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Leon Trotsky 2012 posted:Unless the restricted network is so burdensome to travel to as to make it not worth it, I don't really get the complaint about narrower networks. They are an option you can take to reduce your costs. There are certain instances where people might not want to go with that, but as a general rule "picking" your doctor has no impact on your health. My current PCP is both significantly better than any other PCP I've ever had, but also treats my parents. He doesn't need to ask me about family history, because he already knows, and reviews his notes in advance so he doesn't need to check up with me on stuff that I've already told him. When I get my annual physical, we spend an hour talking about health stuff before the exam -- he takes pages of notes at each meeting. He follows up with every specialist I see and has a copy of their notes and anything they have recommended or prescribed, and checks to make sure that all of the stuff that caused me to see the specialist in the first place is followed up on. A sick visit is usually at least 30 minutes, and it always runs on time. I don't see a NP, no one else is interviewing me and then he's asking the same questions. Changing my PCP would be annoying, because sure you get to pick your doc, but generally speaking, especially with narrow networks, you're picking a doc that's farming out for volume. So you have at most 15 minutes allotted for you. Because of the model, they want to push you down into the shorter office visit codes because that's how they make their money, instead of encouraging detail and thought. HMOs were supposed to create integrated care networks where your doc knew you as part of the narrow network, but they've really failed because all the do is push high volume and turnover docs or practices rapidly. Kaiser is really the only successful one.
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Oct 31, 2018 15:39
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Leon Trotsky 2012 posted:Unless the restricted network is so burdensome to travel to as to make it not worth it, I don't really get the complaint about narrower networks. They are an option you can take to reduce your costs. There are certain instances where people might not want to go with that, but as a general rule "picking" your doctor has no impact on your health. The major drawback of narrow networks is the liability of a patient who, when treated at an in-network facility, is financially responsible for any out-of-network care for which the patient has no say or control, except in the handful of states that have outlawed surprise/balance billing. That could be as simple as a PCP sending bloodwork to an out-of-network lab or as complex as an in-network hospitalization charging for every rando out-of-network practitioner who stops by your hospital bed and scans your barcode. It's one of those "uniquely American" healthcare problems--but it's also a major concern for most Americans. While Dems are touting that "healthcare is the no. 1 issue" for midterm voters, when you look at the polling it's not "covering pre-existing conditions" or "defending the ACA" that's on most voters' minds; it's the ever-increasing out-of-pocket medical costs--but especially those costs for which people have no control when they're being treated. From an August KFF survey:  67 percent are worried about unexpected medical bills:  Given that about one-third of all Americans have health coverage through Medicaid, Medicare and the VA, that's a pretty damning statistic--because all three of those programs have prohibited surprise billing.
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Oct 31, 2018 17:14
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Or it could be as absurd as an in-network hospital emergency room that assigns you an out-of-network surgeon with no advance notice, as I experienced with a family appendectomy two years ago. The explanation was something like that the hospital doesn't directly employ surgeons and they're technically independent contractors with their own insurance setup separate from the hospital. loving crazy. ETA: and as you might expect, we had no idea any of this was a thing until we got a $2000 bill in the mail a few weeks later SousaphoneColossus fucked around with this message at 19:23 on Oct 31, 2018 |
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Oct 31, 2018 19:19
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SousaphoneColossus posted:Or it could be as absurd as an in-network hospital emergency room that assigns you an out-of-network surgeon with no advance notice, as I experienced with a family appendectomy two years ago. That is an issue with "surprise billing" and certain hospital practices rather than some intrinsic part of choosing a narrow network as an option to reduce your premiums. If they banned "surprise billing" in all 50 states the scenario you described would be impossible. If they banned narrow networks in all 50 states, then the scenario could still happen.
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Oct 31, 2018 19:23
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Leon Trotsky 2012 posted:That is an issue with "surprise billing" and certain hospital practices rather than some intrinsic part of choosing a narrow network as an option to reduce your premiums. I mean yeah, it could still happen if they banned narrow networks, but it seems like it would be a lot less likely to happen.
