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View Diary: The ACA and Our Doctor Shortage (149 comments)

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  •  Thank you so much, Velo (30+ / 0-)

    There are far too many Americans who do not understand how the ACA helps address the shortage of Primary Doctors.

    We need to get that word out.

    So, obviously this is being shared far and wide. :)

    "Compassion is not weakness, and concern for the unfortunate is not socialism." Hubert H. Humphrey

    by Onomastic on Mon Sep 03, 2012 at 05:38:17 AM PDT

    •  This shortage can be mitigated, I think, (16+ / 0-)

      by something very important that the diarist mentions:

      Nurse practitioners
      Physician Assistants

      But I would also like to see primary care, in some cases, include:

      Nutritionists
      Pharmacists
      RNs

      The latter three could easily aid in diagnosing and dispensing basic formularies for digestive problems, and problems related to diet (which in this country could be a LOT of related problems). Pharmacists in parts of Europe do often act as primary care for ear aches, etc (at least that is my understanding). Yes, this would mean changing our laws on what these three groups above could do with regard to prescribing and dispensing medicine, but I believe it is something we should look at. Also, paramedics could be trained in greater numbers to work in clinics.

      And as you mention, the ACA is providing $500 million in funding for training. I hope it is used to train not just doctors but many of these additional types of professionals that could earn their degrees more quickly and really serve our health care needs.

      "At stake are not just the details of policy, but fundamental principles of social justice and the character of our country." ~Sen. Ted Kennedy

      by Wendy in FL on Mon Sep 03, 2012 at 06:50:06 AM PDT

      [ Parent ]

      •  Patient care is a consortium of talents (10+ / 0-)

        as you point out.  Nurse practitioners, physician assistants, physical therapists, nutritionists, massage therapists, home care aides, etc.  Patient coordinators will help fill the gap, and as suggested in the diary, address non-medical issues that affect health like access to fitness and wellness facilities, dental care, etc.

      •  Wendy,re:"Also, paramedics could be trained"... (4+ / 0-)
        Recommended by:
        VeloVixen, TexDem, 4Freedom, Onomastic

        ...  & IMHO so could paraSURGEONS.

        I personally see no good reason as to why training could
        not be devoted to uncomplicated Hernia repairs,
        amputations, Appendectomies
        etc.

        Fill the operating suites with such trained personnel, each one with training to do only a few simple operative procedures and have only one or two Board Certified highly experienced Surgeons in the operative suite on hand immediately if the simple appearing surgical procedure morphs into something more
        complicated.

        Such paraSURGEONS would take a mere fraction of the time to train then  time for
        training an MD surgeon. The
        cost for their services would
        be much  less (but quite adequate for the nature of their work of course).

        •  Our military has already trained (5+ / 0-)

          large numbers of combat medics. A friend's son is training to be a medic attached to Army Special Forces. I get occasional updates on the training he is receiving, including doing some procedures in a rapidly moving, vibrating evacuation helicopter. I don't think it would take too much more training to add a few "civilian" surgical procedures to his skills after he completes his military service.

      •  lets call them dieticians (6+ / 0-)

        In my state, nutritionists are not licensed and ANYBODY can call themselves a nutritionist. I do NOT want those people sucking off medicare dollars.

        In my support group, I see women flocking to get advice on supplements--one women is taking 35 per day. They are dupped into thinking that all that crap (unregulated, untested for safety) will prevent a recurrence of advanced cancer.

        However popular it is, it is a quasi-religious belief in "natural" Half that junk is so processed you wouldn't recognize it as related to a plant, and almost all of it is going to get peed right out of their systems.

        •  I wasn't referring to quack medicine, (4+ / 0-)
          Recommended by:
          VeloVixen, SoCalSal, TexDem, Onomastic

          but I see your point. It would certainly need to be regulated if we expanded beyond MDs, Nurse Practitioners, and PAs to delivery primary care.

          "At stake are not just the details of policy, but fundamental principles of social justice and the character of our country." ~Sen. Ted Kennedy

          by Wendy in FL on Mon Sep 03, 2012 at 09:48:21 AM PDT

          [ Parent ]

          •  no, I'm sure you weren't. I'm working on (5+ / 0-)

            a small presentation for ovarian cancer women and bumped up against the alternative med. problem.

            I am finding an INCREDIBLE bias toward alternative therapies that have NO verifiable merit. This is my ISSUE at the moment, since I'll be filling a complaint this month with the board of medical examiners.

