Why would anyone go into primary care nowadays?

[tdram]

---

Members do not see this ad.

You just keep repeating arbitrary statements. Decent care? I'd say being able to go to the ER and have them treat you for sure with no money is pretty darn decent. Health isn't some special commodity. If I can't afford a new car, I don't get a new car. I don't somehow deserve a new kidney any more than a deserve a new corvette. I don't understand why there is this magical sentiment that human life is somehow intrinsically valuable enough to the point where we have to throw the whole fate of the country under the bus to save lives. Sorry, not gonna happen.

+1000000

You really summed it up beautifully.

@jonnythan is incredibly naive. He will learn. I'm sure he would have no problem letting another person suffer from lack of care if it meant his son or daughter could get better care.

 

[Beargryllz]

Let them eat cake.

Here's what I'm thinking. Say you have an uninsured, but still salvageable female-type patient. Why not just bang them and then toss them a little treatment on the side? They'll be back for more and it's not like you're a victim or being taken advantage of, it's just like the barter system.

 

[DermViser]

Can we just eat the poor people? I've been doing some soul searching and I really don't see myself taking a lot of charity cases. But few of those will die in such a way that renders the flesh inedible, especially for my dogs.

And I'm definitely done with taxes. I have a moral objection to those and I bet I can tie it into some religion somewhere and then practice that religion.

You're right, let's just keep raising taxes, just to pay for healthcare, no matter what, so that it crowds out the entire budget. I mean Medicare has gone swimmingly so far, am I right?

 

[tdram]

Here's what I'm thinking. Say you have an uninsured, but still salvageable female-type patient. Why not just bang them and then toss them a little treatment on the side? They'll be back for more and it's not like you're a victim or being taken advantage of, it's just like the barter system.

Honestly, I see no problem with this.

I actually knew an old retired family doc who previously operated on the barter system. People would bring him food and fix his car and whatever they could.

I see no problem with trading some treatment for getting my dick sucked.

I also have no problem with prostitution...

In my ideal world you could pay me in any way you think is appropriate. We can work out a deal.

 

[Beargryllz]

You're right, let's just keep raising taxes, just to pay for healthcare, no matter what, so that it crowds out the entire budget. I mean Medicare has gone swimmingly so far, am I right?

No, you're missing the second half of my post. I'm saying we're done with taxes. I have an objection to them and it will be religious in nature once I find religion. I also have an objection *for you* paying taxes so you need to stop. You're kind of treading on me and my life and frankly I'm sick of it. And enough of this Medicare. It's a scam. They've been taking my money for 8 years now and haven't shown me **** for it. I'm done with that nonsense too.

 

[DermViser]

No, you're missing the second half of my post. I'm saying we're done with taxes. I have an objection to them and it will be religious in nature once I find religion. I also have an objection *for you* paying taxes so you need to stop. You're kind of treading on me and my life and frankly I'm sick of it. And enough of this Medicare. It's a scam. They've been taking my money for 8 years now and haven't shown me **** for it. I'm done with that nonsense too.

You really have no idea of what you're talking about do you? In your attempt to poke fun, you're showing you're an utter fool with how budgets work.

 

[Beargryllz]

You really have no idea of what you're talking about do you? In your attempt to poke fun, you're showing you're an utter fool with how budgets work.

You know more than me. What are you gonna do about it?

I made up a budget the other day and it sucked. What's a good budget for me?

 

[deleted480308]

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.

I understand that there might be those who feel that way...but none of my primary care doctors, nor my kid's pediatricians, have ever been willing to take "I don't have money" as an excuse to not pay them.

 

[DermViser]

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.

No. The title of this thread is why a medical student with nearly 6 figure debt would go into primary care medicine - based not only on salary, but also govt. intervention thru unending paperwork, prior auths, insurance company haggling, etc.

 

[DermViser]

I understand that there might be those who feel that way...but none of my primary care doctors, nor my kid's pediatricians, have ever been willing to take "I don't have money" as an excuse to not pay them.

And for some reason @oldbearprofessor is not willing to give his services for free to those who can't afford it, either.

 

[tdram]

I understand that there might be those who feel that way...but none of my primary care doctors, nor my kid's pediatricians, have ever been willing to take "I don't have money" as an excuse to not pay them.

your avatar is my hero.

 

[BestDoctorEver]

Maybe if we stop wasting money in a bunch of stupid stuff like welfare (corporate, individual), defense (wars), foreign aids and other stupid pet projects we can fix our healthcare system... I don't think taxes need to be higher than what they are now in order to fix our health insurance market and healthcare... The healthcare system in Switzerland is not bad and their tax system is not burdensome.

