<p>I see that Icarus has commented on my statement about family medicine. Not to offend anybody here but:</p>
<ol>
<li> Family medicine in general pays less than most medical specialties.</li>
<li> It is more of a shortage area than other specialties meaning less qualified people can obtain residencies just like any other job.</li>
<li> It usually involves less training - residency etc after medical school than a lot of other specialties.</li>
<li> The usmle scores are lower for family medicine than for most medical specialities.</li>
<li> I go to a lot of doctors and my experience is as stated - I usually get a referral to a specialist.</li>
<li> My daughter’s experience doing clinical rotations and comparing family medicine with other specialties is what I’ve stated. Perhaps I’m being a bit harsh with regards to the “cold” statement but I think you know what I mean.</li>
</ol>
<p>No offense to you, DocT, but none of the points you made have any bearing whatsoever on a family doc’s knowledge base or competence. Your argument is a huge non sequitur. “This specialty is not competitive, gets paid less than specialty x, and my daughter said something about them, therefore those doctors don’t know anything” :rolleyes:</p>
<p>Although this is CC, so I guess I shouldn’t be too surprised that the all-powerful and vague “prestige” means more than anything.</p>
<p>Is there a shortage?
Our family goes to FPs & NDs.
I only go to specialists when forced to.
I also stay informed and work with my providers to find the most effective & appropriate care.
I really don’t care for specialists.
My orthopedic dr for example not only lacks staff to take histories & weight,BP etc, but didn’t examine me at my last visit! ( this is a big time office so they may have staff, they just don’t use them) Panoramic view of the city & the waterfront though.
I was told to return after my synvisc injection- I told him I didn’t feel a difference, he said there wasn’t anything else he could do until I reached 65. Then I would be old enough for a knee replacement. End of visit. I didn’t even have a chance to tell him how my mobility had deteriorated, or how much pain I was in.
However, my ND takes 60-90min per patient.
I get better results from her & she is cheaper!</p>
<p>No shortage in this area. Where my MIL lived, terrible shortage. There are no OB/GYNs at all, the last time I spoke to a cousin there. </p>
<p>I don’t kow how to fix this system. I felt and feel strongly that medical care should be available and affordable for everyone in this country and forcing everyone to have insurance is as important or more so than forcing the to save for retirement (Soc Sec). But articles like the Bitter Pill make me ask, where the limits are? Is EVERYONE entitled to go to MA Anderson or the like when getting a dx? What limits should there be. Let me tell you I don’t know what I’d owe if I had to go to Anderson for treatment like the subject in that article and I have good insurance. I struggle with paying the out of network, way over the customary charge for my son to go to MSK for follow up exams. It’s a lot of money. I’ve had to bite the bullet and use the preferred providers rather than go to the Park Avenue crowd that are supposed to be so much better and smarter. If something comes up that needs that level of care, I’ll do a quick pivot and make tracks there; I’ve done so a number of times in my life already, but I can’t afford the best of the best care for everything even though we are high income and have good insurance, and we are pretty well connected medically. So for someone to buy cheap insurance and then expect it to pay for the leading edge care,…that’s not reasonable.</p>
<p>The total volume of knowledge required to be a general or family practitioner is at least that needed by the specialists; it is just spread thinner over more topics. The Adult Nurse Practitioner I go to (not my wife, by the way), after practicing for 30 years, would outperform 95% of the doctors around here and gives me a hug when she sees me.</p>
<p>Part of being married to a healthcare insider means that I get special knowledge as to who is the best and the brightest.</p>
<p>Back on topic: my wife, more than 10 years ago now, needed a series of shots. She got the first one at the hospital at a cost of $2100, $840 out of pocket for our 60/40 insurance. She ordered the rest of the shots herself at $60 each and had a colleague do the injection for free.</p>
<p>Most people would not need anything more than catastrophic coverage if medical care was priced properly and everyone lived responsibly health-wise. We’ve created a monster that we’re about to fatten further by requiring insurance companies to cover everything including routine care. I know the argument that preventative care reduces costs down the road, but the idea that we must make people give it and get it for free just proves what irresponsible babies we are.</p>
