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You know the scenario all too well.  You show up for your doctor's appointment on time, and if you were smart, you scheduled it for either 8:00am or 1:00pm, hoping for less wait time.  But as the sign at the check-in counter suggests, after 30 minutes you step up to the desk to remind the receptionist that you are still waiting.  According to Merritt-Hawkins and Associates, a consulting firm that specializes in recruiting physicians, since 2004 the wait time to get an appointment has increased by more than a week to 20.5 days. In Boston, it takes 49.6 days on average to see a doctor; in Atlanta it takes 11.2. In 2011, the The NY Times reports an average wait of 23 minutes to see the doctor, with neurosurgeons having the longest wait times (30 minutes) and optometrists the shortest (17 minutes).

The Patient Protection and Affordable Care Act will expand health insurance coverage and access to an estimated 32 million United States citizens by 2014.  Expanded coverage is predicted to increase the number of annual primary care visits between 15.07 million and 24.26 million by 2019. This means that between 4,307 and 6,940 additional primary care physicians will be needed to accommodate this increase.  But right now, in the U.S., according to the American Medical Association, we have a shortage of 15,230 doctors, which is expected to grow to an astonishing 63,000 by 2015.  Those figures do not take into consideration the effects of the ACA.

The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP).  The AAFP predicts a shortage of 40,000 family physicians by 2020, when demand is expected to spike due to the increase of baby boomers who will reach the age of 65 and require increased medical care.  

drsbyspecialty

It takes 10 - 15 years to train a doctor, at an annual cost of $50K per year.  The average debt for a doctor coming out of medical school is $162K.  While orthopedists and radiologists typically make $315K per year, the average starting salary for a primary care doctor is $170,000, with , minus $2100 per month for 10 years to pay off student loans.

Longer days, lower pay, less prestige and more administrative headaches have turned doctors away in droves from family medicine. Internists provide a large portion of care for older and chronically ill patients, who require more time, paperwork, and followup than other patients.  In 2012, 9.2 minutes of every 15 minute visit are spent addressing the patients' resource needs, like care at home, transportation to the doctor's office, and money for prescriptions.  

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With the expected increase of primary care visits due to the aging baby boomer population and the addition of 47 million newly insured thanks to the Affordable Care Act, primary care physician demand will sharply escalate.  Although the primary care doctor has been the gatekeeper in keeping people out of emergency rooms and controlling health care costs, finding a doctor will become increasingly difficult and more people will turn to crowded emergency rooms for their care.  Between 1990 and 2009, 27% of emergency rooms in metropolitan areas closed. (Note: my daughter's medical school class at Emory University lobbied the Georgia state legislature to keep Grady Hospital in Atlanta from closing due to bankruptcy in 2008.)  The lack of ER availability (which isn't a good solution for primary care needs), coupled with the shortage of doctors means less quality care for many Americans, especially those in poor urban and rural areas.

What is being done to address the shortage of doctors and the increase in need for patient care?  Hospital administrators and ER physicians are acutely aware of the coming scarcity, and have taken measures to add non-urgent care clinics to their departments and more physician assistants and nurse practitioners, some of whom can dispense certain prescriptions and recommend specialists, to their staff.   Medical schools are looking at providing more 'cognitive' specialties by adding residencies in gerontology and geriatrics.  (My son is a first-year resident in Geriatrics at the University of Virginia).

There is also much that Congress can do to address the doctor shortage.  Rep. Allyson Schwartz (D-Penn.) and Rep. Aaron Schock (R-Ill.) are co-sponsoring legislation that would eliminate the 1997 Balanced Budget Act residency cap, a cap that limits the amount Medicare can contribute to residency programs.  “It is an expense that is necessary,” Schwartz said in an interview. “We’ve seen an increase in the number of doctors that medical schools are training in this country. There’s not an adequate number of residencies to handle that increase.”
 

The Affordable Care Act Prevention and Public Health Fund allocates $500 million dollars to support the training and development of primary care professionals who frequently deliver preventive services to patients, and supports training of public health providers to advance preventive medicine, health promotion and disease prevention, and improve the access and quality of health services in medically under-served communities.  This is a start in the long journey to bringing healthcare in America to a standard that is acceptable for all.

[A Note From The Diarist: As the ex-wife of a doctor, and the mother of two doctors, I have spent over 30 years supporting their training and practice; financially, physically, and emotionally.  I worked as a programmer while supporting my ex-husband through medical school and residency, spending many lonely hours raising my three kids as though I were a single mom, and now I spend many hours counseling my son and daughter, who are in their residencies, through their ups and downs.  I have participated in the private, emotional, and often scary part of becoming a doctor that most people never see: countless hours of studying and tests, peer pressure, the constant questioning of performance, the self-doubt and worry over patients, sleepless days and nights, interrupted meals, and the ever-present question:  will I make it to the next step?  Medicine is one of the few careers where you can invest years and years of training, only to be told you didn't make it to the next level.  I have watched two generations of doctors grow and change, and with it the changes in medical practice and doctors' quality of life.]

Originally posted to VeloVixen on Mon Sep 03, 2012 at 05:30 AM PDT.

Also republished by ClassWarfare Newsletter: WallStreet VS Working Class Global Occupy movement and Mojo Friday.

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Comment Preferences

  •  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 ]

  •  Another huge burden: malpractice insurance. (11+ / 0-)

    OBY/GYN insurance runs over $200k in parts of NYS. Between malpractice insurance and anemic payouts from insurance cos for service, doctors are forced into large practices where facetime with patients is extremely limited and those taking on new "clients" is increasingly harder to find.
    Thanks for this diary. Very important.

    Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. -Martin Luther

    by the fan man on Mon Sep 03, 2012 at 05:50:46 AM PDT

    •  Malpractice insurance has put some docs out of (10+ / 0-)

      business.  I know several OB/GYN's and a hand specialist who couldn't afford it, and left their practices.  Thank you for making the point!

      •  And As We've Seen Since the 60's, the Cost of (27+ / 0-)

        insurance for any particular issue does not necessarily reflect the overall cost of what it's protecting you from.

        Like health insurance, medical malpractice insurance should be government single-payer or well regulated not for profit private insurance.

        We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

        by Gooserock on Mon Sep 03, 2012 at 05:59:20 AM PDT

        [ Parent ]

        •  Amen to that (9+ / 0-)
          Like health insurance, medical malpractice insurance should be government single-payer or well regulated not for profit private insurance.
        •  Don't expect such insurance w/o tradeoffs. (4+ / 0-)
          Recommended by:
          VeloVixen, FG, TexDem, peregrine kate

          Caps on p&s will more than likely be part of that mix, as it is in other countries.

          Tort reform gives us hives because we know, in absence of any other mandate, money will shift from plaintiffs to shareholders w/o much benefit to the medical community or society at large. It isn't all industry profit that is at stake here. There is a sizable medical cost burden from unnecessary testing and procedures done to stave off claims.

          Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. -Martin Luther

          by the fan man on Mon Sep 03, 2012 at 07:21:38 AM PDT

          [ Parent ]

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

          Has to be cut back as well.  Way too much frivolous suing.

          "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 08:09:29 AM PDT

          [ Parent ]

          •  its a biased group (9+ / 0-)

            but some of the studies and statistics can be traced back to more neutral sources.

            Too many frivolous suits is a right wing talking point.  A major pillar of any right wing republican stance on medical costs, tort control.  Medical malpractice suits are rare, face significant procedural barriers in many states to even make it to a complaint stage.  

            http://www.justice.org/...

            •  I wasn't referring to (2+ / 0-)
              Recommended by:
              flitedocnm, VeloVixen

              a given study rather as people have noted some OBGYNs pay $200k per annum in med malpractice.

              This increases costs.  So it needs to be addressed along with pharma, insurance and fraud.

              Germany has half the cost per capita of the US for medical - we can get there - just have to cut the waste.

              "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 09:12:50 AM PDT

              [ Parent ]

              •  Germany doesn't have (3+ / 0-)
                Recommended by:
                cocinero, peregrine kate, SoCalSal

                half the cost because of 'waste'.  Waste is another right wing word.   It has less cost because it mandates coverages, negotiates prices, and its a government managed system.  Basically all of Europe and the other more advanced industrial nations have managed health care of one form or another, socialized if you want the right wing word, that provide better coverage, by and large better outcomes  at less cost of total GDP.  Romney made a fool of himself praising the Israelis for their low ratio of health care to GDP, because they also have a managed system instead of a private system.

                Some OBGYN's when I lived in Chicago thirty years ago were also still making $500k a year after paying their insurance. Now I live in a small town in a red state, and the doctors still aren't going broke.  The family practitioners were the ones who only made around a $100k a year, emergency room physicians, direct employees of the big hospitals tend not to do as well as the private practioners here.  And its a popular area for doctors, outside the big city, near the mountains, a regional medical center.   There have been problems for doctors, but  they are caused way more by their insurers and the overhead imposed by the reporting requirements, insane distinctions over treatment codes that result in denial of benefits, than by patients suing them.

                You made a claim about malpractice suits, which is pretty demonstrably untrue and part of right wing talking points.  Then you jump to expense as a ratio of GDP and waste, again based on a fallacy and right wing talking point.

                The profit margin and market distortion of the system because of private insurance and regulatory insanity in favor of administrators/over testing/insurance profits and money not spent on patient care, is what is killing the US.  Single payer, government managed care has proven itself around the world.  We just can't have it here because of right wing nut jobs and profiteers.  

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

                  When suing increases costs unnecessarily it makes care more expensive so it has to be addressed.

                  Insurance should be non-profit like it used to be.

                  When pharma blocks competition from alternative and along with doctors they treat symptoms rather than work on curing the cause....

                  This is all waste, profiteering, etc.

                  Now that ACA is passed the tough work needs to be done to make it actually work.

                  So you have to go after "waste" in the 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 10:04:16 AM PDT

                  [ Parent ]

                  •  but suing isn't increasing costs (3+ / 0-)
                    Recommended by:
                    VeloVixen, peregrine kate, slouchsock

                    that, as I have pointed out repeatedly, is almost neglible in its number of occurences and neglible to the total costs.  Its is all built on lies,  repeating lies doesn't make them true.

                    Now that you have defined waste to be profit taking without return of value, then yes,  there is waste in the system.

                    Just because something is non-profit doesn't make it non-wasteful,  just because you don't pay money out to investors doesn't mean someone isn't pocketing a ton of money that could go to patient care, ie, the executives, administrative bureaucracies, etc. that stand between patients and actual health care providers, will take a split whether profit of non-profit.

                    The ACA attempts to control that split and put the money back into patient care.

                    Pharmaceuticals do need to be negotiated, but that isn't what you originally said,  you talked about frivolous suits.

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

                      All areas of medicine to be more efficient so care for everyone becomes a reality - pharma, suing, insurance, tech, edu costs, fraud, more efficient records/communication, etc.

                      And we're at odds on suing, but if it costs $200k for an OBGYN to pay malpractice then prices have to go up.

                      To the extent that OBGYNs are still making a ton of cash then that's another issue.

                      "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 10:17:08 AM PDT

                      [ Parent ]

                    •  Ezra Klein has a great perspective about effects (4+ / 0-)
                      Recommended by:
                      peregrine kate, SoCalSal, TexDem, jfromga

                      of malpractice lawsuits.The direct costs of malpractice lawsuits — jury awards, settlements and the like are a minuscule part of health spending:  the AMA and the trial lawyers’ association — say $60 billion a year, or about 3 percent of overall medical spending is a good estimate.  Only a small percentage of medmal cases are actually reported and litigated.

                      The problem isn't in courtrooms so much as on the operating table. But because it's doctors who are angry about malpractice suits, most of the fixes are from their perspective. What we need is malpractice reform from the patient's perspective. That wouldn't be the system we have now, or mere caps on damages: It would be serious work, much more costly, and investment in better practices.

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

                        the cost of defensive medicine due to fear of lawsuits - is this included in Klein's #s?

                        "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 10:43:23 AM PDT

                        [ Parent ]

                        •  Doctors supposedly practice "defensive medicine" (3+ / 0-)
                          Recommended by:
                          bcdelta, VeloVixen, jfromga

                          because they are afraid of lawsuits.  But they are afraid of lawsuits because the insurance industry told them to be afraid.

                          At the root of it, doctors aren't really afraid of the lawsuits, they're afraid of their malpractice insurance premium going up.  

                          Frivolity is in the eye of the beholder, or, as my father used to say, "It all depends on whose ox is gored."  It's really very difficult for a truly meritless lawsuit to get anywhere.  

                          The "problem" -- if there actually is one -- is that the insurance companies encourage these so-called "frivolous lawsuits."  It's a much better business model to settle suits and raise premiums then it is to actually use the tools that already exist in the U.S. legal system to deal with meritless litigation.  

                          The insurance industry's sole purpose is to increase its revenues, not to lower medical costs.

                          We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

                          by NoMoJoe on Mon Sep 03, 2012 at 11:00:28 AM PDT

                          [ Parent ]

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

                            collusion between legal and insurance.  Nicely made point.

                            "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 11:04:07 AM PDT

                            [ Parent ]

                          •  In NYS, I'd beg to differ, certainly surgeons and (1+ / 0-)
                            Recommended by:
                            VeloVixen

                            OBY/GYN practitioners. I'd love to believe it's insurance companies making them afraid, but it's more likely the pregnant mother who threatens her physician with a lawsuit "if something's wrong with her baby". Certainly most patients aren't like this woman, the problem is too many are. (I happened to be in a room when she took an urgent call from a patient.) We're also seeing OBY/GYNs refuse to take on obese patients for liability reasons.

