Isn’t the limited number of residency spots available the true gating factor in the number of new physicians who can enter the profession in the US, regardless of whether their medical education was done in the US or some other country?
@ucbalumnus, you might be right. I’m not an expert on this topic.
Ucbalumnus is correct. The govt puts limits on the # of residency spots because residencies are partially federally funded.
And ucbalumnus, if you know something to be a fact, it’s ok just to state that fact. I’ve noticed you have a tendency to pose something as a question when you know that it’s the answer. If X is true, you can just say “X is the case” instead of “Isn’t that true that …”
I too would find another doctor. Some offices feel like factories where you are just one more patient on a conveyor belt. If any type of surgery is involved for myself or a member of my family I am going to have questions and only the doctor will suffice for that as far as I am concerned. I am not going to be shuffled off onto a nurse or admin personnel.
The forms drive me crazy as well. Sometimes you can get the forms prior to the day of surgery for review. I always cross out the paragraph giving them permission to photograph or video the procedure. Almost all the forms have the patient absolving the physician of his/her “gross negligence” which is ridiculous. I always cross out “gross” and initial it - sometimes I get away with it and sometimes they say these our the standard forms, take it or leave it. With my D’s recent tonsillectomy they didn’t even notice I crossed anything out.
I am also very careful about the section giving them permission to have someone “assisting” them with the surgery. To me “assist” can mean a lot of things. For my H’s knee surgery I know we revised that section because H did not want anyone else working on his knee but that specific doctor.
It’s all theater anyway because even with informed consent, you could still sue for a bad outcome. Any form that has the patient absolving the physician for gross negligence is worthless.
I don’t know why you’d get picky over someone assisting. It’s in a physician’s best interest only to call in people to assist whom he knows are going to do a good job. H gets called in all the time to assist on other OB-GYN’s c-sections.
When I see the word “assist” I think of residents or medical students especially if you are at a teaching hospital. Which might be fine for some minor procedures but not for knee surgery. If my surgeon were going to call in another doctor to assist I would want to know. Doesn’t the ethics code mandate that?
And a definition of “assist” should be provided. It could mean anything from (1) medical student observing big-wig surgeon operating, to (2) first-year resident actually doing the surgery while the big-wig supervises, to (3) specialist with particularized expertise called in for assistance on particularly thorny issues. The consents are intentionally vague. 1 and 3 would be fine, but I would not agree to 2.
All else being equal, you’re probably safer at a teaching hospital with a first-year resident doing a procedure while an attending supervises, than you are at a non-teaching hospital with a doctor doing something by himself with no oversight.
“Assist” is not just about med students or residents. If H does a C-section, often a second doctor is called into assist. If he’s the doc on call and there’s a shoulder dystocia, they call him to assist. He has a very good sense as to what doctors in the hospital he wants assisting him and which ones he wants to stay away from – and which ones he’s had to “rescue” because their technique isn’t as good as it should be.
They do. I used to go to a free-standing dermatology practice and they were very heavy into pushing cosmetic treatments. Then I developed alopecia and my primary doc referred me to the dermatology department of the very large regional medical group which (now) all of my doctors are in. They don’t do cosmetic dermatology there at all.
I have a good relationship with my docs. I ask them point blank who will be working on me and they tell me. If they ask for permission to have observers, I have always said yes because my docs are also often profs and highly respected. I would be ok with my doc have someone assist, if it’s really JUST assisting. So far, I’ve been mostly conscious when I’ve had most things done, so aware of much of what’s going on.
I will just note that while there are good and bad docs everywhere, teaching hospitals may have less glam facilities, but be more up to date in the latest research in a field. If your doctor is not at a teaching hospital (which certainly isn’t feasible for everyone particularly in smaller areas) it’s typically a decent sign if he or she has some kind of teaching or professorship role there.
I could be wrong but I was told that there was a shortage of dermatologists. That was true in the area we used to live. So finding a new dermatologist could be difficult. My H has a skin problems and finding a good dermatologist was difficult.