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Oct 31, 2018 19:26
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Zauper posted:My current PCP is both significantly better than any other PCP I've ever had, but also treats my parents. He doesn't need to ask me about family history, because he already knows, and reviews his notes in advance so he doesn't need to check up with me on stuff that I've already told him. When I get my annual physical, we spend an hour talking about health stuff before the exam -- he takes pages of notes at each meeting. He follows up with every specialist I see and has a copy of their notes and anything they have recommended or prescribed, and checks to make sure that all of the stuff that caused me to see the specialist in the first place is followed up on. This is a bit of a soap box, but if you are a young (18-40), otherwise healthy person with few or no active medical problems, the utility of seeing your PCP for an annual physical is pretty debatable. For an explanation from someone who is likely smarter and certainly better qualified, read more here. An important exception are the the US Preventative Services Task Force recommendations which you can find here. Note that for young non-pregnant women, the majority of the recommended screenings are best performed by an OB/GYN, making them by extension much more useful as a PCP for this demographic than a family med doc or internist. Zauper posted:A sick visit is usually at least 30 minutes, and it always runs on time. I don't see a NP, no one else is interviewing me and then he's asking the same questions. Lol, the repeat questions from different docs is part and parcel of being at a teaching hospital or affiliated clinic. Students/residents/fellows will usually go in to do the preliminary history and physical, and the attending will follow up just to make sure they didn't gently caress up. I get that it's a little annoying, but it doesn't materially impact the quality of your care. If anything, you're getting two well trained and motivated pairs of eyes on you, which is a good thing. Also, NPs/PAs are great - especially in primary care - and will be essential to addressing the looming shortage of physicians in the US. Absolutely nothing wrong with seeing one vs. an MD for a PCP visit. Zauper posted:... generally speaking, especially with narrow networks, you're picking a doc that's farming out for volume. So you have at most 15 minutes allotted for you. Because of the model, they want to push you down into the shorter office visit codes because that's how they make their money, instead of encouraging detail and thought. HMOs were supposed to create integrated care networks where your doc knew you as part of the narrow network, but they've really failed because all the do is push high volume and turnover docs or practices rapidly. Kaiser is really the only successful one. This is a phenomenon that transcends HMOs and existed in basically every outpatient clinic I ever worked in during medical school. This was even/especially the case when I was at Mayo Clinic, where their attendings are under enormous pressure to increase RVUs generated during their working day. There are lots of reasons for this: the financialization of the healthcare industry, increased admin/charting burden on MDs, changing reimbursement structures, and the fact that there are lots and lots of patients. It's certainly not a good thing, but it's not directly related to the insurance carried by a particular patient. It's also worth mentioning that time with patient do not necessarily result in better medical outcomes. I can elaborate but I've already rambled enough for now. Kommienzuspadt fucked around with this message at 20:23 on Oct 31, 2018 |
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Oct 31, 2018 19:28
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SousaphoneColossus posted:Or it could be as absurd as an in-network hospital emergency room that assigns you an out-of-network surgeon with no advance notice, as I experienced with a family appendectomy two years ago. Yeah that poo poo is hosed up. It's unfortunately a relatively common corporate structure, especially at smaller community hospitals. I would absolutely complain to the insurance company. Leon Trotsky 2012 posted:That is an issue with "surprise billing" and certain hospital practices rather than some intrinsic part of choosing a narrow network as an option to reduce your premiums. I got a $600 medical bill last month for an ER visit back in June 2017 that was improperly coded. However, by the time I actually got the bill, they had charged an insurance plan that I no longer have, making it a huge pain in the rear end to fight. I was livid but ended up paying the bill because like most people I only have so much energy in a given day. Kommienzuspadt fucked around with this message at 19:40 on Oct 31, 2018 |
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Oct 31, 2018 19:35
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Kommienzuspadt posted:There are lots of reasons for this: the financialization of the healthcare industry, increased admin/charting burden on MDs, changing reimbursement structures, and the fact that there are lots and lots of patients. It's certainly not a good thing, but it's not directly related to the insurance carried by a particular patient. I have a hard time feeling bad for doctors, given that their AMA cartel has been consistently one of the major players in shooting down universal healthcare in America for over a century.
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Oct 31, 2018 21:45
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The AMA no longer represents the vast majority of doctors, though--fewer than 25 percent belong. And as older docs age out of the system, if the AMA continues to do bone-headed stuff like this its numbers will further dwindle.