                            As far as insurance companies and payouts vs changing the medical system, sounds far too much like municipalities payout for trip and falls rather than fixing all sidewalks pre-emptively.

                            Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. -Martin Luther

                            by the fan man on Mon Sep 03, 2012 at 01:05:39 PM PDT

                            [ Parent ]

                      •  and the cost actually paid out in suits (1+ / 0-)
                        Recommended by:
                        VeloVixen

                        can be high, but generally don't come close to what it really costs to a person's life if a permanent injury has been done or death of a parent with children is the result, etc.

                        It is hard to find a doctor who is an expert in the medical area being challenged by the patient,  to sign the expert affidavit required prior to filing suit down here.  There are few frivilous claims.  We already have tort reform that caps claims.   It just isn't saving money as they said it would on premiums, etc.

                        It really is a scare tactic by the insurance companies.

                        •  Is that in Texas? (2+ / 0-)
                          Recommended by:
                          VeloVixen, jfromga

                          There was an article about the tort reform in Texas--I wish I could remember where--that says that claims are way down, awards are way down, but insurance premiums haven't budged. More manna for the insurance companies.

                          I also read that something like 83% of all claims in TX are against something like 11% of doctors. And it's worse, the more you narrow it--45% of claims to 5% of doctors, or something similar (this is from memory!)  But TX won't take their damn licenses away. "Ambulance chasing-lawyers", another right-wing meme, are NOT the problem. Insurance vultures and a minority of bad doctors are.

                          "Maybe: it's a vicious little word that could slay me"--Sara Bareilles

                          by ChurchofBruce on Mon Sep 03, 2012 at 01:35:22 PM PDT

                          [ Parent ]

          •  the frivolous suing (1+ / 0-)
            Recommended by:
            VeloVixen

            is corporations who plug up courts suing other corporations over obscure and minuscule infractions.

            If we allow them to cap p&s, it is those who were truly wronged who will suffer.

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

              I still don't like ambulance chasing lawyers; however, there are many legitimate cases of malpractice.

              I don't understand why people are so pro parasitical ambulance chasers on a progressive blog.

              "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 10:31:26 AM PDT

              [ Parent ]

    •  compounded by proposed conservative "cure" (6+ / 0-)

      Unfortunately Ryan-esque conservatives love to use this as an opening to appeal to physician voters. Conservatives propose tort "reform" (which has the usual meaning of "reform" in conservative code) to make things easier for business and worse for patients.

      As Gooserock comments above, pooled single-payer malpractice insurance would be better. Removing the profits-over-patients element from our health system would be an even better long term improvement, of course.

      Cheers

    •  NPR did an entire hour (3+ / 0-)
      Recommended by:
      HeyMikey, VeloVixen, ChurchofBruce

      on this subject a few weeks ago with a diverse panel and not once did malpractice insurance enter the discussion. Not once. However the pay for procedure system dominated the discussion, and ACA is trying to reshape the pay system.

      No Jesus, Know Peace

      by plok on Mon Sep 03, 2012 at 10:45:31 AM PDT

      [ Parent ]

  •  thanks! (10+ / 0-)

    pediatrics is popular because of the love of the job.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Mon Sep 03, 2012 at 05:53:15 AM PDT

  •  One of my favorite doctors at our military (15+ / 0-)

    hospital will be leaving soon. I will miss her dearly but I am sure part of the motivation for leaving is that she can earn so much more money in the civilian world. The military helped her gain her expertise in Neurology and she has served her time to pay them back. No hard feelings there but I do wonder if we can't find a way to train more doctors and put them to work, like military doctors, but in a civilian setting. My dentist actually came up with the idea of a CCC but for medial projects rather than infrastructure. I've been wondering about similar concepts ever since.

  •  I think the family doctor of the future (12+ / 0-)

    will be a nurse.  MDs will continue to migrate toward high-tech and specialty care and advanced practice nurses and PAs will take care of most of our primary care needs.  Just my opinion.

  •  Arrangement with Cuba? (5+ / 0-)

    If we could sell cars to Cuba and import some of their doctors we would do well...

    www.tapestryofbronze.com

    by chloris creator on Mon Sep 03, 2012 at 06:06:08 AM PDT

  •  Hey, girl. What about nurse practitioners? (16+ / 0-)

    Saw the Melissa Perry segment about the shortage of primary care MD's on Sunday.  Thought it was great but how about a segment on nursing and the shortage of both RN's and NPs?  I am an NP and am not sure if this segment, in the 21st century, still represents the old boy idea that only MD's (medical deities)can only provide health care when in fact, care is being delivered by RN's and NP's in the primary care setting and beyond in both a competent and meaningful way.  Hate to call this sexist but , hey girl it is.  I still get the old, couldn't you get into med school instead of becoming just an NP from people.

    So hey, girl what about nurse practitioners?  We do the same work, shoulder the same responsibility but get paid a lot less for the same kinda of work in primary care. Don't leave us out because while there is a shortage of doctors there is an even more critical shortage of nurses who make up the largest segment of health care providers in the U.S.

    •  See the excellent piece BoiseBlue referenced by (8+ / 0-)

      NPR above.  I completely agree that nurses provide the lion's share of care for the sick;  both of my kids would tell you that in a heartbeat.  In Melissa's piece, and in this diary, I mentioned that more NP's are being added to support the added demand on FP docs.  And yes, a separate or followup diary can be done on the nursing shortage.

      This is not intended to be sexist; there are more women in medical schools today than men, and less men in nursing programs.  Anyone who asks you the old question about going to med school instead of being an NP is ignorant.  They obviously have no clue what it takes to become a nurse, so take their comments for what they are worth:  very little.

    •  What the ACA Does: (7+ / 0-)
      Increasing the number of nurse practitioners trained: $30 million will train an additional 600 nurse practitioners, including providing incentives for part-time students to become full-time and complete their education sooner. Nurse practitioners provide comprehensive primary care

      Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

      by delphine on Mon Sep 03, 2012 at 07:37:04 AM PDT

      [ Parent ]

      •  I'm not at all sure this is nearly enough nurse (3+ / 0-)

        practitioners for our significantly expanding elderly population. It might be better than nothing, but 600 more NP's for and ENTIRE NATION per year? This in reality scares me. If someone has a clarification for my understanding I'm surely ready.

        •  The government (2+ / 0-)
          Recommended by:
          VeloVixen, Mr Robert

          can't do everything.

          The government isn't responsible for creating every single NP job.

          We have people becoming NPs and PAs even though the government didn't pay to train them.  Presumably that would continue, so 600 is only the supplemental number added each year.

          How many are added each year without government assistance?

          The ACA also kicks in money for health clinics to be run by NPs, and also serve to train NPs.

          And another word:  Really?