This is my opinion. And our experience with a practice. The practice was owned by the hospital. The doctors were employees of the hospital and had no say in their office staff. Now personally I wouldn’t know why the doctors didn’t have a say in their office staff, but that is what I was told. The office staff was terrible and nothing was done. The doctors in that practice worked their hours but since it wasn’t their business they seemed uninterested in the office politics.
Doctors are human. They have to eat, they have to use the restroom and sometimes they don’t feel well, but they go to work anyway.
There has been a lot of dissatisfaction by providers when practices are bought up by hospitals or other big conglomerates. People who have previously been in charge of decision-making are no longer able to do so about many aspects of their practice. So they do what they can best do to practice and provide patient care the way they were trained and are comfortable doing and not putting themselves or their patients at risk. Office staff policies, etc are, sadly probably not in their control and they have patient care to focus on. It stinks, but if the cannot fix it, and their concerns are falling on deaf ears, they have to choose to focus on what they can do. Don’t know how any patient can know what the providers do/do not get involved in in office “politics” or administrative policies. Perhaps they do try to get problematic staff replaced (and then the new ones have to be trained up to do an adequate job) and it is not addressed. Or at the bigger level, HR issues come into play at the corporate level and getting rid of a bad employee is not easy. Should the docs stage a sit-in until a bad employee is replaced or retrained? Lighten up on the docs a bit, please.
This kind of disconnect may be key to a lot of communication problems between health care providers (and their staffs) and patients. What’s part of the day-to-day routine for the health care people may not be routine for the patient, but I think it must be hard for the health care people to remember this.
Not to wish any health problems on other people, but I think doctors could benefit from having more experience being patients (preferably in a situation where they don’t get special consideration because they are colleagues). It might help if they could see situations better from the other side of the examining room. If they were the ones who were given incomplete information or who had to wait far longer than necessary for important test results, maybe they would see things differently.
A very long time ago, I watched a good pediatrician turn into a great one after she had a child of her own. (Among other things, she stopped making ridiculous pronouncements like “Practically all children are fully toilet trained by two and a half.”) A good doctor might turn into a great doctor by having a health issue that involves parts of the body outside his/her own specialty and going through the experience of being diagnosed and treated.
My dermatologist’s office offers all of the aesthetic treatments mentioned here. But the doctors don’t do them; they have someone who was specifically hired to do those treatments. The dermatologists do medical diagnostics and treatments only. I’ve never had any of those treatments, but I have zero problem with the fact that they are offered.
Thanks to all who expressed an opinion. I probably will try to find a different dermatologist. I don’t dislike the doctors I dealt with; I suspect their medical skills are top notch. I just think I should be treated as something better than the next widget on the assembly line.
Hopefully that person is a doctor, though.
Often, @usualhopeful, the person doing some of the cosmetic treatments (fillers, botox, scrubs, whatever) are nurses.
@jonri,
Most doctors still make patient care their primary focus. As of course they should. Are there some who probably shouldn’t be in patient care or are burned out? Sure. This is true of most businesses. Few doctors chose to go through med school/residency/internship just to find themselves in a large corporate owned practice, having to meet quotas, having no more than 10-15 min to see a patient, review their chart and provide the kind of patient care they were trained to do. Most providers are more unhappy with the changes in practice ownership and healthcare reimbursement than the patients are.
At least in my area, there are many dermatologists who have a strong cosmetic component to their practices who are truly excellent doctors, including in the non-cosmetic aspects of their practices.
In fact, I prefer seeing a dermatologist with a strong cosmetic orientation. I’ve seen both kinds, and the ones with the cosmetic practices are more attuned to avoiding scars from biopsies and the like. I want a dermatologist who is keyed into the cosmetic aspects of treatment, etc.
My relative does some cosmetic stuff, including specializes treatments sold to help eliminate age and sun damage but not the “sculpting stuff,” which she will refer you to others, if you want it. I’m not sure hers is a STRONG cosmetic orientation, but she’s very busy and schedules months out, unless it’s more urgent ( the staff will try to work you in sooner).