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Oct 31, 2018 23:40
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CAPS LOCK BROKEN posted:I have a hard time feeling bad for doctors, given that their AMA cartel has been consistently one of the major players in shooting down universal healthcare in America for over a century. Willa Rogers posted:The AMA no longer represents the vast majority of doctors, though--fewer than 25 percent belong. Yeah, I think I was made a student member of the AMA in my 1st year of med school somehow but I've never given them a dime nor would I ever intend to. I can't think of anyone I know who has a favorable opinion of them. It's worth mentioning that a lot of the incredibly unsavory nature of American healthcare does not come from physicians but largely directly from admin/corporate direction. With the ACA, vertically integrated and monopolistic practice models are very much incentivized, and have driven a huge number of mom and pop doc shops out of business. This has significantly eroded the autonomy of the physician in medical practice, and is directly responsible for a lot of what I described above (e.g. 15min clinic visits). In most clinical practice settings, the average MD is just another cog in a healthcare machine that has a vaunted history of trying to squeeze blood from stones. It's been many years since they started coming after us, too. It's loving awful, and not a small part of the reason that the # of med school applicants declined YoY in 2017 for the first time ever. Not to mention that a huge % of my classmates graduated with absolutely crippling amounts of student loan debt... at my SOM, ~1/3 of my class of 185 students was on the hook for out of state tuition to the tune of ~$72k/yr (before living expenses - another ~$30k/yr). In toto, that averages to a balance of $400k for out of state students after 4yr of medical school. Absolutely loving absurd. Some went military, some (like myself) went MD PhD to get it paid for, but by and large your average doc is just as (if not far moreso) overleveraged as the average American and absolutely completely powerless to do anything at the individual level about the pricing of American healthcare. I get that the pay/job security seems enviable, even worthy of resent, but when you factor in average debt burden, a lot of American MDs don't do much better than teachers or cops. It is also, in very many practices, a back-breaking and thankless job. The epidemic of burnout/depression cited by Willa is absolutely real. I know of many MDs - some of them classmates- that have committed suicide for this reason. It is very common for MDs to be working 70-80hr weeks well into their early retirement years for a plurality of reasons: call service for an underserved specialty or understaffed practice, dramatically increased admin burden in the form of EMR charting/documentation, an increased pressure in academic medicine to mature your career beyond clinical care and into MedEd or Research, the squeeze in all directions on private practitioners to sell out to megaliths like Kaiser or regional healthcare monopsonies, and so on. All while being incentivized or coerced into minimizing meaningful or rewarding interactions with patients for the sake of someone else's profit. Purely my opinion, but I feel this is directly related to a lot of problems associated with American healthcare. It drives people into lucrative specialties of highly questionable societal utility (which in turn decreases the # of PCPs, pediatricians, and other relatively low-earning MD specialties), it drives the competitiveness of residency applications, and ultimately can push physicians away from doing 'the right thing' really across the board (again, solely my opinion). It's a hard and exhausting job that can leave you burnt out to a husk. It is very hard to resist the lure of financial incentive after decades of being treated this way, and this is inarguably incredibly detrimental to our society as a whole. Kommienzuspadt fucked around with this message at 00:57 on Nov 1, 2018 |
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Nov 1, 2018 00:36
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Kommienzuspadt posted:This is a bit of a soap box, but if you are a young (18-40), otherwise healthy person with few or no active medical problems, the utility of seeing your PCP for an annual physical is pretty debatable. For an explanation from someone who is likely smarter and certainly better qualified, read more here. quote:Lol, the repeat questions from different docs is part and parcel of being at a teaching hospital or affiliated clinic. Students/residents/fellows will usually go in to do the preliminary history and physical, and the attending will follow up just to make sure they didn't gently caress up. I get that it's a little annoying, but it doesn't materially impact the quality of your care. If anything, you're getting two well trained and motivated pairs of eyes on you, which is a good thing. quote:Also, NPs/PAs are great - especially in primary care - and will be essential to addressing the looming shortage of physicians in the US. Absolutely nothing wrong with seeing one vs. an MD for a PCP visit. quote:This is a phenomenon that transcends HMOs and existed in basically every outpatient clinic I ever worked in during medical school. This was even/especially the case when I was at Mayo Clinic, where their attendings are under enormous pressure to increase RVUs generated during their working day. quote:There are lots of reasons for this: the financialization of the healthcare industry, increased admin/charting burden on MDs, changing reimbursement structures, and the fact that there are lots and lots of patients. It's certainly not a good thing, but it's not directly related to the insurance carried by a particular patient.
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Nov 1, 2018 01:35
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Zauper posted:Look, there's a difference here. If you ask me to fill out a form in the waiting room, and then the nurse who puts me in the room asks me the same questions without looking at it, and then the doc walks in and throws in the trash can and asks me the exact same questions, you've just wasted a lot of my time. And that's often the way the process feels. And none of this is happening at a teaching hospital or affiliated clinic -- it's different when my dad's at hopkins and the residents are taking pictures of his splinter hemorrhage, they're learning about things. That's fine. When you're the 4th person to ask me if I've had headaches in the last month without checking the sheet you made me fill out or referring to the notes the nurse made or or or... no. That's just wasting my time. If you weren't even going to read what the last person wrote, why have them ask? you ask because you are primarily dealing with sick old people, and it is important to be able to tell how reliable the patient's perceptions are when it comes to diagnosing anything even remotely complex. yes. you feel your time is wasted. if you pay close attention you'll notice they put examples in a different order between time one you're asked the question and time two. this is because one of the biggest early warning signs of dementia is always saying "yes, [FIRST THING YOU SAID]" when asked a question you do not follow. and putting "are you suffering from dementia y/n" on the clipboard is minimally useful as a diagnostic technique. modern medicine is a dehumanizing process. this is one of the few bits of that dehumanization that has a justification better than "it makes us more money this way."
