<p>No problem here with professional people who specialize. I specifically excluded some, surgeons for example, from my suggestion of going more towards a vocational model. I am happy to exclude other specialties, and that would be looked at on a case by case basis. My suggestion is aimed more at allowing doctors to enter practice without so much debt and lost opportunity time. Less debt would encourage more to enter the practice but it would also take away the pressure on doctors to make several hundred thousand a year in order to address their debt and live comfortably. I want them to live comfortably and as economically stress free as possible. I feel that will make better doctors. </p>
<p>Of course, everyone has the right to live where they want, but sometimes people have to relocate in order to work. If a doctor is forced into bankruptcy - what this thread was originally about - in Boston, then there is the option to make a nice living in southern Virgina perhaps. There are not enough doctors in the county in which my mom lives. If it weren’t for the NPs, she wouldn’t get much care at all. </p>
<p>I am a lawyer who no longer practices and anyone who has been to law school knows that you don’t graduate knowing much at all about practicing law. Three years of tuition and lost opportunity is completely unnecessary to the practice of law. I suspect there is some amount of education that is unnecessary to some areas in the practice of medicine too.</p>
<p>While the nitty gritty of my 7 years of specialized medical education and training might not be relevant every day, the core principles apply daily. In fact, I feel this is what separates me from people who can do some aspects of my work but not others. These things are reinforced by 26 years of practice, but I am not sure that I didn’t need substantial didactic insight before I was let loose on others. I feel that if you accept the idea that everything can be learned on the job and therefore your education is abbreviated (and cheaper, which of course would be nice) then you might do ‘fine’ for the every day issues, but not for the sorts complex and rare problems that crop up in medicine.</p>
<p>The problem is, patients don’t come in wearing signs that say ‘my problem is not what it appears to be and I need someone who recognizes that and can figure out how to treat it.’ If you are personally fortunate you have never had the experience of mis-diagnosis and treatment because someone was seeing a zebra but only saw the horse.</p>
<p>"Do they also supply the syringe and needle? In addition, I assume a staff member made the appointment for you, the nurse brought you back into (hopefully) a private area, donned gloves and perhaps even wiped the injection site with alcohol or another disinfectant. I’m not up on the overhead of medical practice, but I suspect $25 wouldn’t cover that, let alone the nurse’s salary. "</p>
<p>Makes no difference. The guy agreed to do that for a set amount of price.</p>
<p>Then cheating on the billing code just because he wants to make a profit is unethical. In my case he was paid about $100, but no he wanted $20 more by screwing me.</p>
<p>There was a local newspaper article on the mandatory move to Electronic Medical Records. One doctor complained that he had to cut down to 55 patients/day because of the extra charting requirements. My wife and I go to an NP whose shortest appt.duration is 20 minutes. An appt. for a yearly physical is 45 minutes, triple what is typical of most MDs. The disparity in pay is between MD/DO and NP can be seen in the waiting room.</p>
<p>I think most agree that in terms of medical knowledge after graduation, MD>DO>PA/NP. But the medical field has constant changes in standards of care requiring consumption of large chunks of new medical knowledge and on-the job learning. If your primary care person is 26 years old, you might want to see an MD, but if she is in her 40s, then the knowledge base is largely dependent of the personality of the provider and her studiousness, not on the college degree. The Medical Director of one of our large local providers is a 50-something NP. It’s important to have an individual provider with whom you are comfortable, not an “office” that you see.</p>
<p>That is not really what I am saying. I think there can be a compromise. Graduating with an average of $200k+ in debt is simply unsustainable. Changes of some sort are inevitable. Moving away from primary care is not working and money has been a driving factor behind this since specialties are more highly compensated.</p>
<p>Yes, it all horse trading in order to get better rates. It is even against the law to ask others what their reimbursement is.</p>
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<p>Agreed. But the office does make a difference. I have left the care of some providers as it was too difficult to deal with their office. But providers should be judged on your personal experience and that of others.</p>
This is actually a terrible argument which displays a stunning lack of awareness of what life is like for most “normal” people. Car mechanics and electricians have to go where the work is. Sure, there are some who work where they like, in the form of business they like - and many more who can’t find work at all. If you want to work as an electrician you have to take the jobs that are available. And for a lot of people that’s:
Not where they’d like to live, or
Not the kind of job they’d prefer, or
Not the kind of pay they’d like, or
No job at all.</p>
<p>I know that that calculus is unfamiliar to doctors. The concept of “Sorry, there are no jobs for you, anywhere” is not a reality for US licensed physicians and surgeons. That’s why much of the caterwauling I hear from the medical profession doesn’t really move me. Yeah - I agree that doctors should be well paid, based on training and job responsibilities. No, I don’t think they should be treated as royalty, or completely insulated from the financial realities of the world. which is the impression I get from some of the whinier members of the profession.</p>
<p>Yes, and instead of collecting unemployment and severance, all of those laid off union workers in depressed industries should be fracking in North Dakota.</p>
<p>For flu shots, Medicare reimburses about $30. It is about $15 for the drug and another $15 for the administration. The actual per unit cost of the flu vaccine is about $12. In the world of pharmacy, we make a lot of money on flu shots.<br>
In a MD office, a MA, making $12/hour, will probably give you the shot. In a pharmacy, the $60/hour pharmacist will give you the shot.
