The success of the healthcare law

[Deleted]

rests on young doctors choosing to do something that is not in their economic self-interest.

This is from an interesting article in the Washington Post about a coming shortage of primary care doctors, the relation of specialists to higher costs, the effect of Medicare regulations on the number of doctors and how hospitals choose to train doctors that will bring in higher revenues.

That worsening shortage, he says, has to do with the economics, with nearly every incentive working against going into primary care.

“No matter what speciality you’re going into, your medical education costs the same,” Stream says. “Think about a medical student who is sort of interested in primary care and has got $250,000 in debt. People are often driven by financial incentives, and you basically get the outcome that you incent. Health-care workforce is not different from any other sector in that regard.”

Full article is here:

www.washingtonpost.com/business/success-of-health-reform-hinges-on-hiring-30000-primary-care-doctors-by-2015/2012/02/06/gIQAnslQ4Q_story.html?hpid=z2

[Deleted]

Let's say that a passing grade for medical school is 70% or better. You can bet your life (& you will be) that those that score 90% or better will generally go into private practice. Even those that score 80% or better will probably go into private practice.
The government (in general) gets the low scoring doctors & doctors from other countries that need a toe hold here to start practicing. That's just the way it is.

[beenherebefore]

This is just one of the many, many bad points about this ridiculous legislation.

[Deleted]

Feb 11, 2012 16:05:00 GMT -5 @oldtex said:

Let's say that a passing grade for medical school is 70% or better. You can bet your life (& you will be) that those that score 90% or better will generally go into private practice. Even those that score 80% or better will probably go into private practice.
The government (in general) gets the low scoring doctors & doctors from other countries that need a toe hold here to start practicing. That's just the way it is.

Actually, almost everybody works for a hospital nowadays. Malpractice insurance and business overhead are cost prohibitive for private practice.

And high paying specialty care can pretty much only be done through a hospital.

The primary care shortage has been a problem since well before the ACA passed.

[Savoir Faire-Demogague in NJ]

The primary care shortage has been a problem since well before the ACA passed.

ACA is exacerbating the problem.

[Deleted]

You're right. Damn poor people booking all of the appointments. I'm middle class dammit. I shouldn't have to wait. My health is more important than everyone else's because my salary makes me an inherently better person.

[Deleted]

Damn poor people booking all of the appointments. I'm middle class dammit. I shouldn't have to wait. My health is more important than everyone else's because my salary makes me an inherently better person.

Medicaid's reimbursements are so low that practices have to limit how many patients they take - otherwise they would go out of business. They try to keep a certain mix of medicaid, medicare, private and charity care that allows them to remain solvent. Middle class people with employer based insurance have a much easier time booking appointments than people with medicaid.

[Deleted]

Let me give you a real world example. I used to do billing in an optometrists office. For cash patients the charge for an eye exam was about $107. Private insurance paid around $80-90 for the same service. Medicare paid for the physical examination portion - around $50 - and the patients kicked in $17 for the refraction portion (what you use to get a prescription for glasses). Medicaid paid $41 for an exam and $20 for glasses and lenses every two years. The doctors I worked for preferred to have plenty of time with their patients - they scheduled appointments to last between 30-45 minutes depending on age, contact lens use and other factors. So they could see a maximum of two medicaid patients an hour at a rate of around $80. Meanwhile they were paying me (16-17 an hour) and two ophthalmic technicians at a rate of over $20 an hour each. So $60 at the least in payroll (probably higher than that when you included retirement, health and vacation benefits). Then you throw in the doctors having to earn money and overhead and it's pretty clear that you losing money on every medicaid patient, which is why we limited the number of appointments.

We would refer medicaid patients who called to a new optometrist who would take them. He scheduled 15 minute appointments and was still busy a month or two out.

[vandalshandle]

Another example of, "This is another medical care crisis! It has been a crisis coming on for 40 years, and it is all Obama's fault! No, I don't have any solutions, but you can bet your bottom dollar that we would have solved the problem by now if only McCain and Palin had been elected!"

[Deleted]

"This is another medical care crisis! It has been a crisis coming on for 40 years, and it is all Obama's fault! No, I don't have any solutions, but you can bet your bottom dollar that we would have solved the problem by now if only McCain and Palin had been elected!"

Would it surprise you if I told you I think the only solution for poor people is universal healthcare? It would certainly improve their medical access. Well-off people would go to boutique clinics and private hospitals - their care would likely remain the same. Middle class and union people would, in a lot of cases, see their care decline.