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Nov 1, 2018 01:49
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In order for any of that to work, they would need to all be in the room at the same time, or look at the others notes. Given that they don't, that's a flawed assumption.
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Nov 1, 2018 01:58
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Zauper posted:In order for any of that to work, they would need to all be in the room at the same time, or look at the others notes. Given that they don't, that's a flawed assumption. given that none of them were doctors, that would also be a flawed assumption. thankfully, in the real world, those are in fact logged independently and conferred on when the answers differ. it's half the reason for all this electronic record standardization poo poo, there are programs being rolled out as we speak to help automatically flag precisely that to take some of the human error out of the equation. i know. it sucks being on the receiving end of a vast, uncaring bureaucracy to which you are nothing but an entry in a spreadsheet with a dollar sign attached. rest assured not ALL the steps involved are based purely on profit.
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Nov 1, 2018 02:02
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Zauper posted:Sure. I'm in that age group, but not otherwise healthy. My brother had cardiac arrest in the 30s because of a genetic heart condition, I have a skin graft on my leg from when I was 18mo that significantly impacts my ability to walk well, have EOE, etc. Things where you are recommended to have monitoring. So yeah, I get a chest x-ray every few years and a ECG every year as part of my annual physical. May I ask what the condition is? Depending on your brother's diagnosis, it may very well be worth paying to be genotyped (i.e. genetically screened) for the condition, if you haven't already. If it is a monogenetic disease, screening these days is coming down dramatically in price and could very well save you a lot of future expenses if you are negative. It also could be exceedingly healthy to your cardiology team (if you see one) should it be positive. Happy to talk more via PM. Zauper posted:
Some of that are documentation standards (nursing will put in their own notes separate from resident, sometimes separate for attending). It's exceedingly dumb, but in these instances its faster to ask you again than to read the note if it is a busy day. Also, in some cases, subtlety can elicit more information that a bored nurses' boilerplate questionnaire. Also - lots of ridiculous SOP bullshit (e.g. pat depression screening). Sorry. This varies highly from clinic to clinic, service to service. Zauper posted:
Physical exam is exceedingly overrated in the setting of a young otherwise healthy patient with no real complaints. It's not magic. We look at your eyes, in your mouth, listen to heart + lungs, poke at your belly, maybe watch your gait or focus in the setting of a chief complaint. When you come in to the ER with evident acute illness, physical exam and history may elicit a lot of important information. Either way, NPs and residents will staff the case with a licensed and board-certified MD, who will absolutely follow up and focus should they be suspicious of something bad. quote:It does transcend HMOs, but it's the problem that they were intended to solve which is why I called them out. The way you solve coordination of care and doc attention is by finding a PCP that's willing to do that stuff. That's why I don't want to change PCPs. I do some work with a couple of Mayo docs, it's incredibly difficult to get their attention. Don't blame you or feel you should change PCPs. That degree of quality time is rare air in the modern world, though I admit I am biased for lots of reasons. quote:Time with patient may not result in better outcomes at visit 1, but over years if you're doing more than chatting I would bet it does. Hard to quantify and I am not sure I can comment effectively as I don't work in primary care. I think this is also highly dependent on the nature of your community - in rural areas the PCP is of much greater importance than dense, populous urban areas. I do agree however that truly trusting your doc and knowing them over a long period of time is the ideal - maybe gold standard, if you will - for how medicine should be practiced in the outpatient setting.
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Nov 1, 2018 02:06
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They definitely are not electronically logged from the trash can. In my experience (with specialists, my PCP doesn't do this questionnaire duplication stuff), the only ones logged are the ones the doctor asks. Because he's logging them as I answer. But OK, if you say so.
