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<p>No, it’s a rigged system. There’s price fixing by the government, closely followed by insurance companies to see what they can get away with, along with laws preventing MDs from even discussing fees with each other.</p>
<p>OK audiophile, I take back what I said. You are correct. Medicine is not allowed to function in a free market.</p>
<p>lol shrinkrap… 30 minutes? that’s peanuts… i was on hold for over an hour yesterday to ask about a remittance advice…the person told me i didnt have one…i said "“yes i do, i’m looking at it and it says denied and here are the codes”… NO you do not have a remittance advice… “excuse me but again…i am looking at it right now” final reply…well i say you dont have one!</p>
<p>You can go off grid and only take ‘paying customers’ who then file with their own insurance company. Then the price fixing is irrelevant, but it limits the patient pool and might not be compatible with a doctor’s idea of whom they want to serve. That is the ‘free market’ aspect of medicine. </p>
<p>I was recently invited to a webinar to learn how to improve coding to get better reimbursement from insurers. It is not relevant for me because I am off grid, but… in general, wouldn’t you rather your doctor be spending their non-patient time learning about actual advances in medicine, rather than how to fill out an insurance form better?</p>
<p>"lol shrinkrap… 30 minutes? that’s peanuts… "</p>
<p>It was thirty minutes when I posted…by the time I got a person on the phone, he asked who is the doc, and about ten other questions, then he asks who he speaking is to. I say this is Dr. Shrinkrap…he seems confused…implying you actually make these calls yourself???..he stammers a bit, then says something like …“so this is Mrs. Shrinkrap?”</p>
<p>"You can go off grid and only take 'paying customers…but it limits the patient pool and might not be compatible with a doctor’s idea of whom they want to serve. "</p>
<p>And there’s the rub…</p>
<p>Not too mention a potentially slippery slope into becoming what feels like a drug dealer. Think Conrad Murray.</p>
<p>Haven’t read the whole thread but just wanted to comment. I come from a family of surgeons. Father, grandfather, great-grandfather, great-great-grandfather. My father earns a substantial income in a group practice. He works long hours, lots of stress, etc. The usual issues doctors’ deal with. He has strongly advised against going into medicine - there is too much **** to deal with that has nothing to do with providing patient care and he believes the financial rewards are no longer worth the difficulties.</p>
<p>This is the real change that’s occurring in medicine. It’s not a trade anymore. It is now strictly a business and all activity must be adapted to market demands (and in medicine, government action plays a huge role in shaping the direction of market forces). </p>
<p>My grandfather ran a private practice in a small town. He had personal relationships with his patients, was a prominent member of the community, made house calls, etc. That’s over, and I think it’s quite sad.</p>
<p>Not to sound belittling, but times change…there was a time Doc’s made house calls, times changed that…the days of small practices are on life support…for better or worse, the days of doctors personally knowing you are over</p>
<p>^^^^^^Isn’t that exactly what JanofLeiden just said?</p>
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<p>Under what circumstances can that be better?</p>
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<p>I’m not a doctor, but I’ve been in a similar situation, so my approach to that now is: “Would you prefer to receive a copy of it by email or by fax?”</p>
<p>Nrdsb4, my page hadn’t refreshed, but thanks for pointing it out…</p>
<p>It iisn’t for the better for the most part, but what i see now is i don’t need a Doc personally knowing me…i i have a myriad of Doctors who all have my electronic records…i see a cardiologist,a dematologist,a optomitrist,opthamologist, and a GP…having a small practice GP is a concept that is over…</p>
<p>I agree EMR’s share info, but as noted above, the info is often not too meaningful. I still hold on to the believf that there is efficiancy to be gained from actually knowing, and having a relationship with at least SOME patients. I would say this is espeecially true of what some call “heavy utilizers”, but I can see how it could paly a role in other situations as well. Still, I agree it is a lost cause, at least for now. I do wonder though, if in two or three generations, someone will be rethinking it.</p>
<p>I shold have also added all the doctors i see are all based with a major medical center,so there is continutity throughout the visits etc</p>
