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View Diary: Doctors exposed as complicit with Big Pharma fraud (21 comments)

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  •  Not really true. (4+ / 0-)
    Recommended by:
    cotterperson, BlueGoo, drchelo, Pinecone

    It's not the AMA. The Association of American Medical Colleges has essentially nothing to do with the AMA. The physician supply has more to do with the willingness of states and health insurers to subsidize the (very expensive) education of medical students, and especially the grotesque mal-distribution of physicians among specialties.

    The truth is that America has enough doctors already. We do! We have more per-capita than most European nations. The problem is that we have far, far more subspecialists, surgeons and proceduralists than we rationally need, and far, far too few family physicians and general internists. This disparity has been cemented in place by gross underpayment of primary care docs, and gross overpayment of thoracic surgeons and radiologists.

    The paradoxical result is that we have a dwindling force of grossly overworked primary care docs getting paid peanuts, and mushrooming ranks of procedural specialists chasing the well-insured and inventing new procedures to keep themselves busy and well-paid. This grotesque distortion of the physician workforce creates the illusion of a shortage.

    •  Well, no offense, but you guys have to figure out (1+ / 0-)
      Recommended by:
      cotterperson

      ... a way to change this if you don't like any of our layperson's suggestions. Because the "system" cannot continue to function like this.

      While we're on the topic of medications, somebody needs to get real motor- vated to start figuring out how to pressure the FDA into forcing pharmaceutical companies to be more careful with their ingredients, because the Chinese are now supplying so much of our binders and fillings and raw ingredients but are not being real careful about what really is IN them.  It is only a matter of time before we have an even bigger problem than tainted heparin killing a few heart/dialysis patients and sickening hundreds more.

      There is a huge problem going on right now with mystery ingredients in otc and prescribed drugs, such as the major allergens not being called out on the labels.  When the companies are contacted, there is then a lot of CYA vague statements about how they can't confirm or deny what was used in that batch. Or the batches switch from lot to lot, and what was corn sourced last time could now be from wheat or rice or who knows what.  This may not be a big deal to most people, but if you have allergies or intolerances it is a HUGE deal, esp. if the pharmacy you are using wants you to confirm the status yourself because they cannot get an answer.  If a pill has white powder filler in it, should we not be able to expect to know what it is ?

    •  I can't find a link, so you must be right. (0+ / 0-)

      I know the rest of what you say is true. Sorry for passing bad information.

      I watched the super-subspecialization of internal medicine happen, and saw surgeons, internists, and pediatricians compete for position in the then-new  subspecialty of critical care. The reimbursement in that area is great for hospitals and physicians as well.

      Money shouldn't be deciding these things, imho.

      Thank you for the thoughtful, knowledgeable response.

      "This chamber reeks of blood." -- Sen George McGovern, 1970

      by cotterperson on Fri Mar 07, 2008 at 08:03:20 PM PST

      [ Parent ]

      •  Sadly, money always decides these things. (3+ / 0-)
        Recommended by:
        cotterperson, BlueGoo, drchelo

        The average medical student graduating today carries (depends on the study) between $100,000 and $150,000 in educational debt. Thanks to BushCo's absurd "free market" ideology, programs for loan forgiveness and subsidies like the National Health Service Corps have been obliterated. Interest begins compounding while students are still in school. Most doctors are about 30 years old by the time they finish residency training and start their careers; many if not most are married and already have a few kids. Consequently the pressure to earn a lot of money quickly is overwhelming, and the vast majority feel compelled to choose a subspecialty that pays very well. This problem is greatly exacerbated by the "culture" of academic medical centers, which exalts the God-like procedural subspecialist and treats primary care doctors like slightly retarded door-mats. I shit you not, the withering contempt directed toward primary care by the "gurus" is mind-boggling.

        So until we start paying primary care docs a bit more, and interventional radiologists a hell of a lot less, this crisis will only deepen.

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