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Nov 1, 2018 02:07
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Kommienzuspadt posted:May I ask what the condition is? Depending on your brother's diagnosis, it may very well be worth paying to be genotyped (i.e. genetically screened) for the condition, if you haven't already. If it is a monogenetic disease, screening these days is coming down dramatically in price and could very well save you a lot of future expenses if you are negative. It also could be exceedingly healthy to your cardiology team (if you see one) should it be positive. Happy to talk more via PM. It's believed to be related to a mutation in the NKX1-2 gene. All four of us (trio + me) got a WGS. Apparently EDS runs in the family, not sure if we looked at the gene for vascular EDS. I should check that.
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Nov 1, 2018 02:13
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Zauper posted:They definitely are not electronically logged from the trash can. In my experience (with specialists, my PCP doesn't do this questionnaire duplication stuff), the only ones logged are the ones the doctor asks. Because he's logging them as I answer. like Kommienzuspadt points out, the nurses often have their own parallel systems. (the institutional origins of which are funny, in a very ahahahah jesus christ what the gently caress kind of way: when a doctor gets old and lovely, it was extremely useful to have a paper trail on hand to justify firing his rear end. improved patient outcomes were considered a pleasant side effect.) synergizing those, hypothetically, results in the holy grail everyone in the industry has been chasing since the dawn of EMR, a chance to automate away a tired nurse and a checked-out doctor missing something real expensive. the institutional wrangling over the most financially viable definition of "missing something real expensive," of course, is still the stuff of nightmares, but it's a nightmare that's a few business cycles away from being properly addressed at this point. the first round of studies on the implementation are going to have to come back first.
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Nov 1, 2018 02:16
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As I've come to have a number of employees working in factory work in the recent years, I've learned that helping be proactive on dealing with injuries is preferred to them working themselves to death. I grew up very aware of the danger of specialist billing and and want my employees to not have to worry about such things so I encourage them to be proactive about screening and being ready to see a doctor rather than going and just winging it and letting the doctor figure it out on their own. Be smart. If it hurts stop doing it and if it doesn't heal on it own see a doctor. Tell me if I'm wrong in eliciting this advice(I'm not a doctor) Ex. My wrist hurts, it feels like i broke it, I go see a PT(20$co-pay/cash out of pocket 75) and request an X-ray referral(20$ copay/75$ cash) before I see my specialist at a larger institutional hospital who most likely will order those tests anyway causing more wait time and a chance I get hosed because I'm caught in the stream of the system. Doctors are generally smart people, but I should know my body more than they do. I feel like this country really lacks a general knowledge on first aid and active medicine much in the same way it does with finance. This country sucks when it comes to life skills education.
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Nov 1, 2018 02:41
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Yea but man that poo poo adds up. A lot of people including me can’t afford even the 100ish dollar copays and that’s before they heap some stupid rear end fees they never tell you about cause they need to take a “routine” blood test that cost 200 dollars.
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Nov 1, 2018 03:13
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Invalid Validation posted:Yea but man that poo poo adds up. A lot of people including me can’t afford even the 100ish dollar copays and that’s before they heap some stupid rear end fees they never tell you about cause they need to take a “routine” blood test that cost 200 dollars. Wheres the knowledge come from to go "No, I'm here for this, handle this, I accept my risks." I cant afford poo poo and neither can anyone I work with. But when you need poo poo looked at you gotta figure out a way.
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Nov 1, 2018 03:31
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Yes but that’s not a good solution.
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Nov 1, 2018 03:58
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Zauper posted:They definitely are not electronically logged from the trash can. In my experience (with specialists, my PCP doesn't do this questionnaire duplication stuff), the only ones logged are the ones the doctor asks. Because he's logging them as I answer. Varies highly from setting to setting but in anything resembling a modern US hospital, RNs will put in their own documentation separate from the MD note(s). If it's an MA that takes your vitals and screens you for depression that usually doesn't go in as its own note and instead gets recorded in vitals flowsheet. Again, largely for medicolegal and billing reasons, documentation has increased dramatically. Zauper posted:It's believed to be related to a mutation in the NKX1-2 gene. All four of us (trio + me) got a WGS. Do you have a family history of aortic aneurysm/rupture/other scary sudden death vascular stuff? If so it may be worth getting screened for EDS (type VII IIRC). EDS is a spectrum and a lot of EDS subtypes are basically harmless, so if you just have 'stretchy' people in your family maybe not worth the expense. I don't know anything about NKX1-2 and OMIM doesn't have much on it so I don't