<p>There’s an enrollment period for buying insurance on the exchanges. You can’t just sign up the day after you have your car accident.</p>
<p>"I was trying to refute that by pointing out that my non-poor area has NPs. "</p>
<p>I live on a street with about 30-40 homes with at least 10 home owners who are all doctors, at least 3 homes with both husband and wife being doctors. However, this pediatrics practice is about 2 miles from here and in a pretty poor area and one of the doctors serving there lives in my community. They have 3 doctors and 3 NPs but all of the doctors seem to have other practices in suburbs. One time I asked how we can see one particular doctor and they asked me to go to a clinic in suburb. Very nice place, two pediatricians, not a single NP. Different strokes for different folks.</p>
<p>^^^^</p>
<p>I’m sorry too, for all the typos! I must have re-written that about three times, then quickly hit post without reading it when my “boss” was at my shoulder. </p>
<p>He is not really my “boss”, as he is a social worker, and technically he is not allowed to tell me what to do. He is a great guy, and he gives me a lot of freedom, but what I am relating to is feeling a little “degraded” by having to work for him. </p>
<p>I know I am taking this further of topic, but I think it is a mistake to allow the media to cause “splitting*” among health care providers . I’m pretty sure we all feel a bit “degraded” at this point.</p>
<ul>
<li>“Staff splitting,” … is a much-discussed phenomenon in which professionals treating borderline patients begin arguing and fighting about a patient, the treatment plan, or the behavior of other professionals with the patient. …” (M. Linehan, Cognitive Behavioral Treatment of Borderline Personality Disorder, Guilford Press, 1993)"</li>
</ul>
<p>texaspg, I didn’t mean to impugn your area, about which I know nothing. You asked whether poor people tend to be shunted to NPs, leaving doctors to take care of rich people. I say, not in my area. At my doctor’s practice, they don’t seem to be choosing who goes to the NP by the patient’s wealth.</p>
<p>I am not suggesting the doctors don’t see the poorer patients. I am saying the same doctors with multiple practices are allowing NPs in their clinic in poorer area while not employing them where they might only be receiving privately insured patients.</p>
<p>If people were as accepting of NPs as people claim to be on CC, I should have seen an NP listed on the suburban practice too.</p>
<p>“The ACA is forcing full time workers to become part time workers.”</p>
<p>No, companies are deliberatly choosing to be lousy corporate citizens. Not all, however. Cumberland Farms/Gulf has announced that any employee who wants health insurance only needs to ask to work 30 hours a week and they will be accommodated.</p>
<p>Starbucks has also announced that it will not demote workers to part-time to evade the provisions of the law.</p>
<p>Starbucks already provides good health insurance benefits to workers.</p>
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<p>But the system is still required to treat you…and the insurance company has to take you because there are no more pre-existing condition clauses. So, yes you may have a wait (30 days?) but you will be covered…after the fact.</p>
<p>Yes, Starbucks already does but even though it will be costing them more because of the new requirements, they are not going to use ACA as an excuse to cheap out. I’m not a fan of their coffee but I’ve decided to start giving them my business because of their stance.</p>
<p>No you won’t be covered for any charges you incur for treatment before you have insurance. You will be billed. Depending on what your medical situation is, it could ciost one many, many of thousands of dollars. Enrollment period is only going to be about a 60 day period (except this year) and unless one can postpone treatment until then, people without coverage at the time will be SOL. Why anyone with half a brain would take that risk is beyond me, but I am sure a lot will. They will get no sympathy firom me if they chose to be irresponsible.</p>
<p>You have to wait a year to sign up (well, average half a year, obviously). The enrollment periods are only once a year, not once a month. The insurance company has to take you during the enrollment period, but not otherwise.</p>
<p>The emergency room has to treat (hypothetical) uninsured you for your (hypothetical) car crash, but without insurance, good luck getting your physical therapy, or the surgery to repair the problems caused by the accident. </p>
<p>There are the usual exclusions for the enrollment period. You can enroll a baby when it’s born or adopted, and you can sign up for insurance through the exchanges if you lose your job, or if you move back to the US from overseas. But if you decided to go without insurance and pay the penalty, and then you have a health problem… sucks to be you, that’s why people buy insurance.</p>
<p>So much misinformation out there, it makes me wonder where people are getting all this misinformation from.</p>
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<p>“The system” isn’t required to treat uninsured people now. Emergency rooms are required to treat uninsured people (and will bill them and send collection agencies after them) but no other part of the health system is required to treat uninsured people.</p>
<p>In the Obamacare regime, the health system is still not required to treat uninsured people. If you want treatment, pay for it or buy insurance. The insurance subsidies are pretty generous.</p>
<p>Oh, don’t get me wrong…I think going without insurance would be very stupid. </p>
<p>With the penalty structure as it is there is still an incentive for the stupid to continue on as in the past using the ER (which must treat you) and roll with the odds.</p>
<p>We need to pull the non-emergency load off ERs.
I’ve said I’m in favor of clinics.</p>
<p>I guess the NP/PA issue depends on one’s area, whether it’s become popular. Some ob-gyn practices offer midwives, others don’t. Many offer nutrition counselors, have social workers attached or whatever.</p>
<p>I am an NP in a pretty affluent area. I have patients that don’t want to see me (only want the doc) and I have patients who only want to see me. I have kids with cancer, cardiac conditions and physician’s kids that request to see me rather than the doctor,because I listen to them.<br>
I have been an NP for 15 years and I’m pretty good at what I do. Here’s the reality. Do you really think you need a doctor to see 80% of the stuff that comes through the door? I can diagnose bronchitis or an ear infection as well as any doctor. In any practice, care should be tiered. I see the small stuff. That leaves to doctor available to see the more complicated issues. And if I see a patient who requires more expertise than I have, I refer it to the doctor in the practice. I have no ego, and the care of the patient is what’s important.
As far as insurance payments. The insurance is paying for you to see a qualified healthcare provider; sometimes that"s a doctor, sometimes that’s an NP.
With the ACA you’re going to see more mid levels providing the first level of care. It’s not cost effective otherwise.
And as far as seeing an NP once and not liking her/his care; I can tell you that there are plenty of doctors that I wouldn’t let touch my dog, let alone a family member. You have bad apples in all professions.</p>
<p>^ Do you have any comments on practicing independently? Is that something you want to do (set up a private practice), and if so, can you say why? </p>
<p>If you are working with a group, I would love to hear about how your group handles mental health codes and diagnosis. PM me if more appropriate.</p>
<p>I have no desire to practice on my own. I am not a doctor, and I think that there are some things that the doctor needs to address. I just feel there is a place and a need for midlevels and Americans need to adjust their ways of thinking about healthcare. You cannot have everything unless you want to pay for it.</p>
<p>I think NPs who don’t want to do solo practices should not do solo practices.</p>
<p>But it doesn’t bother me that an NP would have a solo practice, and refer some patients to an MD. A pediatrician could have a solo practice, and yet sometimes refer patients to oncologists or orthopedists. Seems like the same thing: tiered care.</p>
<p>I had a certified nurse midwife in a solo practice when I was pregnant with my son. She was great, although I didn’t end up with the home birth I was planning.</p>