 

[DermViser]

I'd rather pay a professional police officer than expect everyone to spend a few hours a week walking the beat. Maybe that's just me.

I am also pretty positive Medicaid recipients would rather me pay for their physician through taxes than have me try to provide medical care, considering I've never been to medical school.

You realize that you're not paying enough in taxes for Medicaid for a physician to actually see them right?

 

[deleted480308]

your avatar is my hero.

I want a mt. rushmore with swanson, ron paul, von mises, and friedman on it but I suck at photoshop

 

[DermViser]

Maybe if we stop wasting money in a bunch of stupid stuff like welfare (corporate, individual), defense (wars), foreign aids and other stupid pet projects we can fix our healthcare system... I don't think taxes need to be higher than what they are now in order to fix our health insurance market and healthcare... The healthcare system in Switzerland is not bad and their tax system is not burdensome.

They also have a MUCH smaller, homogeneous population.

 

[Beargryllz]

The healthcare system in Switzerland is not bad and their tax system is not burdensome.

Utter nonsense

How many desert kingdoms have the Swiss conquered? How many moons do they land on? They tax their citizens into oblivion for the sake of healthcare when they could have F35s instead

 

[deleted480308]

Maybe if we stop wasting money in a bunch of stupid stuff like welfare (corporate, individual), defense (wars), foreign aids and other stupid pet projects we can fix our healthcare system... I don't think taxes need to be higher than what they are now in order to fix our health insurance market and healthcare... The healthcare system in Switzerland is not bad and their tax system is not burdensome.

I'm actually with you on ending all welfare and minding our own business militarily.....not to free that money up for other uses, but to just stop taking it from citizens..

so we halfway agree!

 

[DermViser]

So to summarize @jonnythan's plan:

Problem: "What I want is for people to actually get medical care and not suffer and die."
Solution: People being mandated to get health insurance plans that hospitals/providers don't accept and higher taxes.

Yup, what could possibly go wrong?

 

[BestDoctorEver]

I'm actually with you on ending all welfare and minding our own business militarily.....not to free that money up for other uses, but to just stop taking it from citizens..

so we halfway agree!

I think that we are 100% in agreement...

 

[el_duderino]

I didn't say that, at all. You keep proclaiming you won arguments by making up things the other person supposedly said. Good job. Derp.

 

[BestDoctorEver]

They also have a MUCH smaller, homogeneous population.

Homogeneous--yes... smaller while is it true, but it is not a good argument.

 

[DermViser]

Homogeneous--yes... smaller while is it true, but it is not a good argument.

That's why they're able to pay for it, genius. Much different than 350 million people.

 

[DermViser]

I didn't say that, at all. You keep proclaiming you won arguments by making up things the other person supposedly said. Good job. Derp.

Um, yeah you did. Your solution was govt. control and raising taxes. The only other way it would work is by providers giving their medical services for free to the populace.

 

[oldbearprofessor]

And for some reason @oldbearprofessor is not willing to give his services for free to those who can't afford it, either.

This is not true, past, present or future. Please avoid personal commentary about me and my medical practice and focus on the discussion about pediatric/primary care motivation.

 

[el_duderino]

Um, yeah you did. Your solution was govt. control and raising taxes. The only other way it would work is by providers giving their medical services for free to the populace.

I didn't mention government control. I did mention higher taxes. I did not mention "People being mandated to get health insurance plans that hospitals/providers don't accept and higher taxes." Nor did I mention anyone giving their services to anyone else for free. You are, quite simply, a liar. You are straight-up lying about the things I've supposedly said.

I'm open to any effective method that actually gets people health care. It works in other countries; there are other nations in the world that have accomplished this.

I also want to say that, as a human being, I don't deserve more effective/better healthcare than any other human being. If I make more money I'm happy spending more to get better coverage for myself and my family. But I don't DESERVE better coverage than anyone else, any more than I DESERVE more effective police protection or cleaner drinking water than anyone else.

 

[tdram]

I didn't mention government control. I did mention higher taxes. I did not mention "People being mandated to get health insurance plans that hospitals/providers don't accept and higher taxes."

I'm open to any effective method that actually gets people health care. It works in other countries; there are other nations in the world that have accomplished this.

I also want to say that, as a human being, I don't deserve more effective/better healthcare than any other human being. If I make more money I'm happy spending more to get better coverage for myself and my family. But I don't DESERVE better coverage than anyone else, any more than I DESERVE more effective police protection or cleaner drinking water than anyone else.