<p>HI still has a LOT of docs who are solo or VERY small practices. Two of my docs are practicing with a partner, another is in a small practice (but I have never seen his partners). In the 30 years I’ve been seeing my internist, I have seen his partner only once for a visit when mine was unavailable. He has been to all of our weddings and major celebrations, treats my folks, my sibs (who aren’t in HMO), our kids, and knows our family histories very well. He treats many multi-generational families. We are glad to have him & he DOES know all of us and what problems we are likely to have vs. not have. He is one of the few holding out on using hospitalists. I treasure him!</p>
<p>Even the doc I have seen at a hospital far from our home is the doc who always works with me since I 1st went there in 2000. We have built up a relationship in the 11+ years we have been working together and he knows me & my case well. He has many other docs working with and under him but has not had me go to any of them. He follows my case and responds to my emails, directing my care. It has worked very well, keeping me healthy all of these years.</p>
<p>Our allergist has been working VERY hard to help keep all of us as healthy as possible. She has stuck with us when all the other docs gave up because our kids were so complicated to diagnose and treat over the past 10 years. We would have gotten no care or very fragmented care if she hadn’t stepped forward and taken charge of their cases. We are VERY grateful that she has been willing to do this for us and them. When your case is complicated or unusual, it takes more time and coordination and a better understanding of what has been tried, what has worked and not worked.</p>
<p>One of my sibs works for a HMO & his spouse & kids are covered by it. They are fine going to the doc available, as they fortunately have always been pretty healthy. If you’re healthy, it is not as important to have the same doc all the time, as you rarely even need to see a doc or healthcare professional.</p>
<p>[What</a> the Top 1% of Earners Majored In - NYTimes.com](<a href=“http://economix.blogs.nytimes.com/2012/01/18/what-the-top-1-of-earners-majored-in/]What”>What the Top 1% of Earners Majored In - The New York Times)</p>
<p>“According to the Census Bureaus 2010 American Community Survey, the majors that give you the best chance of reaching the 1 percent are pre-med, economics, biochemistry, zoology and, yes, biology, in that order …
…In other words, more than one in 10 people with a pre-med degree make it into the 1 percent”</p>
<p>Looking at that chart, I think their conclusions were wrong. Of Zoology majors, 6.9% are in the 1%, but they collectively make up only 0.6% of the 1%. Of Political Science majors, 6.2% are in the 1%, but they make up 4.7% of the 1%. Of Accounting majors, 3.9% are in the 1%, but they make up 4.75 of the 1%.</p>
<p>I think the percentage OF the 1% is more telling than the percentage of any particular major that IS the 1%. In that case the top 5 are Biology, Economics, Political Science tied with Accounting, and English Language and Literature.</p>
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<p>I disagree. Almost 1 out of 8 pre-meds is a 1-percenter. For English majors it’s less than 1 out of 25. That means the student following the pre-med path is statistically roughly 3 times more likely to become a 1-percenter than an English major. You’ve got to use a statistic that reflects the fact that there are almost 14 times as many English majors out there as pre-med majors.</p>
<p>^^ it could also just mean that the “floor” is higher for pre-meds than for English majors. Some go to Law school, some go to taxi school. There’s a smaller discrepancy for the pre-health group, which I assume ranges from nurses and pharmacists to cosmetic dermatologists and plastic surgeons. Either way, the statistics are interesting, but I wouldn’t make too much out of them otherwise the easy way out looks like zoology - good chance of getting to the 1%, not too much competition.</p>
<p>This graphic is more damning, if you’re trying to damn doctors. As a side note, I love the NY Times graphics department.</p>
<p>[The</a> Top 1 Percent: What Jobs Do They Have? - NYTimes.com](<a href=“http://www.nytimes.com/packages/html/newsgraphics/2012/0115-one-percent-occupations/index.html]The”>The Top 1 Percent: What Jobs Do They Have? - NYTimes.com)</p>
<p>The chart says nothing about how many required graduate degrees to get into the 1%. I’m betting that, for those with only undergrad degrees, art and art history do very well ('cause they were born into it).</p>