          Obama is supposed to pull a perfect health care system out of his ass?  Before the ACA, we had NO additional government support for training of NPs.  

          If the worse thing that happens is you have to wait for an appointment (in contrast with foregoing treatment at all because you don't have insurance), I count that as a win.  

          No bill can address every issue with the ideal, maximum focus.  Sure, ideally, in a perfect world where there is an endless amount of money and no blue dog dems, the bill would be as costly as necessary to cover all of these issues.

          What if training 1000's of NPs meant there were no tax credits for students who choose to focus on primary care in underserved areas?

          Perfection=enemy of the good.  

          By all means, let's be pessimistic instead of celebrating progress.  

          I hope the convention speeches celebrate progress at every turn, every opportunity to say

          CHANGE HAPPENED
          without the oh noes republicans will criticize our optimism "it's not as good as it should be".

           I'm not saying you don't have a point.  There is a shortage in primary care.

          But I'm hearing at phone banks that people are disappointed in the President because he hasn't fixed everything like magic.  Why hasn't he created jobs for everyone, fixed the housing crisis, instantly restaffed every hospital and doctor's office?

          Abracadabra! :)

          I think it's time we celebrate what the ACA does, and if that were the only thing this President has done, it would be a big fucking deal.

          Only it's not the only thing.

          Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

          by delphine on Mon Sep 03, 2012 at 10:29:58 AM PDT

          [ Parent ]

    •  And also: (6+ / 0-)
      Establishing new nurse practitioner-led clinics: $15 million for the operation of 10 nurse-managed health clinics which assist in the training of nurse practitioners. These clinics are staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.

      Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

      by delphine on Mon Sep 03, 2012 at 07:38:08 AM PDT

      [ Parent ]

    •  Agree 100% (3+ / 0-)
      Recommended by:
      VeloVixen, ER Doc, ekyprogressive

      "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 08:15:15 AM PDT

      [ Parent ]

    •  The joke is on the sexists (4+ / 0-)

      as females passed 50% of the med school population years ago. I have the utmost respect for nurses, yet it's kind of annoying when I'm wearing my white coat and people assume I'm a nurse. Likewise, I have an African American friend who's an R.N. and patients ignore her in favor of white colleagues.

      The founding fathers knew of the mutually corrupting influences of Church and state, wisely sending them to opposite corners.

      by emidesu on Mon Sep 03, 2012 at 09:13:41 AM PDT

      [ Parent ]

    •  Excellent point. (1+ / 0-)
      Recommended by:
      VeloVixen

      The number of advanced practice Registered nurses with similar scopes of practice has grown in this nation, and will continue to do so and help fill these gaps. This is part of why I am in a FNP program right now, because there is a shortage of primary care providers in my area.

    •  my GYN is actually the NP (1+ / 0-)
      Recommended by:
      VeloVixen

      I have never, ever, see the MD, even though the bills show his name. She's IS my doctor, whether the credentials are on the wall or not.

      Tangent...my mom was a CNA at an elderly care facility back in the 90s. She got paid 6.00 an hour to work 12 hour shifts 7p-7a. (minimum wage I think was $5.15 then) Of course a CNA does not have the training of an LPN or RN, but that wage was a joke.

      "Watch what you say or they'll be calling you a radical, a liberal, fanatical, criminal..."-7.75, -5.54

      by solesse413 on Mon Sep 03, 2012 at 11:47:32 AM PDT

      [ Parent ]

  •  Would not a change in the reimbursement rates (8+ / 0-)

    for primary care practitioners help get more doctors to choose primary care as opposed to a specialty?

    While I have no opposition to the government funding residency programs, I do not like the fact that it comes from Medicare funds unless those doctors either go into geriatrics or somehow treat a significant number of Medicare patients. Those funds should come from the general funds, IMO.

    As you said, an increase in Nurse Practitioners would go a long way in solving the problem at a significantly lower cost in time and money.

    Also, a change from the model of a single doctor or a partnership of a few doctors to a model of a corporation of doctors with longer office hours and a salary might be helpful. While the gut reaction of most of us to the corporate model is probably "ugh," Atal Gawande had a very interesting article in a recent New Yorker about how hospitals could learn from Cheesecake Factory and about innovations in the industry that sound very exciting if they were expanded. And corporations don't have to be huge multinationals; just like grocery store corporations such as Kroger can provide better food choices at better prices than a mom and pop grocery and can do it with good pay for employees (Kroger is a union shop), medical corporations can provide economy of scale for billing, insurance, etc. and thus work for the benefit of  doctors, nurses, and patients.

    You can't scare me, I'm sticking to the Union - Woody Guthrie

    by sewaneepat on Mon Sep 03, 2012 at 06:20:28 AM PDT

    •  Many doctors already work for a corporation; (6+ / 0-)

      it's called a hospital.  So-called 'not-for-profit' hospitals are sucking up doctors' practices in exchange for regular hours, guaranteed salary pay, little or no call.  Their incentive?  Control (and profits) from medical equipment, like CT scanners and MRI machines, for which you pay a 'royalty' every time you have one.  Medicine, whether we like it or not, is a business, and a profitable one at that.

      •  You are right, of course. But it doesn't have to (4+ / 0-)

        be that way. Years ago, my daughter was a patient at St. Jude, where the doctors were all salaried and it was truly a not-for-profit hospital. It is a damned shame that there are not more St. Jude's in this world. Or more Danny Thomases.

        But the New Yorker article gave me hope for better healthcare. Gawande works for Brigham and Women's Hospital in Boston.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Mon Sep 03, 2012 at 07:47:09 AM PDT

        [ Parent ]

    •  There are ways (7+ / 0-)

      Yes, increase Medicare and Medicaid payments to primary care providers.  Also forgive medical school debt for providers who go into certain needed medical disciplines (including primary care) and certain need geographic regions.  It takes money, and that takes the will of the people and the will of those who own our congress.

    •  What the ACA does: (8+ / 0-)
      Building primary care capacity through Medicare and Medicaid: Currently, there are unused Medicare-funded resident training slots. The Affordable Care Act reallocates Medicare resources to primary care residencies in underserved areas of the country. Teaching hospitals benefiting from the additional slots must ensure that the number of primary care residents is not reduced and at least 75 percent of the slots received must be in primary care or general surgery for at least five years. Medicare will provide a 10 percent bonus payment for primary care provided by qualified physicians from 2011-2015. In addition, Medicaid payment rates to primary care physicians will be increased in 2013 and 2014 to at least 100 percent of associated Medicare rates.  Emphasizing the critical importance of primary care by providing financial incentives will build capacity in underserved areas.

      Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

      by delphine on Mon Sep 03, 2012 at 07:43:51 AM PDT

      [ Parent ]

    •  Almost all doctors treat a significant (1+ / 0-)
      Recommended by:
      VeloVixen

      number of medicare patients- if they didn't use such a large portion of our health resources we wouldn't need medicare, right?
      Sorry if I sound annoyed but there is a bottleneck in medical training due to lack of residency programs. New medical schools have opened, physicians are needed but there is a lack of political will to increase residency slots. And yes, I'm in favor of nurse practitioners and P.A.'s handling simpler things to free up doctors' time.

      The founding fathers knew of the mutually corrupting influences of Church and state, wisely sending them to opposite corners.

      by emidesu on Mon Sep 03, 2012 at 09:23:11 AM PDT

      [ Parent ]

      •  I agree that there should be an increase in (2+ / 0-)
        Recommended by:
        VeloVixen, Mr Robert

        residency programs, just the funding should come from the general funds and not the Medicare budget or else those funded by Medicare should be focused on programs for Medicare recipients.

        I have no idea whether Pediatric residency programs, for example, are funded by Medicare but I would hope not.

        You can't scare me, I'm sticking to the Union - Woody Guthrie

        by sewaneepat on Mon Sep 03, 2012 at 10:25:39 AM PDT

        [ Parent ]

        •  I've never heard of a residency not (3+ / 0-)
          Recommended by:
          Mr Robert, sewaneepat, VeloVixen

          being funded by medicare, although I hear you regarding peds. Most residency training takes place in hospitals and patients skew heavily toward seniors. Of course, in my ideal world we'd have medicare for all and none of this would matter.

          The founding fathers knew of the mutually corrupting influences of Church and state, wisely sending them to opposite corners.

          by emidesu on Mon Sep 03, 2012 at 11:45:44 AM PDT

          [ Parent ]

  •  My goddaughter, the surgeon (13+ / 0-)

    She has told me that we are the only industrialized country that does not train its doctors, but leaves it to the private sector.  

    Yes, the new doctors then owe some time to the citizens of their country to provide health care.  But the state assumes the cost, the people benefit, medicine is open to a greater number of people.  Everyone wins.  

    She maintains that many good people who would make excellent doctors simply cannot afford to do so in the U.S.  The pressure is then on to go into money-making specialties in order to pay off the exorbitant debt.  She maintains that women in general want to make a good living of course, but are better at factoring in "it's enough money, thank you" and would be more inclined to provide health care in areas that need it.  

  •  Waiting 7 weeks to make an appointment in Boston (5+ / 0-)

    Now that I think about it, with all the world class hospitals in Boston, and medical schools in three major universities (Harvard, BU, and Tufts), one would think that Boston would have a surplus of doctors. That one in Atlanta has to wait only about 20 percent of what you would wait to get an appointment in Beantown makes no sense whatsoever.

  •  Great diary! One little nit: (4+ / 0-)

    your last link is busted.  I tried to follow it and ended nowhere.  A shame, too.  Everything you've posted here is really interesting.  Any chance you could make this last link work?

    "I speak the truth, not as much as I would, but as much as I dare, and I dare a little the more, as I grow older." --Montaigne

    by DrLori on Mon Sep 03, 2012 at 06:38:22 AM PDT

  •  PA's, Nurse Practitioners! (7+ / 0-)

    should supply a large share of front line family practice in the future. A fraction of the time to train and every PA I've ever seen has been just as good, and in some cases better than MD care.

    •  That's part of the idea behind ACOs.... (6+ / 0-)

      ....or accountable care organizations, which are also part of the ACA.

      Hospitals will no longer be big boxes, but amalgams of hospitals, practices, clinics, and ambulatory care operations, with many levels of care.

      If Obama didn't get Bin Laden because he didn't pull the trigger; then Bin Laden didn't take down the World Trade Center because he didn't fly the planes.

      by Bush Bites on Mon Sep 03, 2012 at 06:49:26 AM PDT

      [ Parent ]

    •  Just as in the world of mental health where (6+ / 0-)

      several levels of competency and licensing work under the supervision of a psychiatric MD, primary care clinics and other operations could do the same.  Electronic communication should be continuously facilitating this trend.  My last gyn exam performed by a NP came up with something oddball and she went directly to the doctor via Inet, and moments later I was scheduled for a benign follow-up test.  This clinic does not automatically schedule follow-up office calls just to share test results; they do so only when the results raise concerns and then you hear from them and they see you pronto.  

      As for getting more NP's and nurses onboard, it would be helpful if they could do some of their training as VISTA workers or enter into contracts with rural, isolated and some metropolitan areas where their skills are needed.  Think "Northern Exposure" for RN's and NP's using electronic connections to larger medical institutions.

      Romney went to France instead of serving in our military, got rich chop-shopping US businesses and eliminating US jobs, off-shored his money in the Cayman Islands, and now tells us to "Believe in America."

      by judyms9 on Mon Sep 03, 2012 at 06:54:22 AM PDT

      [ Parent ]

  •  Rural Medicine (8+ / 0-)

    is also something that is becoming more difficult to find, since unless you were from a community or had a community sponsor your way through med school, chances are you, as a graduate of a (probably) wealthy suburban school district, having gone through Med School and your internships and residency in a largely urban setting, will have little desire to relocate to what, for you, is an isolated place, dealing with a high percentage of elderly residents and residents on Medicaid while trying to pay off student loans. This is especially true in high minority rural areas (Black Belt, Colonias, Rez's, etc).

    •  There is a wealth of info in this article about (3+ / 0-)
      Recommended by:
      TexDem, ER Doc, Mr Robert
    •  Someone mentioned the CCC above (4+ / 0-)

      It would be great to have a Medical version of the CCC. It could offer a 10 year program to a rural community with a forgiveness of Medical school debt. Or an enrollment program that allowed you to make that determination when you enter Med school.

      Offer a similar program for urban settings and reservations etc.

      And don't forget dentist and eye Docs.

      Add to that all the supplementary staff, NPs, PAs etc.

      The problem is as always funding. The GOP would never support any of this.

      So in the short term, what are the best options?

    •  What the ACA Does: (5+ / 0-)
      Expanding tax benefits to health professionals working in underserved areas: In addition to the incentives provided by the Departments of Labor and Education to pursue primary care as a profession, the Department of Treasury is responsible for providing tax benefits to students. The Affordable Care Act includes a provision that excludes from taxes the value of student loans that were repaid or forgiven because the individual worked in certain health professions, including primary care. This provision is retroactive to 2009. Also on June 16, 2010, the Internal Revenue Service took steps to ensure health professionals are aware of this benefit. For 2009, approximately $10 million in tax refunds will be made available to health care professionals who practice medicine in areas that need it most.

      Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

      by delphine on Mon Sep 03, 2012 at 07:33:01 AM PDT

      [ Parent ]

    •  Also: (6+ / 0-)
      Increasing access to providers in underserved areas: The Affordable Care Act builds on the important work of the National Health Service Corps (NHSC) to address the nation’s workforce demands. The NHSC repays educational loans and provides scholarships to primary care health care providers who practice in areas of the country that have too few health care professionals to serve people who live there. Eligible providers include primary care physicians, physician assistants, and nurse practitioners. The Affordable Care Act provides $1.5 billion over five years to expand the National Health Service Corps. This builds on a $300 million investment in the NHSC in the American Recovery and Reinvestment Act. The combined nearly $2 billion investment is expected to result in an increase of more than 12,000 additional primary care physicians, nurse practitioners, and physician assistants by 2016.

      Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

      by delphine on Mon Sep 03, 2012 at 07:40:10 AM PDT

      [ Parent ]

  •  make brain-drain work for us (4+ / 0-)

    give visa's to more of those well-trained east european & south asian docs who want to come here

    •  This is how UK gets its doctors. There are some (3+ / 0-)

      small visa programs like this and doctors can likely get a regular H1B as well. The problem is that it takes at least 2 years for a non-US educated doctor to pass the board exams. It's almost like going to med school again. And then there is residency.

      However, I expect strong bipartisan opposition to anything like this. Claims along the lines of 'furrinners come here to take our jobs' are commonplace both on this blog and elsewhere.

      •  It does take time... (4+ / 0-)
        Recommended by:
        VeloVixen, Mr Robert, FG, TexDem

        The language issue is always there, which is why Indian, Pakistani, & Filipino docs have been predominate; they have a head start on English skills over docs from many nearby countries, as well as the Eastern European countries. And, unless they're being hired as a university professor or research scientist or they've been certified by the Canadian boards, even if they completed residency-level training at home they have to do an American residency to get American licensure & board certification.

        -7.25, -6.26

        We are men of action; lies do not become us.

        by ER Doc on Mon Sep 03, 2012 at 11:09:11 AM PDT

        [ Parent ]

    •  Already happening... (4+ / 0-)
      Recommended by:
      VeloVixen, SoCalSal, Mr Robert, TexDem

      Many of those family practice & internal medicine residency slots unfilled by American medical school grads have been filled by Indian, Filipino, & other Asian docs for many years. Many rural communities are served by immigrant docs, because the American kids won't go to those practices.

      -7.25, -6.26

      We are men of action; lies do not become us.

      by ER Doc on Mon Sep 03, 2012 at 10:03:51 AM PDT

      [ Parent ]

  •  Canadians believe you walk in w/o appointment (8+ / 0-)

    anywhere in America and get your lung, heart, and liver replacement while you get your oil changed! :) My family doctor (mid-50s) works in a two clinic multi-doctor practice (and made $390,575.67 in gross billings 2010-11) in a burgh of 83,000 people. If I phoned this morning, I would expect to have an appointment with him by Friday; if it were urgent but non-emergency, I would expect to see another doctor in the practice today. Both clinics have after-hours and weekend walk-in clinics which are available to anyone, i.e. includes "non-clients".

    Now explain to me about how Canadians have to wait years for medical treatment? "...since 2004 the wait time to get an appointment has increased by more than a week to 20.5 days. In Boston, it takes 49.6 days on average to see a doctor; in Atlanta it takes 11.2."

    •  I'm going to guess that Canadian docs may (4+ / 0-)

      not be as profit-driven as US doctors because they may not carry the student loan debt of US docs.  Don't know.  The other thing is that Canadians living along the US borders often have some procedures done here in the US, especially here at some of our Detroit and Ann Arbor hospitals, and the Canadian government pays for the care that they have in effect contracted out to the US.  We also see many Canadian RN's over here where they can make more money and are willing to deal with the hassles of the International bridge every day.

      Romney went to France instead of serving in our military, got rich chop-shopping US businesses and eliminating US jobs, off-shored his money in the Cayman Islands, and now tells us to "Believe in America."

      by judyms9 on Mon Sep 03, 2012 at 07:27:05 AM PDT

      [ Parent ]

  •  Adequate primary care also means (5+ / 0-)

    that people will need less follow up care.  The ACA needs to stress and encourage yearly physicals (not just make them automatically covered), so that people can catch and detect illnesses before they become untreatable.

    For the ladies, your OBGYN will usually be happy to send you for labwork to check your blood for cholesterol, diabetes, and other potential problems.  That eliminates needing to get a second checkup at a family doctor later on.

    Tradition says that God gave us choice. Some of His disciples act like it is up to them to remove it. ~ kjoftherock

    by catwho on Mon Sep 03, 2012 at 07:29:46 AM PDT

  •  The model and the payments (6+ / 0-)

    The problem isn't so much a shortage as our models. We participate in a wonderful practice with great PAs, primary care physicians and specialists.

    The problem is payment. If my otherwise-healthy husband gets his PSA read by a urologist, that guy gets more than the primary who knows his whole body. And it was the physician's assistant two years ago who saved his life by recognizing that he looked like #$%^&* when he walked in to get a medication checked.

    When we change the method of payment to care rather than per-treatment (as ACA proposes to do) and reward coordination rather than competition, the system will change.

  •  What the ACA Does: (7+ / 0-)

    The ACA recognizes the crucial role of Nurse Practitioners and Physician Assistants.

    It recognizes and addresses the issue of underserved areas.

    It recognizes and addresses the issue of the expense of a medical education and student loans.

    It recognizes and addresses the issue of ancillary health care staff (career training).

    It's a great law, written by people who understand the challenges in our health care system.

    I heard the NPR story and wanted to yell into the radio.  

    I found this easily at www.healthcare.gov

    http://www.healthcare.gov/...

    Why is it that a 3% tax increase for the wealthy is considered "socialism" and an 8% wage cut for the middle class is "doing your part"? MartyM

    by delphine on Mon Sep 03, 2012 at 07:51:47 AM PDT

  •  Education (3+ / 0-)
    Recommended by:
    VeloVixen, ER Doc, Mr Robert

    Costs have to be addressed and not just for medical school, but all university.

    No future doctor is going to wish to be a few hundred k in debt if they don't make enough to pay down the debt before they are 60.

    University and grad school get more expensive every year regardless of inflation or the state of the economy.

    How is this possible?  

    If people want more doctors then the cost of education has to drop a lot.

    And if a lot more affordable maybe one gets more future doctors that are into healing and make a decent living versus those that wish to make big bucks.

    "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 08:21:23 AM PDT

  •  The view from Massachusetts... (8+ / 0-)

    ... where we've had RomneyCare for a while.

    My wait times to see my primary care physician went up ( a lot, once 90 minutes) the first two years after full coverage started.

    The waits have since gone down.  There's a sign at check-in to please remind them if you haven't gone in by 20 minutes after your scheduled time.  The longest I've waited has been that 20 minutes.

    It used to take 4-6 months to get an appointment.  Now, it takes two months; they send out a card at about 10 weeks ahead of your anticipated date to remind you to schedule your physical or regular visit.  

