some single-payer system, which I think is inevitable, or some other means, such as expanded Obamacare, is a matter of debate and doesn't much matter to me.

 

[tdram]

You know Medicaid already exists, right? I don't think any physicians are being forced into slavery to work for free to provide care to Medicaid recipients. Maybe they are and I just don't know.

But I'm pretty sure Medicaid was funded by taxes, which means that pretty much EVERYONE is working a portion of their time for free to provide those services. Just as we're all working a portion of our time for free to pay the police force. So since I have a job now, I'm ALREADY working for free to provide public services for people.

Personally, I'm an advocate of privatizing all government services and operations, including the police force, as are all free-market advocates.

 

[oldbearprofessor]

And tell me who is supposed to pay for those services? You realize intubation tools cost money right? You realize that healthcare services and all they entail -- salaries, equipment, etc. all cost money right?

BTW, you didn't answer my question. If a baby is born and I am attending the delivery, should I refuse to intubate him if he needs it based on the legal immigration status of his parents? Would I not be guilty of murder if I didn't?

 

[DermViser]

We all are. I'm fairly knowledgeable about the cost of neonatal care and that doesn't change my view.

Yeah, by raising taxes, including those of the middle class (who are already struggling as it is to make ends meet), for illegal immigrant (a.k.a. uncompensated) care. Very easy for you to be magnanimous with other people's money. I have a better idea -- why not just do your services in that instance for free, or out of your own paycheck?

 

[el_duderino]

Yeah, by raising taxes, including those of the middle class (who are already struggling as it is to make ends meet), for illegal immigrant (a.k.a. uncompensated) care. Very easy for you to be magnanimous with other people's money. I have a better idea -- why not just do your services in that instance for free, or out of your own paycheck?

I'm already well above median income, and when I finish residency I'll be way above even that. I can't provide medical care for millions of people by myself. I'm comfortable paying more in taxes, or sacrificing some federal or state programs, or paying higher insurance premiums, in order to make sure everyone can get basic medical care.

 

[tdram]

That is one thing we can do. It sucks, but to me it sucks a lot less than leaving people uninsured. That's simply not acceptable.

We can't have everything be awesome all the time forever. As a society we need to make sacrifices. I'm to a large degree comfortable with the idea of sacrificing certain things to make sure we have a bare minimum of societal services. Clean water, decent roads, police and fire protection, and some basic level of medical care are part of that IMO. Whether we accomplish that with some single-payer system, which I think is inevitable, or some other means, such as expanded Obamacare, is a matter of debate and doesn't much matter to me.

No, we can't save everyone. Even if we could, we'd eventually run out of everything and we'd all die. Unfortunately that's the reality of the world we live in. Nature wasn't made for everyone to survive and be happy.

Bottom line is, no one gets a free lunch. If you want something, you have to give something.

 

[DermViser]

BTW, you didn't answer my question. If a baby is born and I am attending the delivery, should I refuse to intubate him if he needs it based on the legal immigration status of his parents? Would I not be guilty of murder if I didn't?

Here's a bright idea. As a hospital who has to run on a budget to pay employee salaries (esp. one as high as yours), medical equipment, beds, etc. you don't admit people who have come in illegally (and have a higher chance of being a infectious disease health risk) to deliver in the first place.

 

[tdram]

Social programs should be run by charities with funds from generous individuals, not by the corrupt politicians with money stolen from the public, most of which never sees it to helping anyone anyway.

 

[el_duderino]

Social programs should be run by charities with funds from generous individuals, not by the corrupt politicians with money forcefully stolen from the public.

I would be 100% in favor of that, if it worked. Problem is that it doesn't. If it worked we wouldn't have so many people dying because of lack of access to medical care, and we wouldn't have people who are financially ruined for life because they don't have or lost their insurance.

I am completely in favor of getting government out of everything it doesn't need to be in. But I think that in this day and age, medical care is something that should be considered a right, and private interests cannot and will not make sure everyone gets medical care.

 

[DermViser]

That is one thing we can do. It sucks, but to me it sucks a lot less than leaving people uninsured. That's simply not acceptable.

We can't have everything be awesome all the time forever. As a society we need to make sacrifices. I'm to a large degree comfortable with the idea of sacrificing certain things to make sure we have a bare minimum of societal services. Clean water, decent roads, police and fire protection, and some basic level of medical care are part of that IMO. Whether we accomplish that with some single-payer system, which I think is inevitable, or some other means, such as expanded Obamacare, is a matter of debate and doesn't much matter to me.

You are absolutely free to give your medical services for free once you've finished 4 years of med school and 3-7 years of residency. Just remember, when you owe a six figure loan at the end of 4 years with compounding interest thruout med school and residency, just remember then pittance physician reimbursement you get thru single payer, Obamacare exchange plans, won't decrease your monthly loan payments when the bank comes knocking on your door for repayment.