The big difference is with billing. Pharmacy uses point of service billing. We know immediately if a claim is covered. Physicians bill after the service.</p>
<p>“Yes, and instead of collecting unemployment and severance, all of those laid off union workers in depressed industries should be fracking in North Dakota”</p>
<p>No kidding. People need to quit complaining and go to where the work is. Even if it’s in North Dakota.</p>
<p>^ This is a good theory but I know a young couple in this situation. They have a young child, both were working and they live near their families in this small town for decades and the family helps take care of their child. They live the kind of small life you don’t see a lot of on CC: where you live for your friends and family, not your career, going back generations in the same town. </p>
<p>Now they’ve lost their jobs and have moved back home (but their parents just barely get by financially themselves). We talked to them about pulling up and moving to where the jobs are. As minimum wage earners to begin with, it is not easy to move: needing the gas money, the funds to cover motels until they find jobs, the rental deposit, not even the reliable vehicle to move several states away. And if they move, their social support system and care for their child disappears and they are down to one income. It’s a real catch-22. Even as a very resourceful and well educated person, it is difficult to imagine what I would do in their situation.</p>
<p>"A doctor can always find work. "
-Exactly
"A lot of people are unable to pick up and move to NDAK because they cannot sell their house. "
-Tough. Then you have 2 mortgages until you sell. Some are even going to different country altogether if they have a job. Whatever it takes. I have friends who cannot move because they travel 1 hr (one way) in opposite directions, they consider themselves lucky to be employed. Most MD’s spouses are not working anyway, some do, but I do not know single one around me, I knwo lots of MD’s. They definitely have less problem, less adjustment than working couples.</p>
<p>In HI, most spouses of MDs do work. Some are dual MDs & some are MDs married to others (sometimes teachers, pharmacists, nurses or others). It’s a huge challenge if there are no jobs in the area and the couple/family has to choose between staying with social support or move in the HOPE of finding a job. Our kids both will be living where the jobs are, 2500 and 5000 miles from home. They want to gain experience before trying to crack our tough job market in HI & know our home is always open to them. We want them to gain skills & experience that they can bring back here.</p>
<p>The outer islands are having a huge crisis with not enough healthcare professionals, especially not enough MDs and definitely acute shortages of MD specialists. MDs and patients have to fly for medical care. It’s very bad.</p>
<p>^“It’s a huge challenge if there are no jobs in the area and the couple/family has to choose between staying with social suppor”
-We always had this in our area, many still travel to Detroit (out of all places) for work. Yes, we are much worse than Detroit, always have been. And "social support’ is a luxury than not many can afford any more.</p>
<p>Don’t know that we as a society can afford NOT to have social support, as it helps folks through the rough times. It’s not always family–for my kids it is mostly those they meet at work/school, with us in the far background, far, far away geographically.</p>
<p>Haha. This is such a ‘let them eat cake!’ argument. Why on earth would you assume everyone can qualify for two mortgages?</p>
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<p>You missed my point. The social support covers child care. What is your brilliant idea about how someone at the low end of the pay scale can go to work when they have a toddler at home? When they live near family, someone can watch the baby so they can both earn an income; if they move, only one of them can afford to work (since childcare would go beyond the cost of working).</p>
<p>^if one does not qulify for 2 mortgages, does not he live somewhere anyway, like apartment? I did not asume anything, just answered about concern. People who are waiting to sell houses might never sell it. Everybody goes where the job is. Many, many left our city and sell thier houses …few years later.
And toddler at home goes to Day Care. I did not share any “brilliant idea” I was sharing my life experience. Low pay is better than nothing, there is a better chance to find another job while working and gain another experience or go to school on employer dime. Done all of the above and, yes, have been unemployed 9 times without option of relocating, had to find a next one in economically depressed area, sometime with 50% cut. Again, you do what you have to do, brillint or not only history can tell. Mine was brilliant for me.</p>