    The practice where my husband and I are treated went from 4 to 6 doctors, plus a nurse practicioner, and weekly specialist clinics (the podiatrist is on Wednesday).  There is both a nurse practicioner and a locum for urgent care during business hours, and the practice doctors are all clinical fellows at the closest teaching hospital. The hospital has expanded their association offices; two new offices (5-6 doctors, visiting specialists) have opened in adjacent towns.  

    The pediatric practice where my daughter is treated just replaced a doctor, but also has 4 pediatricans, a nurse practicioner, and privileges at the three closest hospitals, plus Boston Children's.  Wait times there for scheduled visits have been about 10 minutes; for flu clinics they've been about 20.  Urgent care on weekends (once) had no waits; our pediatrician said that her urgent care calls had been going down in number since 2009 -- but up in severity.  

    Emergency room wait times have gone down as well; the last two times HerrDoktor was sent, the waits were 0 and 10 minutes.  

    The first three or four years are the rough ones;  it takes time to ramp up a system for dealing with more regular patients, and it's not trivial.  But, despite my misgivings back in 2004 that this was both a give-away to the insurers and would break healthcare, the opposite has proved true.

    I agree that Medicare would be an appropriate place in the budget to add to for supporting residencies; I'd like to see all of the states start setting up systems for supporting doctors-in-training.

  •  Call me a socialist, but I really think that (3+ / 0-)
    Recommended by:
    VeloVixen, ER Doc, Mr Robert

    single payer is part of the solution to problems like these.  Offer subsidized student loans to doctors.  If they then become doctors available through single-payer, then forgive a portion of their loan each year.  If they leave public practice, they still have to pay off what remains of their loans.

    I think such a scheme is much more easily justifiable with single payer - more doctors (Particularly doctors without debts paying interest to private institutions) keeps costs down - both because patients have easier access to doctors, making preventative care more available, and because doctors can be paid a bit less, while still making a very healthy salary.

    •  Of course the root of the (4+ / 0-)
      Recommended by:
      VeloVixen, Flying Goat, llywrch, Mr Robert

      problem is that education is so expensive - WHY?

      The cost structure at universities needs to be examined.

      "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 08:33:42 AM PDT

      [ Parent ]

  •  Thanks for your part in supporting America's (8+ / 0-)

    physicians :) I am in the business of making new ones, too, but for me that is in the sense of educating them. One part of my faculty duties as a biology professor puts me in front of a lot of pre-meds. I do see a lot of students really interested in direct patient care, especially primary care. A lot of students go out of their way to study Spanish, too (this is CA we're talking about...) hoping to serve an as yet underserved part of the population.

    For the most part, I really like the crop of young people I'm seeing (and some up into their thirties, and even forties on occasion) and their motivation and intelligence. I am especially excited about the number of first-generation college students who are heading into medicine. I heard from one yesterday - a former student of mine just starting at Harvard med. Whoooo-eee! In my mind, knowing this student, she is really a model for what I think the future of medicine should be, and fortunately, she is not that much of a rarity.

    "Maybe this is how empires die - their citizens just don't deserve to be world leaders anymore." -Kossack Puddytat, In a Comment 18 Sept 2011

    by pixxer on Mon Sep 03, 2012 at 08:26:21 AM PDT

    •  Thank you for your dedication (4+ / 0-)

      to educating them!  I sincerely hope that these bright, enthusiastic students stay that way.  There is often a change somewhere between 3rd year med school and 1st yr residency in the outlook and psyche of young doctors.  In many, a perceptible 'wall' of protection goes up, in my opinion, protection against the constant scrutiny, and demeaning attitudes of the older, set-in-their-ways faculty. (i.e., "I had to put in the hours and time, you should too").

      •  {Sigh} I can believe that. My sister, who was a (4+ / 0-)
        Recommended by:
        VeloVixen, SoCalSal, Mr Robert, TexDem

        physician, once joked, on another "burnout" issue, "I had to take Saturday classes in med school so this appendectomy is going to cost you big time," and I'm sure some resentment comes through from negative situations in medical schools and residencies. OTOH the way the med schools present themselves to our students, and the strong encouragement many of the seem to place on collaborative attitudes and practices, give me hope that a lot of places really are working at keeping that young physician's dream alive. I've heard it's the 8 minutes-per-patient that ends up getting them frustrated in the end.

        When I write letters of reference for my students (about two dozen this year!) I require that they drop me a note from time to time as payback, so perhaps I will over time have something of a reading on this.

        "Maybe this is how empires die - their citizens just don't deserve to be world leaders anymore." -Kossack Puddytat, In a Comment 18 Sept 2011

        by pixxer on Mon Sep 03, 2012 at 08:53:12 AM PDT

        [ Parent ]

  •  Medical school trustees (4+ / 0-)
    Recommended by:
    VeloVixen, loretta, bcdelta, TexDem

    ...have artificially constrained the number of slots for medical students over several decades.  And while, students select specialties over primary care at a higher rate, there seems not to be an oversupply of specialists such that their pay suffers.  But then, large hospital systems set up specialty clinics as profit centers and primary care clinics as referers to specialists.

    Also, higher medical fees mean more people avoid preventive care, which lengthens the time required for an office visit.  And increases the demand for specialists to treat seriouos problems.

    The first step to solving the supply problem will be to get physicians to accept that an MD is not a license to print money.  The second is to fire all of the MBA in large medical systems and restore the independence of professional practice partnerships.  As long as there are 1500 sets of insurer rules, that cannot happen, which is why Medicare for All taps incredible amounts of savings.  Remember that compared to the best health care systems in the world, the US has costs per patient that are twice as high and outcomes that are not as good.  That means that there is a 50% upside in reduction in costs in the US system, most of which will come from preventing catastrophic situations.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Mon Sep 03, 2012 at 08:44:54 AM PDT

    •  I like (2+ / 0-)
      Recommended by:
      VeloVixen, Mr Robert

      getting rid of all the MBAs.

      As for getting doctors to think that a medical license is not for printing money...

      I wonder if the cost of medical school isn't attracting the wrong applicants???

      If it were a lot less expensive you might attract people that are into healing and not so greedy.

      "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 10:51:29 AM PDT

      [ Parent ]

      •  Doctors printing money (3+ / 0-)
        Recommended by:
        VeloVixen, Mr Robert, TexDem

        It's an expectation that started in the 1960s when the federal government was subsidizing medical education, the Boomer population was increasing in size an briefly in affluence, and medical schools couldn't keep up with the expansion of teachers needed.

        There  is no reason why the federal government couldn't buy out all of the remaining student loans in exchange for commitments to Medicare pricing.   It would help some medical system physicians break the golden handcuffs and set up their own practices.

