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View Diary: Perspective On Health Care Reform (166 comments)

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  •  Many docs are coming around. (2+ / 0-)
    Recommended by:
    stitchmd, ER Doc

    I represent doctors before the medical board and know many of them.  Many docs are changing their views on government sponsored health care.  They are changing because private insurers have bargained down the fees to very low levels.  As the insurers squeeze the docs to take less and less, more of the docs I know are leaning toward single payer government reimbursement.  We just need to shove them a little bit, and they will get in line, too.

    Stay angry at injustice.

    by Misanthrope2 on Fri Jan 25, 2008 at 11:49:02 AM PST

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    •  I've been reading way too many articles (3+ / 0-)
      Recommended by:
      DemFromCT, ER Doc, Misanthrope2

      about the crisis in primary care, about the dearth of internal medicine applicants (my specialty) and about the coming doctor shortage - largely driven by the 1997 Balanced Budget Act, which also set in place the "mandatory" cuts in Medicare that we get 'rescued' from every year.

      When the system pays better for someone to get an amputation than it does for them to go to the podiatrist in the first place, this is what the system has led us to.

      The docs you mention tend to be us 'generalists,' IM, Family Practice, Peds, and even general surgeons. However, find me an orthopedist who agrees to single payor healthcare and I'll kiss your feet.

      Civil marriage is a civil right.

      by stitchmd on Fri Jan 25, 2008 at 01:10:45 PM PST

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      •  Quite so! (2+ / 0-)
        Recommended by:
        stitchmd, Misanthrope2

        The proceduralists making half a million per year and up like to complain about insurance companies, but when their rates are cut by 10%, they can just add another knee replacent to their schedule before that 3:00 pm tee-time and all is well. For us primary care docs, we're already maxed out working 80 hours a week seeing 30 - 35 patients a day and getting (if we're lucky) $60 per visit, to manage 78 year old diabetic patients on dialysis with 18 presciptions to refill, trying to pay our nurse and keep the lights on. When our rates get cut 10%, there's just no way we can work any harder to make up the difference. Not if we want to treat our patients right.

        •  A family practice doc tells me (0+ / 0-)

          that with increasing copays, patients are saving up two or three conditions per visit, so it is taking longer to diagnose and treat them.  Thus, visits are becoming longer.  In the LA/OC area, my friends are seeing 20-25 patients a day in private practice.  I don't think you can see more and do a good job, particularly with things like diabetes management and multiple prescriptions.  But blue cross and blue shield are beating down the rates so far that the pay is getting near medicare rates.  I just saw a chemotherapy bill of $5,000. written down to about $700., as an example.  And that includes medications.  You working guys probably know the details better than I do, since my concern is quality of care, not income.

          Stay angry at injustice.

          by Misanthrope2 on Fri Jan 25, 2008 at 08:06:29 PM PST

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      •  So very true. (1+ / 0-)
        Recommended by:
        stitchmd

        Yes, that is my experience, too.  Docs driven by the dollar to go through the fellowships to become orthopods, or pretty much any surgery specialty, are mostly about the dollar.  Or maybe it is a personality thing, since many of the surgeons I know are kind of distant, non-empathetic, estranged types, while IMs and family practice docs tend to be the opposite. I have a gas passer friend now on the executive board of a great OC hospital, and his view is changing with the administrative role.  Just my opinion and I am sure your mileage may vary.  Thanks for your comment.

        Stay angry at injustice.

        by Misanthrope2 on Fri Jan 25, 2008 at 08:01:07 PM PST

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        •  I agree with you (0+ / 0-)

          as far as personalities in medicine are concerned, I think it works both ways: the fields tend to attract certain types of people, whether it's a money thing or something else (I had a pathology professor who said he went into that field because he couldn't deal with "non-compliant patients") and then the training seems to reinforce it. I interviewed a medical student for a preliminary spot in IM the other day; he's going into radiology but wants to do clinical, when he really should be doing research; he had no interpersonal skills, not only during his interview but throughout the transcript. Great scores, though, and should really go into research. Hopefully he'll find that calling.

          OTOH, we had a medical student who went to an offshore school; had some trouble in pre-med courses. He went on to get an MBA and an MHA, yet decided to go to medical school even through the non-traditional route. And he was just flat-out excellent in his clinical rotations and will be a fantastic primary care doc, which is his true calling, despite the fact that he could make boodles of money in administration.

          That is, he'll be a great doc if he can get past the prejudice against offshore grads.

          Civil marriage is a civil right.

          by stitchmd on Sat Jan 26, 2008 at 07:33:06 AM PST

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