You don't deserve healthcare at all. It's a commodity like anything else. You also don't deserve a car, or a house, or a computer. These are all things that you purchase if you can afford them. Healthcare is no different. We just came up with a way to force some people into paying for other people's healthcare, which, as a libertarian, I strongly oppose. If you can't afford a car, you don't get a car. If you can't afford healthcare, you don't get healthcare - someone else doesn't buy it for you.

 

[el_duderino]

You don't deserve healthcare at all.

That's where we fundamentally disagree. I think that I do. Everyone in this country does.

 

[tdram]

That's where we fundamentally disagree. I think that I do. Everyone in this country does.

What is it about healthcare that makes you think you deserve it as opposed to any other good or service?

 

[BestDoctorEver]

That's why they're able to pay for it, genius. Much different than 350 million people.

They are able to pay for it is because their income per capita is higher than US--not because they have less people... There are other countries that have less people but have ****ty healthcare...

 

[tdram]

@jonnythan Let's also clarify what type of healthcare you think you deserve? Do you just deserve emergency medical services? Or you think you deserve everything, including viagra if you can't get it up? Because Medicare pays for it all.

 

[PL198]

That's where we fundamentally disagree. I think that I do. Everyone in this country does.

ok so is health care the only thing they deserve? to what extent do they deserve these things?

 

[Beargryllz]

@jonnythan Let's also clarify what type of healthcare you think you deserve? Do you just deserve emergency medical services? Or you think you deserve everything, including viagra if you can't get it up? Because Medicare pays for it all.

Bull****

Medicare doesn't cover anything and I'm not giving myself end-stage renal disease. It covers literally nothing and I'm sick of it. I'm already paying for it and I'm not satisfied at all.

 

[Flamen04]

A family friend makes over 1 million a dollar a year and he's a family doc. Being business savvy and having the smarts to open multiple practices are hire people can go a long way... Sucks to suck if you don't have good business skills

 

[Silent Cool]

To answer the OP's question:

Because you were too stupid to get a high board score

 

[PL198]

A family friend makes over 1 million a dollar a year and he's a family doc. Being business savvy and having the smarts to open multiple practices are hire people can go a long way... Sucks to suck if you don't have good business skills

Yes this is true, but this is still becoming harder and harder to do. It's a risk and can pay off great in the event one succeeds, but the % of that happening is just going to decrease over time.

 

[Nidor]

.

 

[circulus vitios]

Can we just eat the poor people? I've been doing some soul searching and I really don't see myself taking a lot of charity cases. But few of those will die in such a way that renders the flesh inedible, especially for my dogs.

And I'm definitely done with taxes. I have a moral objection to those and I bet I can tie it into some religion somewhere and then practice that religion.

 

[Psai]

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.

Oldbearprofessor, I'm doing my first rotation in peds at an outpatient clinic and the topic of the medical home came up. All the attendings and residents were against it because even though it sounds good in theory, in practice, it doesn't work well just like most things that are implemented from the top down. They have a social worker who is excellent but the rest of it is just eh. Like people thought that giving patients educational papers at the end of visits would improve care but no one reads those things. I'm a medical student and I just throw them out. And the worst part is that you have to chart that patients received it. So it wastes time, effort and paper for no good reason whatsoever.

 

[el_duderino]

http://www.un.org/en/documents/udhr/index.shtml#a1

Article 25.

• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The rights you are disputing are such a basic part of human dignity and modern society that they where specifically mentioned in the universal declaration of human rights. It is not 'fairness' that you are defending, it is the fundamental belief that right to life itself is bound to merit, it is saying that an 8 year old child with an appendicitis and poor parents doesn't deserve care, it is letting people rot and die.

This is a good post. Thank you.

 

[tdram]

http://www.un.org/en/documents/udhr/index.shtml#a1

Article 25.

• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The rights you are disputing are such a basic part of human dignity and modern society that they where specifically mentioned in the universal declaration of human rights. It is not 'fairness' that you are defending, it is the fundamental belief that right to life itself is bound to merit, it is saying that an 8 year old child with an appendicitis and poor parents doesn't deserve care, it is letting people rot and die.

And what do you do when this becomes unsustainable? What happens when you run out of food, clothing and medical care for everyone? Do you magically invent resources out of thin air? Are you really as naive as to think that these things are unlimited?

I certainly do not agree with that and don't even think that is practical. No one is entitled to anything in life. The idea that you should be provided with everything for free by society just because you happened to be born is absurd. The idea that other people are forced to sacrifice for you just because you exist is ridiculous.

 

[Frazier]

This is not true, past, present or future. Please avoid personal commentary about me and my medical practice and focus on the discussion about pediatric/primary care motivation.