        50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

        by TarheelDem on Mon Sep 03, 2012 at 11:10:03 AM PDT

        [ Parent ]

  •  Want a scary thought? (2+ / 0-)
    Recommended by:
    VeloVixen, Mr Robert

    I've thought about trying to become a doctor. Not only would it mean I could give myself my own medical care, but if I chose an underserved community, they might pay my costs of education in return for practicing there my first 5-10 years out.

    I'm nearly forty and not in the best of health, but I've considered it. I wonder who else has.

  •  My personal experiences completely agree.. (4+ / 0-)
    Recommended by:
    VeloVixen, SoCalSal, solesse413, Mr Robert

    I used to have HMO earlier. Used to see a young doctor who practiced in a large group called Healthcare Partners in Los Angeles.

    The wait was always interminable. So one time I asked for the first morning appointment that was available in the future. It was for 8:30am - when the doctor starts seeing patients. I waited 20 minutes before I saw the doctor. I asked him what was wrong with the practice when even for the first appointment it took 20 minutes past the time! That was the last time I went to see him.

    My wife's medical insurance changed, so we opted for the higher premium PPO (we are lucky to have that option!). Then I selected a doctor who had less wait. While I have changed doctors once more, I still have a older doctor where I can see him within 10 minutes of the appointment time - primarily because he sees few patients.

    But still getting an appointment takes time. I recently needed to see an orthopedic specialist. The initial appointment took 1 week from when I called. That was the first open slot.

    Once I saw him, he recommended a MRI scan for possibly a torn meniscus on my right knee. The MRI scan took another week to schedule. Now to go back and see him after the MRI results are in - that is taking another week to schedule!

    Our daughter is applying for medical school, and it is worse than getting into a top 10 college.

    The AMA controls the supply of doctors, partly by restricting how many get admitted to medical schools, and partly also by the number of internships available.

    I recently heard that in our Indian American community several future doctors are going back to India to get their MD degree, then coming back here to do the residency and fellowship!

    We need ACA!

    The only reason people want to be masters of the future is to change the past - Milan Kundera

    by Suvro on Mon Sep 03, 2012 at 10:20:57 AM PDT

  •  The Republicans (2+ / 0-)
    Recommended by:
    VeloVixen, Mr Robert

    constantly bang the drum (and lie) that malpractice insurance costs are what drive future doctors away from primary/family medicine. This is a lie. They also constantly spread fear that ACA will ration care because of too few family doctors. The ACA, as you wrote, addresses this directly.

    They are also considering reducing residency from 4 to 3 years.

    No Jesus, Know Peace

    by plok on Mon Sep 03, 2012 at 10:38:29 AM PDT

  •  I have walked the same path as you, with one (4+ / 0-)
    Recommended by:
    VeloVixen, solesse413, Mr Robert, TexDem

    exception.  I, too, am a physician's wife of 36 years.  Put my husband through all of his schooling, went through all of the same ups and downs as you, and raised my boys nearly alone.  My husband is a wonderful man, husband, father, and physician, and we would both agree with all that you said in this diary.  

    The exception?  Neither of my boys ever remotely considered following in their father's path.  They saw him be beat down day in and day out by what medicine has become and wanted no part of it.  I read an article recently somewhere about how "back in the day" a huge percentage of doctor's children (especially son's back then) would follow in their dad's footsteps and go into medicine.  Not anymore.  The percentage has dropped dramatically, thereby adding to the physician deficit. I'm not sure from reading your diary if you're glad your kids went into medicine.  It's certainly the noblest of professions, and you are obviously a wonderful mother and friend to them.  As for me, I'm honestly so relieved my sons avoided it, and so is my husband.

    All we're waiting for now is the chance to get out ASAP, and so are nearly all of my husband's peers in medicine.  Most don't have enough retirement to stop for quite a few years yet.  The last five years have just deteriorated in so many ways for someone nearly 60.  We had hoped it would go the same for my husband as it did for his father, but it's not even close in any way.  

    My husband's father was a surgeon, too, and he had to be pried out of medicine at 87 (with a full pension).  He wasn't operating by then, only teaching at that point.  He and my husband are miles apart in their experience of medicine as a lifelong career.  Both are and were wonderful physicians, but only one would choose to take the same path again.  This makes me very sad in so many ways.

    Thank you for writing this diary.  I hope it opens some eyes to what is coming at us in the next years.  A tsunami of a medical nightmare.

    •  Thank you for sharing your story. (2+ / 0-)
      Recommended by:
      Mr Robert, TexDem

      My ex-husband and I did not overly encourage our children to go into medicine; at some points we discouraged them.  My daughter and son have had similar experiences with some aspects, and very different experiences in others.  My son has had the most challenging; there have been many times he has expressed that he might choose differently if he had known going in what it was going to be like.  I think in the end, it is their desire to care for the sick that wins.

  •  Your openning paragraph is confusing (1+ / 0-)
    Recommended by:
    VeloVixen

    You talk about wait time in the office, then switch to appointment scheduling wait time. Then you show a statistic that states wait time for specialists is very long, while study after study shows doctors are choosing specialty instead of family medicine (which contradicts wait times).

    I can see my family doctor tomorrow if I wanted and I would not have to wait. But for my wife to see a specialist, yes, she has to schedule weeks in advance sometimes.

    No Jesus, Know Peace

    by plok on Mon Sep 03, 2012 at 10:51:15 AM PDT

    •  The discussion on office wait time (1+ / 0-)
      Recommended by:
      TexDem

      and appointment wait time was illustrative.  It was intended to have the reader relate to the basis of the story.

      •  You're right (1+ / 0-)
        Recommended by:
        VeloVixen

        I'm sorry if I was rude. But in this course of this discussion both my wife and noticed that while statistics show med students going into specialty practices, it's still a very long wait to see a specialist. This is contrary to me.

        My personal opinion is that folks don't go into family medicine because Americans are assholes! My doctor is Chinese, from a line of Chinese doctors.

        Anyway good luck to you and yours.

        No Jesus, Know Peace

        by plok on Mon Sep 03, 2012 at 07:42:49 PM PDT

        [ Parent ]

  •  170 k not enough? (1+ / 0-)
    Recommended by:
    VeloVixen

    Really this is part of the argument? Not enough people are wiling to train to be a general practioner because they only start at 170k and have to pay a small percentage of that in loans?

    Let's talk about the shortage being caused by the intentional decision to train insufficient doctors by the guilds that control enterance into the profession. Let's talk about the entire non-sensical medical profession which instead of having a profession that people start at the bottom and through years of working and education rise to the top is organized as a case system in which people are slotted into a single immobile tier based upon their initial educational path.

    •  Not part of an argument, more a statement (1+ / 0-)
      Recommended by:
      TexDem

      of fact.  The diary is not an argument so much as it was intended to be informative.  The medical profession does start at the bottom; after 4 yrs of college, 4 yrs of medicine, and 2-4 yrs of residency, a doctor usually starts practice around age 30.  Most other professions with that level of training will earn a commensurate salary.

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