[swamp]

Feb 11, 2012 16:05:00 GMT -5 @oldtex said:

Let's say that a passing grade for medical school is 70% or better. You can bet your life (& you will be) that those that score 90% or better will generally go into private practice. Even those that score 80% or better will probably go into private practice.
The government (in general) gets the low scoring doctors & doctors from other countries that need a toe hold here to start practicing. That's just the way it is.

Grades have nothing to do with how good a doctor is.

[vandalshandle]

Feb 11, 2012 17:51:57 GMT -5 @anne81 said:

"This is another medical care crisis! It has been a crisis coming on for 40 years, and it is all Obama's fault! No, I don't have any solutions, but you can bet your bottom dollar that we would have solved the problem by now if only McCain and Palin had been elected!"

Would it surprise you if I told you I think the only solution for poor people is universal healthcare? It would certainly improve their medical access. Well-off people would go to boutique clinics and private hospitals - their care would likely remain the same. Middle class and union people would, in a lot of cases, see their care decline.

You are preaching to the choir, Anne!

[weltschmerz]

Would it surprise you if I told you I think the only solution for poor people is universal healthcare? It would certainly improve their medical access.
-----------------
Universal healthcare only works if EVERYONE pays into it.

[Deleted]

Universal healthcare only works if EVERYONE pays into it.

That's going to disappoint a lot of people, considering that half of households in the U.S. have no federal tax liability.

[Deleted]

Grades have nothing to do with how good a doctor is.

Swamp they have nothing to do with their bedside manor. Grades are a good indication of how good their memory is. Memory is VERY important to doctors. They may have a patient that has something that they were tested in school on 15 years ago. Now I will agree that it's not 100% or that some doctors might be better than their grades indicate. On the other hand some doctors that I've know puzzled me as to how in the hell they graduated (cause they were dumber than dirt).

As for most doctors working for hospitals now days....most doctors are affiliated with hospitals (like my heart doctor) & he works closely with a local hospital. But he doesn't work for them. He has his own totally separate business & has 2 other doctors working for him (plus some PA's) & associated businesses (like a cardiac exercise program, etc). To the casual person it does look like he works for them but he doesn't. Hospitals like it that way because of the insurance aspect of the business.

[handyman2]

Our family doctor closed his private practice even though he had a good sized one and went to work for a large hospital in the trauma department.
The massive new paperwork requirements of the health care bill and large increases in liability insurance even though he had never had a claim was the factor that made him go work for a hospital. He had been in our town 15 years and was well liked and trusted. The local hospital now has only one practicing surgeon left and he is retiring in about a year.
By the way our family doctor had come from Canada to practice in the US. His comment was that the Canadian health system is badly flawed in reasonable compensation to doctors and he had other collegues looking to come to the US. That was before our current healthcare bill was passed.

[vandalshandle]

"His comment was that the Canadian health system is badly flawed in reasonable compensation to doctors and he had other colleagues looking to come to the US. That was before our current health care bill was passed. "

...and yet, he does not return to Canada to practice medicine...

But, I can see his point. He is not really expecting too much in the USA. Just lots of money with little paperwork. By all means, we should accommodate him, even if our poor are left with no access to health care....

[ugonow]

The government (in general) gets the low scoring doctors & doctors from other countries that need a toe hold here to start practicing. That's just the way it is.

I have to think the fact that this is the last frontier for the industy is why doctors from other countries flock here.

[billisonboard]

Feb 11, 2012 22:40:20 GMT -5 handyman2 said:

...
By the way our family doctor had come from Canada ...

...American medical schools, which charge more (and sometimes significantly more) tuition than their Canadian counterparts. On average, it’s $38,000 per year in the States for med school, while here in Canada it’s closer to $15,000. But it’s still an interesting idea. oncampus.macleans.ca/education/2011/06/01/should-med-school-be-free-in-canada/

So he took advantage of the Canadian taxpayer subsidies for his education and then left there to practice here where he could rake in more cash. got it

[The Walk of the Penguin Mich]

Actually, almost everybody works for a hospital nowadays. Malpractice insurance and business overhead are cost prohibitive for private practice.

And high paying specialty care can pretty much only be done through a hospital.

Right now, I'm under the care of an orthopedic surgeon and an infectious disease doctor. While both are affiliated with a hospital, they both have private practices as well. In fact, the orthopedic surgeon who took out my hip is in yet another private practice and the surgeon who did my first replacement is also in a private practice. When I pay their bills, I pay their practices, not the hospital. Come to think of it, the anesthesiologist service that I have used for the last 2 surgeries is also paid through their private practice. Radiology is yet again, a separate bill where I pay the radiologist through their practice.