@oldbearprofessor

That's the one thing that stunk to me during my stint as a moderator on SDN: you're always expected to be civil and take the higher ground -- regardless of what's said by other posters.

How do you do it? 😉

 

[Nidor]

.

 

[oldbearprofessor]

Oldbearprofessor, I'm doing my first rotation in peds at an outpatient clinic and the topic of the medical home came up. All the attendings and residents were against it because even though it sounds good in theory, in practice, it doesn't work well just like most things that are implemented from the top down. They have a social worker who is excellent but the rest of it is just eh. Like people thought that giving patients educational papers at the end of visits would improve care but no one reads those things. I'm a medical student and I just throw them out. And the worst part is that you have to chart that patients received it. So it wastes time, effort and paper for no good reason whatsoever.

Sounds a lot like a specific implementation strategy that isn't working, as the concept is decades old and has been successfully implemented in many places. My point actually in the post in which I originally mentioned it was just to note that the field of general pediatrics is not stagnant or "declining" as had been suggested. Rather innovative approaches to patient care continue to be tried and these have the possibility, when done properly, to improve the world of general pediatrics as well as specialty pediatrics. Do you find that your attendings and residents wish they were not in pediatrics? That's the real question, not the challenges in the implementation of the medical home concept.

 

[PL198]

Lol the UN is not the group that sets policy for the world. It's literally an organization that has 0 power. I do not acknowledge any UN declarations or policy, personally.

 

[tdram]

This is a slippery slope argument (http://www.nizkor.org/features/fallacies/slippery-slope.html). Naturally and unfortunately there is some point where not everybody can be helped, where that point lays is for a society to figure out.

The fact that not everybody can be helped is a weak argument to support not helping anyone though

I don't mind helping people, and I do help people all the time and will continue to do so my entire life. However, I do mind being forced to help people. I want to help people the way I want to. It should be up to the individual to decide how they will help their fellow citizens, not the government. No one has a right to my time, my skills, or my property other than me.

I will certainly help the poor man who is sick due to no fault of his own. I will not help the lazy bum who is gaming the system.

 

[oldbearprofessor]

@oldbearprofessor

That's the one thing that stunk to me during my stint as a moderator on SDN: you're always expected to be civil and take the higher ground -- regardless of what's said by other posters.

How do you do it? 😉

Actually, one of the things that keeps me and I think others of the long-standing mods around SDN is the fun of interacting with trainees, students, etc in a forum in which there is relatively little hierarchy as would be usual in medicine. What is disappointing to me though is how often what could be interesting arguments (e.g. the challenges of innovation in primary care medicine) become personalized and nothing more than insults. That and MD/DO and AA threads.😴

 

[DermViser]

I didn't mention government control. I did mention higher taxes. I did not mention "People being mandated to get health insurance plans that hospitals/providers don't accept and higher taxes." Nor did I mention anyone giving their services to anyone else for free. You are, quite simply, a liar. You are straight-up lying about the things I've supposedly said.

I'm open to any effective method that actually gets people health care. It works in other countries; there are other nations in the world that have accomplished this.

I also want to say that, as a human being, I don't deserve more effective/better healthcare than any other human being. If I make more money I'm happy spending more to get better coverage for myself and my family. But I don't DESERVE better coverage than anyone else, any more than I DESERVE more effective police protection or cleaner drinking water than anyone else.

What do you think Obamacare is? You think health insurance rains down on people? You are MANDATED to get it - whether it's Medicaid (an entitlement), Medicare (another entitlement), Obamacare exchange plans (a subsidized entitlement), or a non-exchange private insurance plan. The only other way it would work is if providers gave their services for free.

Yeah, you know how those other countries "accomplish" it? They take the whole thing over thru single payer and they ration care (in which the govt. decides which medical care they are willing to pay for, based on the collective good and a curve like this).


Again, police protection, fire protection, roads, etc. are LOCAL matters in which you pay directly thru LOCAL taxes and property taxes, which benefit you directly by living in vicinity.

 

[DermViser]

That's where we fundamentally disagree. I think that I do. Everyone in this country does.

Very typical of your entitlement mindset.

 

[Nidor]

.

 

[tdram]

an 8 year old child with an appendicitis and poor parents doesn't deserve care, it is letting people rot and die.

Who brought that 8 year old child to life? Was it me? No, it was that child's parents. If they knew they couldn't support the child but decided to have one anyway, how in the world do I have to work harder to make money to pay for that child. If the taxpayers are required to pay for any child that is born, then the taxpayers should also have the right to decide how many children people should be allowed to have. Oh that's a human rights violation too.. right. Well then sorry, you pay for your own choice to have a kid.