really have any commentary there, sorry. Can I ask if you got whole genome sequencing out of your own pocket, or as part of a study? Sorry if this is too personal, PM is fine if you prefer not to disclose publicly Invalid Validation posted:Yea but man that poo poo adds up. A lot of people including me can’t afford even the 100ish dollar copays and that’s before they heap some stupid rear end fees they never tell you about cause they need to take a “routine” blood test that cost 200 dollars. FWIW I called to dispute a medical bill today that was ridiculously over-charged due to labs that were not medically indicated. Usually the fees aside from copay are referred to as coinsurance, which is a % of the negotiated price with the insurance co. Labs, radiographic studies, EKGs, etc often fall under this category and they can be insanely expensive, even when insurance is paying 80-90%. It's especially galling when it's unnecessary or inappropriately billed. BlueBlazer posted:Wheres the knowledge come from to go "No, I'm here for this, handle this, I accept my risks." Most of the time healthy young people don't need a doc, and then usually it's still relatively inexpensive for USPTF screenings or similar PCP visits. When you actually get hurt or sick (as I have) it is usually unsubtle and seeing a doc is negotiable. It also can get incredibly expensive really fast - you will most of the time get the services you need (and may get bankrupted in the process), but without money chronic medical problems can fester when people skip meds, follow up appts, etc due to fiscal pressure. I lived this in the first person well before I ever considered a career in medicine; I thought it was morally abhorrent then, and still think it's unconscionable now. Kommienzuspadt fucked around with this message at 04:09 on Nov 1, 2018 |
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Nov 1, 2018 04:06
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Willa Rogers posted:The AMA no longer represents the vast majority of doctors, though--fewer than 25 percent belong. While many doctors might not be members of the AMA, the AMA does push for policies which raise the cost of medical care in the interest of further enriching doctors. Doctors in the US make gobs of money, and if the rules were changed so that they made a little less, it would not really be a big deal. Kommienzuspadt posted:It's worth mentioning that a lot of the incredibly unsavory nature of American healthcare does not come from physicians but largely directly from admin/corporate direction. With the ACA, vertically integrated and monopolistic practice models are very much incentivized, and have driven a huge number of mom and pop doc shops out of business. This has significantly eroded the autonomy of the physician in medical practice, and is directly responsible for a lot of what I described above (e.g. 15min clinic visits). In most clinical practice settings, the average MD is just another cog in a healthcare machine that has a vaunted history of trying to squeeze blood from stones. It's been many years since they started coming after us, too. It's loving awful, and not a small part of the reason that the # of med school applicants declined YoY in 2017 for the first time ever. The cost of health care is too high! Of course they should be taking all measures to reduce cost, including coming after the doctors. Why should the average American care about doctor pay maybe being reduced a little bit? Kommienzuspadt posted:I get that the pay/job security seems enviable, even worthy of resent, but when you factor in average debt burden, a lot of American MDs don't do much better than teachers or cops. Lol, this is not true at all. Kommienzuspadt posted:It is also, in very many practices, a back-breaking and thankless job. Are you kidding? There’s an entire genre of TV show dedicated to telling the world about how hardworking and selfless doctors are! Kommienzuspadt posted:It is very common for MDs to be working 70-80hr weeks well into their early retirement years for a plurality of reasons: . . . You missed a huge one. The long hours is a problem doctors have created for themselves by creating an artificial shortage of doctor labor. If we allowed for the training of more doctors, doctors could work more normal hours. But it might mean that their pay would go down . . .
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Nov 1, 2018 18:29
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Minting more MDs doesn't help because you need residency slots for every graduate and thats controlled by medicare.
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Nov 1, 2018 18:33
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Pretty much, one of the most successful propaganda campaigns of the 20th century was convincing the average american that doctors were demigods who needed to be worshipped and deferred to in every context. In other countries, doctor is just a job, and if doctor doesn't do a good job then they go down the elevator shaft. Here they're almost as powerful as the priesthood was before the reformation in terms of getting the state to do their bidding.
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Nov 1, 2018 18:34
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hobbesmaster posted:Minting more MDs doesn't help because you need residency slots for every graduate and thats controlled by medicare. That’s a constraint the doctor lobby created! It doesn’t really negate my point.
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Nov 1, 2018 18:36
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silence_kit posted:That’s a constraint the doctor lobby created! It doesn’t really negate my point. But they don't want it to work that way anymore?
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Nov 1, 2018 18:40
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Of course they do, by making it a loving requirement to do a residency in the first place.