<p>I agree. I think people today are willing to pay for their cell phone plans and internet/cable use but think someone else should pay for their health care. It makes me feel like an old grouch, but there it is. We pay almost 2x more for cell phones and cable/internet each month as we pay for electricity, gas and water.</p>
<p>“The total volume of knowledge required to be a general or family practitioner is at least that needed by the specialists; it is just spread thinner over more topics.”</p>
<p>It’s about to get worse: PCPs are now going to be “gatekeepers” for mental health and chemical dependency care. And most of them don’t know diddlesquat about either, and don’t want “those people” in their practice.</p>
<p>Mini, here in NY, they already are. You want that kind of care, a doctor gatekeeps you nad has to continually certify that it is medically necessary even if it is another doctor, say a psychiatrist one is seeing. Wouldn’t be an issue but I also suspect that these managed care plans put pressure on the doctors as to how often they refer to specialists and make them by that extension part of that bureaucracy. You don’t play ball with the insurance company, you become out of network. Blue Cross Blue Shield dropped the major county hospital here because of disputes which has put a lot of doctors who are affilated with it into a quandry…</p>
<p>But I DO know how to fix the system, and it isn’t hard. My former business is still up there in British Columbia, and they think we are a bunch of idiots. It works. It would work better with more resources, but it works. Everyone is covered. My colleague with Parkinson NEVER waits for anything - he receives wonderful, holistic care, including alternative care - and he never has to worry about paying for it because he has already paid for it. His wife has never waited in an emergency room. It really isn’t very hard. And I don’t know ANY Canadians - and certainly no British Columbians - who would trade their system for ours (though polls says there are 6% of them; I just don’t know where they hide. )</p>
<p>It really isn’t very hard (just politically difficult), and anyone who thinks it is just isn’t looking very hard. Get rid of the insurance companies, make sure everyone has access, and all kinds of things become possible. Not perfect, but possible. And then, with everyone having a stake in it, you fix it as you go.</p>
<p>I love to get called into the hospital, take time away from my family, spend 3 hours evaluating a patient and doing surgery on them, get home in the wee hours of the morning and not get paid. Nothing more fun than that! </p>
<p>And our recourse? Send them to a collection agency. Then wait for the next midnight phone call.</p>
<p>I did not come away from that article thinking that the problem is what physicians earn. A few weeks ago I saw my doctor for my well woman check. He probably spent 20-30 minutes with me. Then I went down the hall for an ultrasound. The adjusted rate for the half-hour ultrasound was over $1,000. That machine is in constant use throughout the day. The person running the machine is trained, but not as trained as my M.D. I’m betting that those procedures bring in far more money per minute than the time my doctor spent with me. I’m not saying I didn’t need the test. I’m just saying that where costs seem out-of-proportion are with imagining tests, medications, lab work, etc. The physician’s time and expertise is probably getting a short shrift when you consider there is an office to maintain, malpractice insurance (which for OB-GYNs is astronomical), highly-trained nurses, office staff, etc.</p>
<p>^ look for procedures involving medical devices to get more expensive (new ACA device manufacturers tax)</p>
<p>Re: Health Insurance as the source of all our health cost pain. Interesting how the industry is morphing with the ACA. The big move is toward “disease management” and that is very much something the insurers are pushing. They could well emerge as the big players in the brave new world of healthcare as the purveyors of protocols and formularies for all the biggie health cost drivers – diabetes, copd, cancers, etc.</p>
<p>In other words, they will work with the government to reign costs by hatching very specific and thrifty frameworks for treating patients with certain disease categories. They will then drive the bargains with the pharma companies, determine the formularies – what anitbiotic (usually generic, no doubt) will be used for what infection, where to get your physical therapy and how many sessions, etc. Their whole bent will be to hold costs down because they will then net more since they are really receiving their money from the govt.</p>
<p>So health insurance as we know it may be a very different player going forward.</p>
<p>I prefer to be treated by an MD vs a NP or PA or whatever. Just seems as if they had to do more and bring a higher level of IQ to the table to make it through. Lots of lousy docs of course and brilliant NPs. But I think we need MDs at the helm.</p>