I'm guessing that if they were on the hospital payroll, these bills would have come from the hospital, and both me and my insurance company would be paying the hospital. We're not.

The surgeon who did my first replacement was affiliated with a medical center, but the pay and the stress was so abysmal that he went into a private practice with a couple of other people.

[safeharbor37]

www.youtube.com/watch_popup?v=7n2m-X7OIuY

[Deleted]

I think a lot of specialists find it pretty lucrative to have their own private practice while primary care doctors tend to have to affiliate.

[handyman2]

One problem that needs to be addressed is the cost of meeting the required paper work costs to doctors. Some reembursements do not even cover that cost. According to our current doctor. The problem for doctors and hospitals is that there is a lot of redundent reporting that could be standardized and lower costs.

[Savoir Faire-Demogague in NJ]

Feb 12, 2012 13:46:46 GMT -5 handyman2 said:

One problem that needs to be addressed is the cost of meeting the required paper work costs to doctors. Some reembursements do not even cover that cost. According to our current doctor. The problem for doctors and hospitals is that there is a lot of redundent reporting that could be standardized and lower costs.

Whatever happened to the Paperwork Reduction Act???

[The Walk of the Penguin Mich]

Last summer the White House launched the Primary Care Residency Expansion at 82 hospitals across the country, with two strings attached: The programs must train residents dedicated to primary care, and the residents must work in underserved areas.

And this is going to be an abysmal failure.

A couple years ago, there was a physician in one of my healthcare management classes. She was hired under one of the programs in family practice, where if she practiced in a historically underserved area, her substantial medical school loans would be forgiven.

The problem that she encountered were that: (1) she had no backup, she was on call 24/7/365 since she was the only physician in the area. (2) continuing education requirements were impossible to do because she could not get away long enough to be able to attend the seminars. (3) she had no support from other professionals, many physicians discuss cases amongst themselves and she was isolated from professional interaction and (4) her school age children were not getting the education that they needed, the schools were not the best and neither she nor her DH could afford the time to homeschool.

After crunching the numbers, it wound up being CHEAPER for her to bail on the program that would have paid her 6 figure loans and move to a city where she'd have support, a higher salary, professional interation and better schools for her kids and pay the loans herself.

[vandalshandle]

I don't really care anymore, since I am retired, but when I was working, it never occurred to me to complain to the guys who paid my salary that they were requiring too much paperwork from me. Oh, well. I guess that was an opportunity that I failed to take advantage of.

[milee]

"I don't really care anymore, since I am retired, but when I was working, it never occurred to me to complain to the guys who paid my salary that they were requiring too much paperwork from me. Oh, well. I guess that was an opportunity that I failed to take advantage of. "

If you're paid a salary, then it really doesn't matter to you whether you have to do paperwork or not, you get paid the same. Unfortunately, that's not how docs are paid. Most docs are paid based on the number of patients they see and the procedures they perform. If the reimbursement for the patient/procedure is not enough to cover the amount of time they spend - and that includes the time they spend in paperwork - then a doc doesn't have much of an incentive to do the work. Totally different than being paid a salary.

But you might get your wish. If we do migrate towards universal healthcare or docs employed by the government, they'll be on a salary. They won't have to deal with that pesky paperwork any more, but they also will have no incentive to inconvenience themself by squeezing you in when you're sick or seeing a few extra patients to cover their overhead or make some extra money. So they'll be just as efficient as the post office and the DMV. It will be fantastic.

[Savoir Faire-Demogague in NJ]

But you might get your wish. If we do migrate towards universal healthcare or docs employed by the government, they'll be on a salary. They won't have to deal with that pesky paperwork any more, but they also will have no incentive to inconvenience themself by squeezing you in when you're sick or seeing a few extra patients to cover their overhead or make some extra money. So they'll be just as efficient as the post office and the DMV. It will be fantastic.

They'll likely all be unionized, so when you walk into the office needing emergency care two minutes before their afternoon coffee break, you will have to wait one half hour until they return.

[vandalshandle]

Wow! Living in a society like that must be unbearable! In view of the fact that the USA is the only industrialized nation on earth not to have universal health care, it must be hell living anywhere else!

[milee]

Well, judging from some of the stories of my British relatives (my husband is English), it's not exactly hell, but it's much worse than what we have now. My father in law died of a form of skin cancer that is almost completely curable if treatment is given in a timely manner. His treatment wasn't very timely, but it was free.