             Naturopaths make outrageous claims to having training equivalent to MD's. Some of my friends,  educated lawyers, counselors, teachers swallow their claims whole. They take an exam after 2 years of schooling to go on to their "clinical training." The exam is two parts, one hour each of 50 question multiple choice questions. No MCAT's or any kind of admission testing. They are now offering programs in naturopathic oncology. They are working diligently at getting licensed in every state because they want those medicare bucks.

            Naturopaths (many) are part of the anti-vaccine b.s that WILL cost kids lives. The believe stuff like going to bed with ice cold wet socks will prevent ear infections.

            •  Insurance companies promote it (3+ / 0-)
              Recommended by:
              VeloVixen, Onomastic, slouchsock

              Insurance companies may prefer that patients use "alternatives" because they are way cheaper than real treatment.      

              Since a large portion of treated illnesses would get better even if they are left alone, the "alternative" provider can report a 30-50% success rate even if nothing was done.

              Religion gives men the strength to do what should not be done.

              by bobtmn on Mon Sep 03, 2012 at 12:20:22 PM PDT

              [ Parent ]

        •  Slouch (3+ / 0-)
          Recommended by:
          VeloVixen, TexDem, Onomastic

          Well said.  Any alternative stuff has to be vetted and regulated so you don't get quacks/snake oil salesmen.

          I had a tumor removed from my spine last year and it was very slow growing.  12 years earlier I did a reiki healing kind of on a lark.

          The woman asked if I had injured my back and I hadn't.

          The area she thought was injured was exactly where the tumor was.

          So I don't know much about reiki, but there is something to it.

          So perhaps it can be developed/regulated more because early detection would save a lot of lives and costs.

          "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

          by bcdelta on Mon Sep 03, 2012 at 10:40:48 AM PDT

          [ Parent ]

          •  at least, as far as I know, reikki is free (3+ / 0-)
            Recommended by:
            bcdelta, VeloVixen, Onomastic

            and its non-invasive.

            It would be interesting to find out if your MD thinks the tumore could have been 12 years old. .

            •  The Reikki (3+ / 0-)
              Recommended by:
              4Freedom, VeloVixen, Onomastic

              Actually cost about $70, but still cheap.  The doctors told me it had probably been growing for 15-20 years.

              As for mentioning it to the doctors - not a chance.  They are very into their way of doing things so I don't think mentioning it would have been well received.

              For example, the oncologist wanted to try chemo for another type of cancer as what I had was too rare to warrant pharma spending the money on a drug for it.

              I also didn't have good insurance so everything was a fight = no percentage in pissing them off.

              So my interest in the alternative is that Western medicine doesn't have a clear answer for what I have other than very risky surgery = 1/3 success rate.

              So this forces one to think about the alternative.

              "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

              by bcdelta on Mon Sep 03, 2012 at 11:49:59 AM PDT

              [ Parent ]

            •  So my thought (2+ / 0-)
              Recommended by:
              4Freedom, VeloVixen

              is if reikki detected it perhaps reikki or other could also be used to treat it.

              And for all types of cancer - in my mind it merits further exploration.

              My take though is cancer is such a cash cow that pharma, oncologists, surgeons and rad tech OEMs would block any alternative healing.

              "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

              by bcdelta on Mon Sep 03, 2012 at 11:52:29 AM PDT

              [ Parent ]

              •  If the medical profession were more inclusive, (4+ / 0-)
                Recommended by:
                bcdelta, VeloVixen, Onomastic, TexDem

                it would encompass issues like the negative effects of too much sugar and refine carbohydrates on health, and people could learn about things like ph balancing on health.

                Perhaps someday our medicine will be more like that of some European countries, where nutrients are considered as part of an overall approach to health. I know several local docs who think drugs are over-prescribed, and good dietary practices under-utilized.

                •  agreed (3+ / 0-)
                  Recommended by:
                  4Freedom, Onomastic, VeloVixen

                  And in this regard the medical business is a protected one - much like oil.

                  "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                  by bcdelta on Mon Sep 03, 2012 at 12:13:13 PM PDT

                  [ Parent ]

                  •  I would recommend reading the history (2+ / 0-)
                    Recommended by:
                    bcdelta, VeloVixen

                    of why we have regulation in this country.
                    food and drug law history

                    The medical industry is "protected" so we don't have "doctors" killing people by transplanting goat gonads. Look up John R. Brinkley.

                    •  Right (1+ / 0-)
                      Recommended by:
                      VeloVixen

                      But one could have similar regulations for alternative.

                      Not advocating quackery at all, but I think there is something to alternative/eastern medicine like reikki and other.

                      So why not study it and maybe alone or in conjunction with western medicine if can be used to heal and treat people more effectively with less side effect.