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Nov 1, 2018 18:43
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CAPS LOCK BROKEN posted:Of course they do, by making it a loving requirement to do a residency in the first place. you want new doctors doing a residency dude how many residency slots there should be, etc, that's all up for debate - that you need new doctors to have some sort of apprenticeship where someone else is looking over their shoulder as they make life or death decisions for some period of time before sending them out on their own, not so much
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Nov 1, 2018 18:45
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evilweasel posted:you want new doctors doing a residency dude I don't see why new doctors need a residency. You're falling for the assumption that the status quo is as good as it'll ever get and all that is needed are tweaks. Residencies are optional for pharmacists even in clinical settings. There is no reason why there needs to be a period of hazing and indentured servitude for junior doctors. Hire them directly as junior doctors reporting to a senior doctor. They do not need a loving residency that serves to enrich the medical cartel while delivering negligible value to the patient. For a historical perspective: quote:But even mid-century, residency was not seen as necessary for general practice and only a minority of primary care physicians participated. By the end of the 20th century in North America though, very few new doctors went directly from medical school into independent, unsupervised medical practice, and more state and provincial governments began requiring one or more years of postgraduate training for medical licensure.
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Nov 1, 2018 19:01
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evilweasel posted:you want new doctors doing a residency dude A smarter way IMO to reduce doctor debt and make doctor training faster is not to get rid of on-the-job training but to make the medical degree an undergraduate degree. It is pretty wasteful to make people pay for 4 years of undergrad to take the pre-med requirements. It should be structured differently.
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Nov 1, 2018 19:01
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Pharmacy school lets you do only a couple of years of undergrad - that’s a potential model. That’s still only cutting out 2 years though. That’s also the cheap part
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Nov 1, 2018 19:05
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CAPS LOCK BROKEN posted:I don't see why new doctors need a residency. You're falling for the assumption that the status quo is as good as it'll ever get and all that is needed are tweaks. i don't think relying on a historical perspective for a profession that is miles better at doing its job than it was at the time of that "historical perspective" proves what you think it does the economic side of the medical industry is bad, but actual medicine and the practice of medicine has gotten way loving better
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Nov 1, 2018 19:07
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CAPS LOCK BROKEN posted:I don't see why new doctors need a residency. You're falling for the assumption that the status quo is as good as it'll ever get and all that is needed are tweaks. There's a gigantic difference between pharmacists and doctors, so that comparison doesn't really make sense. How is a residency itself indentured servitude though? If anything med school itself is that; by the time they're able to participate in a residency they're getting paid though (average of $55k/year). And you mention that you rather them just serve under a senior doctor; that is literally what they do. You then quote about how the number of doctors going straight into independent unsupervised practice has gone down; which it should! We don't want a doctor at the residency level to be completely on their own; they absolutely need to be supervised. Whether you call it a "residency" or "supervised hours" is a distinction without a difference. The value delivered to the patient is that the newbie doctor has someone more experienced to be able to supervise them as they cut their teeth and get more experience. I don't see any alternative to supervised hours here since sending them out on their own unsupervised after going through their internship would be a disaster. silence_kit posted:A smarter way IMO to reduce doctor debt and make doctor training faster is not to get rid of on-the-job training but to make the medical degree an undergraduate degree. It is pretty wasteful to make people pay for 4 years of undergrad to take the pre-med requirements. It should be structured differently. There exist programs that combine undergrad and med school to make it a more streamlined process. The problem is selection of valid candidates since it is very hard to judge if an 18 yo is going to be able to cut it as a doctor. Whereas with the traditional med school process; usually candidates are able to make it through the entire program (80%ish graduation rate). I suppose if it was substantially cheaper (or even free for the user as they're going through the program) some of this would be alleviated but even if you streamline out some of the undergrad reqs (gen eds and such I guess? I see a lot of value in those types of classes for everyone, but that's probably where you would have to cut) you can reduce some of the cost but by and large med school is expensive and that isn't going to change by reducing undergrad requirements.
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Nov 1, 2018 19:12
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Raldikuk posted:There's a gigantic difference between pharmacists and doctors, so that comparison doesn't really make sense. How is a residency itself indentured servitude though? If anything med school itself is that; by the time they're able to participate in a residency they're getting paid though (average of $55k/year). And you mention that you rather them just serve under a senior doctor; that is literally what they do. You then quote about how the number of doctors going straight into independent unsupervised practice has gone down; which it should! We don't want a doctor at the residency level to be completely on their own; they absolutely need to be supervised. Whether you call it a "residency" or "supervised hours" is a distinction without a difference. The value delivered to the patient is that the newbie doctor has someone more experienced to be able to supervise them as they cut their teeth and get more experience. I don't see any alternative to supervised hours here since sending them out on their own unsupervised after going through their internship would be a disaster. $55k/year is fairly dramatically underpaying those doctors - but that would also change if there were more residency spots and more competition. artificially reduced residency spots lets you underpay the doctors who have to complete residency, but restrict the supply of new doctors. it's just a different side of the same coin of there being too few residency spots.