 

[el_duderino]

You are absolutely free to give your medical services for free once you've finished 4 years of med school and 3-7 years of residency. Just remember, when you owe a six figure loan at the end of 4 years with compounding interest thruout med school and residency, just remember then pittance physician reimbursement you get thru single payer, Obamacare exchange plans, won't decrease your monthly loan payments when the bank comes knocking on your door for repayment.

I already give medical services to people for free, in the form of income tax that I pay. I work a portion of my day for free ALREADY to provide things like health care and police protection to people.

 

[Beargryllz]

Here's a bright idea. As a hospital who has to run on a budget to pay employee salaries (esp. one as high as yours), medical equipment, beds, etc. you don't admit people who have come in illegally (and have a higher chance of being a infectious disease health risk) to deliver in the first place.

Why not admit them and then poison them so they can't come back and clog up the system?

It's a win/win since KCl is dirt cheap and works fast and then we don't have this huge immigrant burden anymore

 

[tdram]

I would be 100% in favor of that, if it worked. Problem is that it doesn't. If it worked we wouldn't have so many people dying because of lack of access to medical care, and we wouldn't have people who are financially ruined for life because they don't have or lost their insurance.

I am completely in favor of getting government out of everything it doesn't need to be in. But I think that in this day and age, medical care is something that should be considered a right, and private interests cannot and will not make sure everyone gets medical care.

People can't get healthcare because it's too expensive. It's too expensive because government regulates it too much. If government stopped meddling with the prices of things and introducing ridiculous legislation that limits supply and drives prices up, more people would be able to afford medical services.

The government officials are no more angels that want to help everybody any more than any private businessman is. The difference is that the entrepreneur will be omtivated to find a way to get everybody care because he knows everyone has some money to spend. Every customer is valuable, and there are always ways to serve them all. The government has 0 motivation because your tax dollars come in whether they do a good job or not.

 

[DermViser]

I'm already well above median income, and when I finish residency I'll be way above even that. I can't provide medical care for millions of people by myself. I'm comfortable paying more in taxes, or sacrificing some federal or state programs, or paying higher insurance premiums, in order to make sure everyone can get basic medical care.

You don't get it. YOU may be above median income. Much of the American public is not. Yet, you expect them to gladly pay up more money in taxes to pay for your do-gooder project so you get warm, fuzzy feelings inside. Once you finish residency and Obamacare is in full swing, your salary will be lower than what you're expecting, bc the hospital you work for will be taking in less reimbursement thru Medicaid, Obamacare exchange plans, etc. You didn't think you could make a six figure salary just bc you're a physician did you?

 

[oldbearprofessor]

Here's a bright idea. As a hospital who has to run on a budget to pay employee salaries (esp. one as high as yours), medical equipment, beds, etc. you don't admit people who have come in illegally (and have a higher chance of being a infectious disease health risk) to deliver in the first place.

Okay, so you recommend mandatory delivery of "illegal" immigrants at home or wherever there are no neonatologists/other providers to care for their babies? This would massively increase the cost of caring for these infants (lack of prenatal care, etc) and doesn't actually answer my question as these babies would then just come in by ambulance and I'd still be stuck with trying to decide what to do.

 

[DermViser]

Why not admit them and then poison them so they can't come back and clog up the system?

It's a win/win since KCl is dirt cheap and works fast and then we don't have this huge immigrant burden anymore

Who is talking about actively killing immigrants?

 

[el_duderino]

You don't get it. YOU may be above median income. Much of the American public is not. Yet, you expect them to gladly pay up more money in taxes to pay for your do-gooder project so you get warm, fuzzy feelings inside. Once you finish residency and Obamacare is in full swing, your salary will be lower than what you're expecting, bc the hospital you work for will be taking in less reimbursement thru Medicaid, Obamacare exchange plans, etc. You didn't think you could make a six figure salary just bc you're a physician did you?

I expect to pay more money for this, in the form of taxes or insurance premiums or something. The money obviously has to come from somewhere.

And I'm OK with this. Whether I'm working as a physician has nothing to do with it. I'm OK with making less money for this purpose.

 

[Beargryllz]

Who is talking about actively killing immigrants?

Don't think of it as actively killing but as proactively sustaining an overburdened system

 

[DermViser]

I already provide a portion of my time for free to provide things to people. That's what taxes are - a portion of the money I make goes towards things like police protection, fire protection, road construction and maintenance, public housing, food stamps, national defense, etc.

Taxes aren't providing "a portion of my time". If your idea of charity is filling out an IRS form, then you really are a hypocrite.