                      "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                      by bcdelta on Mon Sep 03, 2012 at 04:46:51 PM PDT

                      [ Parent ]

                      •  the National Institutes of Health has a huge dept. (2+ / 0-)
                        Recommended by:
                        bcdelta, VeloVixen

                        we do study alt therapies. We spend about $250million a year. NCCAM and OCAM.

                        Most have shown about the same benefit as placebo.

                        •  Well (1+ / 0-)
                          Recommended by:
                          VeloVixen

                          I certainly don't have the experience that you do on the matter.

                          But until western med can treat me I have to look at alternatives.

                          "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                          by bcdelta on Mon Sep 03, 2012 at 05:59:58 PM PDT

                          [ Parent ]

                      •  we should totally have similar regulations (1+ / 0-)
                        Recommended by:
                        bcdelta

                        but there is a huge vitamin/supplements industry that makes a lot of money without having to prove their products are safe, let alone effective.

                        There are also a lot of "medical libertarians" (my word) who absolutely will die protecting their right to put anything they want into their bodies and to believe any ol' damn thing anyone tells them.

                        The vitamin/supplement industry totally uses fear to manipulate the medical libertarians. See Republican party tactics.

                        •  Yes (1+ / 0-)
                          Recommended by:
                          slouchsock

                          Lot's of expensive things in holistic stores.

                          Don't take vitamins myself.

                          As for medical libertarians don't know what to say here.

                          "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                          by bcdelta on Mon Sep 03, 2012 at 06:12:26 PM PDT

                          [ Parent ]

              •  Most cancer healthcare professionals embrace (2+ / 0-)
                Recommended by:
                TexDem, bcdelta

                alternative healing methods.  They enhance and improve what the professionals are already doing.  I have worked as a cancer fitness specialist, and have seen many cancer centers that offer nutritional counseling, exercise and fitness classes, mental health counseling, financial counseling, massage therapy, etc.

                •  Never saw this (1+ / 0-)
                  Recommended by:
                  VeloVixen

                  when I went to the hospital, but good to hear that it goes on.

                  "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                  by bcdelta on Mon Sep 03, 2012 at 04:48:27 PM PDT

                  [ Parent ]

                •  how is financial counseling "alternative"? (0+ / 0-)

                  any life threatening illness is VERY stressful and very costly. I understand that we need good nutrition and exercise. Help in managing all the aspects of illness is wonderful.

                  But this has nothing to do with treatments that are based on "ancient wisdom" that were made-up in 1920.

                  Do I want medicare dollars going for financial counseling? No, I want socialized medical care, with single payer being an ok second.

            •  I'm a huge fan of alternative care, having had a (5+ / 0-)
              Recommended by:
              bcdelta, Pluto, Onomastic, VeloVixen, TexDem

              stillbirth due to medical negligence, and a near-death experience due to a prescribed-drug compromise of my immune system. I'm so convinced there is value there I now own a health food store, after careers in finance and fashion. Because of my experience with the health food store, I have personally learned how to not have allergies, asthma, migraines, colds and flu that used to plague my life.

              But I don't prescribe for others, because I don't have any degrees, and it is illegal. By FDA law, only a drug can treat, cure or prevent disease., which I think is a misuse of the law. I don't tout myself as a 'nutritionist'. What I do is make customers copies of good research - I have spent years in college in labs - and let customers inform themselves of options. And anyone presenting serious and chronic pain and inflammation should immediately go for a medical diagnosis.

              I would like to point out that alternative medicine has a much lower incidence of death than the 100,000+ iatrogenic deaths/year from drugs and docs. There is much of value to be found in learning about diet and good nutrition.

              All medicine has its place. And I have know people cured of cancer by alternative methods. I don't refute the many positives that can be achieved by conventional medicine, but deriding all alternative care as bogus is simply not valid.

              Good diary on an important topic, VeloVixen. We will need many more MDs in the future to treat our aging population. The diseases of the elderly are often advanced before diagnosis, which ends up causing patients needless pain and our medical system unneeded expense.

              There needs to be a balance between diagnosis, treatment and nutrition. We are nowhere near where we need to be on these fronts.

              •  Nice (3+ / 0-)
                Recommended by:
                4Freedom, Onomastic, VeloVixen

                I have been doing meditation and some diet stuff.  Also have greatly reduced stress.

                As for the FDA saying only pharma can cure = taking care of their customers to prevent competition to preserve their cash flows.

                Doesn't mean western med should be shunned, but as you say nor should alternatives been shunned.

                "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                by bcdelta on Mon Sep 03, 2012 at 12:32:43 PM PDT

                [ Parent ]

              •  NDE (3+ / 0-)
                Recommended by:
                4Freedom, Onomastic, VeloVixen

                Was your NDE interesting?  I've done a lot of reading on this.

