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View Diary: The Corporatocracy of Healthcare and everything else… (22 comments)

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  •  My wife's a doctor also. (2+ / 0-)
    Recommended by:
    a2nite, unfangus

    Not that this fact has any significance in this debate. Single physician practises have been declining for at least three decades. This decline is the result of the development of newer and more expensive diagnostic tools.

    Most physicians envy the person who owns a radiology lab, because the big bucks are in CT scans and MRI's. This has led to the formation of "physician groups" which form partnerships enabling them to purchase expensive equipment and reap larger reimbursement from the insurers.

    Many of thst groups even operate small hospitals. They have transformed the role of general practioners who were going out of business because the payers pay big for prodedures, but not so much for a doctor's time.

    Now Internists are recruited constantly because these phyician practises are willing to pay handsomely to doctors who geherate referrals for testing and procedures that thier group specializes in.

    This all has nothing to do with ACA. ACA is a very good concept for more fairly allocating medical care. It is hot the be all and end all, but is is a promising first step.

    Physicians in single practises are unlikely to make a comeback, as medicine has become so complex and expensive. My wifw hated being a practising physician. Sne now works on developing early stage drugs, in the hope that she can make a real contribution to people's health.

    Here's my take on it - the revolution will not be blogged, it has to be slogged. - Deoliver47

    by OIL GUY on Sun Jan 05, 2014 at 11:21:14 PM PST

    [ Parent ]

    •  If your wife is not practicing (0+ / 0-)

      she has not experienced the very real and direct effects the ACA has had on physician productivity.

      But yes, I see you do recognize that only practices large enough to afford the equipment for costly (and often unnecessary) diagnostic procedures can survive. This trend has only been enhanced by the ACA, leading to the corporatization of medicine as large systems swallow smaller, less economic (due to regulatory burdens including reimbursement rates) practices.

      •  How hS ACA impacted (0+ / 0-)

        physician productivity?

        I don't really see the connection. Physicians are still dealing with the same set of payers (ie. insurance companies) that they did prior to ACA.

        ACA imposes some new rules on payers, and it will mandate electronic medical records, but these changes should benefit most physicians.

        Here's my take on it - the revolution will not be blogged, it has to be slogged. - Deoliver47

        by OIL GUY on Mon Jan 06, 2014 at 08:46:58 AM PST

        [ Parent ]

        •  As I said before, (0+ / 0-)

          required physician entry of orders alone is reducing physician productivity by about 30% in the hospital where my wife works. You have to find a computer, sit down, open the patient's electronic medical record, and type in the orders rather than just dictating it as you walk to the next patient's room.

          Data entry is something that should be done by less highly trained (cheaper) labor than a physician. And there is already a physician shortage in this country. Adding physician order entry, on top of EMRs to begin with, is seriously aggravating this problem. Should doctors be doing secretarial work, or treating patients?

          •  Many doctors carry a handheld device (0+ / 0-)

            Such devices can be integrated into larger systems.

            •  Sure, you can type it on an i-phone and send it (0+ / 0-)

              but you still have to sit down and do it. My wife saw over thirty patients yesterday. Even if it only takes five minutes to sit down and type in your orders on your i-phone, that is still two and a half extra hours of work.

              •  The Hospital I use and (0+ / 0-)

                the related physician practice group have a terminal in every exam room. the physicians assitant or intern - whoever sees you first - pulls up your chart.

                This actually saves time as it speed s the process of  confirming  your list of current meds and recent medical history. My physicians generally type in orders while we talk, which alos enables them to quicklu review them with me at the end of the visit. Physicains are also less reliant on getting accurate information from patients, as they can see other doctors orders in my chart.

                Here's my take on it - the revolution will not be blogged, it has to be slogged. - Deoliver47

                by OIL GUY on Thu Jan 09, 2014 at 12:34:51 PM PST

                [ Parent ]

      •  The family of one dead prisoner (0+ / 0-)

        sued the county to my north because the jail doctor didn't detect the bone tumor in his shoulder in time.

        The doctor would have needed imaging to detect the tumor earlier when all the evidence the doctor knew was the patient's complaint of pain.

      •  In my book of musculoskeletal imaging (0+ / 0-)

        there is one page that shows an x-ray that fails to show a fracture but an MRI image that does.

        The best possible care often costs more.

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