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Nov 1, 2018 19:14
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evilweasel posted:$55k/year is fairly dramatically underpaying those doctors - but that would also change if there were more residency spots and more competition. artificially reduced residency spots lets you underpay the doctors who have to complete residency, but restrict the supply of new doctors. it's just a different side of the same coin of there being too few residency spots. There's an argument to be made that they're not being paid enough; but it isn't indentured servitude by any means. But yes, there definitely should be more residency spots so that we can increase the pipeline of doctor training.
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Nov 1, 2018 19:18
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Raldikuk posted:There's a gigantic difference between pharmacists and doctors, so that comparison doesn't really make sense. Not really, pharmacists have been wanting to be providers for a while now too and probably have enough training to handle basic sniffles and birth control questions. Raldikuk posted:We don't want a doctor at the residency level to be completely on their own; they absolutely need to be supervised. Whether you call it a "residency" or "supervised hours" is a distinction without a difference. The value delivered to the patient is that the newbie doctor has someone more experienced to be able to supervise them as they cut their teeth and get more experience. I don't see any alternative to supervised hours here since sending them out on their own unsupervised after going through their internship would be a disaster. No other profession works like this. Consultants start out at the analyst level making 70-80k a year doing the grunt work. They are not matched to a 'residency' according to an opaque, collusive process designed to kneecap the number of doctors and create an artifical shortage. If medicine wasn't exempt from anti-trust provisions the residency matching bullshit would be blatantly illegal. Raldikuk posted:There exist programs that combine undergrad and med school to make it a more streamlined process. The problem is selection of valid candidates since it is very hard to judge if an 18 yo is going to be able to cut it as a doctor. Whereas with the traditional med school process; usually candidates are able to make it through the entire program (80%ish graduation rate). I suppose if it was substantially cheaper (or even free for the user as they're going through the program) some of this would be alleviated but even if you streamline out some of the undergrad reqs (gen eds and such I guess? I see a lot of value in those types of classes for everyone, but that's probably where you would have to cut) you can reduce some of the cost but by and large med school is expensive and that isn't going to change by reducing undergrad requirements. Currently, med school is a grindfest that attracts sociopaths and money-driven suburban kids who should not be doctors. I would reform medical school as well and make it far less competitive than what it is currently, which is again part of a cartel system designed to reduce the supply of doctors. People in this thread are falling for the typical "polite awfulness" of liberalism, where problems are acknowledged but for which solutions can only include minor tweaks to the machine. When in reality the system as set up is designed to be a broken cartel. CAPS LOCK BROKEN fucked around with this message at 19:30 on Nov 1, 2018 |
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Nov 1, 2018 19:26
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CAPS LOCK BROKEN posted:No other profession works like this. Consultants start out at the analyst level making 70-80k a year doing the grunt work. They are not matched to a 'residency' according to an opaque, collusive process designed to kneecap the number of doctors and create an artifical shortage. consultants are not making life or death decisions, and junior consultants aren't allowed to do anything at all, are basically in on the job training, and exist as a business reason to allow the equity partners to charge the client far more than the senior consultant could get away with for his time by spreading the markup around the junior people on the team (because the junior people on the team will be charged at like 50-70% of the hourly rate of the senior people to the client, even though the senior people make like 7-10x what the junior people do on a take-home basis) CAPS LOCK BROKEN posted:Currently, med school is a grindfest that attracts sociopaths and money-driven suburban kids who should not be doctors. I would reform medical school as well and make it far less competitive than what it is currently, which is again part of a cartel system designed to reduce the supply of doctors. you are pretty clearly someone who has no useful thoughts on how medicine should be practiced and are getting whiny that your lack of any sort of knowledge is being exposed
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Nov 1, 2018 19:29
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evilweasel posted:consultants are not making life or death decisions, and junior consultants aren't allowed to do anything at all, are basically in on the job training, and exist as a business reason to allow the equity partners to charge the client far more than the senior consultant could get away with for his time by spreading the markup around the junior people on the team (because the junior people on the team will be charged at like 50-70% of the hourly rate of the senior people to the client, even though the senior people make like 7-10x what the junior people do on a take-home basis) Many professions involve life or death decisions and don't retain this level of cartel style control over hiring. tell me why medicine deserves an antitrust exemption for a residency matching system that is blatantly collusive evilweasel posted:you are pretty clearly someone who has no useful thoughts on how medicine should be practiced and are getting whiny that your lack of any sort of knowledge is being exposed i would have expected a higher level of discourse from a distinguished former moderator of the debate and discussion subforum
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Nov 1, 2018 19:32
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