                "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                by bcdelta on Mon Sep 03, 2012 at 12:41:56 PM PDT

                [ Parent ]

                •  Me too. I have had chronic bronchitis since I was (3+ / 0-)
                  Recommended by:
                  bcdelta, Onomastic, VeloVixen

                  a child. Winters used to frighten me, because I would spend so much time being sick. Since I learned about NAC, both the bronchitis and asthma have cleared. When I added mushrooms to my diet on a more regular basis, I found myself not getting sick anymore.

                  Now I figure my body is a lab and I try this and that, varying diet and supplements. As everyone is different, what applies to one physiology doesn't always work or work as well for another. That is why I think people should learn to take more responsibility for their own health, and inform themselves about diet and nutrition as adjuncts to a healthy life.

                  Old Ben Franklin's saying about an ounce of prevention being worth a pound of cure still holds true today.

          •  No relationship, IMO (2+ / 0-)
            Recommended by:
            VeloVixen, slouchsock

            I am always surprised at how people will reach out to any thread of a connection to look for a positive correlation.

            I don't believe this, but I wonder why you don't hypothesize that the reike healing might have CAUSED the cancer?  Perhaps the "energies" of some other patient who had cancer were passed on to you through the "healer"?

            I have never had a Reicke healing, and have never had cancer, so perhaps I should choose to avoid Reike healing on that basis?

            Religion gives men the strength to do what should not be done.

            by bobtmn on Mon Sep 03, 2012 at 12:15:41 PM PDT

            [ Parent ]

            •  Sure (1+ / 0-)
              Recommended by:
              VeloVixen

              anything is possible as per the reikki causing it, but I don't think that's what happened.

              I wasn't trying per say to find a correlation rather thought it was an interesting coincidence.

              And I discovered in the MNCC group that another person had been diagnosed alternatively before she was later diagnosed traditionally with cancer as well.

              So I think it needs to be looked into - not trying to sell anyone on anything nor am I trying to build a scientific case study on it either.

              And again when Western medicine provides no viable solution - what do you expect people to do?

              Lie down and wait for death?  No - you look for other solutions, which is quite logical.

              "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

              by bcdelta on Mon Sep 03, 2012 at 12:41:08 PM PDT

              [ Parent ]

            •  One correlation (1+ / 0-)
              Recommended by:
              VeloVixen

              that I do see is how pharma treats symptoms and makes a lot of money in doing so.

              Hey, don't change your diet - we have a pill so you can keep eating the wrong food and when you get sick we have a bunch of pills for your new illness.

              Side effects?  Hey we have a lot of pills for this too.

              "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

              by bcdelta on Mon Sep 03, 2012 at 12:45:10 PM PDT

              [ Parent ]

              •  In all fairness, pharma has responded to public (1+ / 0-)
                Recommended by:
                bcdelta

                demand for such pills.  We do live in a 'fix-it-now' society, and if the demand is there, someone will capitalize on it.

                •  Fair Enough (1+ / 0-)
                  Recommended by:
                  VeloVixen

                  But makes the point that medicine is all about the profit.

                  And I do not begrudge people earning profit in fact in balance it's a very good thing.

                  If a doctor prescribes a pill heavily marketed to them and on TV to patients by big pharma the prescription of which enables bad health behavior by treating the symptom and such patient gets a worse illness later on then...

                  Ethically a disservice has been done to the patient and the future illness increases HC cost more.

                  And I think this goes on all day long in our health system.

                  "And there are those who give and know not pain in giving, nor do they seek joy, nor give with mindfulness of virtue; They give as in yonder valley the myrtle breathes its fragrance into space" Khalil Gibran

                  by bcdelta on Mon Sep 03, 2012 at 04:57:25 PM PDT

                  [ Parent ]

      •  I'm a huge fan of nurse practitioners. (6+ / 0-)

        I have not seen a regular gyn dr in years, but have been well and truly taken care of by caring, smart, nps.  It makes perfect sense to me that the day to day mundane care that many people need can be provided by nurse practitioners and physician's assistants, and hopefully slightly lower the cost of healthcare in the future.

        My f-i-l tried to question the credentials of a NP who worked for his oncologist.  She cheerfully took it, explained and did her job.  Three years later, he respects her as much if not more than the oncologist who is himself a wonderful doctor.

        It will take creative solutions.  A "village" of healthcare providers, if you will.

        Was a cold and dark December when the banks became cathedrals...

        by althea in il on Mon Sep 03, 2012 at 09:50:41 AM PDT

        [ Parent ]

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