<p>Let all the behind the scenes PMing resume…</p>
<p>I really don’t like all the pegging of people that happens here, and assumptions regarding what people are about. Some of us are not spending all of our time here posting in a way that defends and insulates our own choices.</p>
<p>I learned something about the medical field by living with and knowing my father for 40 years. He was a “local suburban/rural” surgeon. When there was a car wreck on the interstate he would treat maybe 3-4 of the victims and often there would be 1-2 that he “needed to send to Duke or Carolina.” He didn’t go to Harvard med. I don’t have any affiliations with Harvard med or Hopkins, etc. But I did grow up surrounded by physicians my whole life in the Duke-UNC corridor, and I learned some of what I said here from my Dad. He was a very fine surgeon, but he often talked about colleagues or some he had been in school with who were brilliant at another level and who often went into academic medicine. It wasn’t and isn’t always about the biggest salary. Geez, the Prez of the USA makes far less than many CEOs and Exec VPs. Anyway, I would be interested to hear Pizzagirl how your H decides who to take into residency. Does he just draw out of hat, or are there certain credentials that he looks for. And is the 3.65 at Illinois Wesleyan rated exactly the same as the 3.65 at Harvard, Yale, Hopkins, Wash U, Williams, etc?</p>
<p>sally, it’s OK. Why do you think I knew about Mr. Shah? Certainly not because of my interest in Harvard med. I knew about him because I was and still am very interested in Ursinus. See, my interest was Ursinus. I bet I know more about Ursinus than most posters on this thread and on this site in general. (And Wooster, and Hendrix, and Birmingham-Southern, and Rhodes, and Centre, etc, etc.) But I also know Shah was very special, and that he didn’t get into Harvard med by being an average Ursinus pre-med student or an average pre-med student in general. I don’t know what the top pediatric neurosurgery residencies are, but I’m gonna take a wild guess that there are a few that stand out and that applicants for pediatric neurosurgery residencies know what they are. In other words, they aren’t ‘flat.’</p>
<p>And I’m sure the significations embedded in the words ‘Harvard Med’ and "Rhodes Scholar’ have nothing to do with how Ursinus has proudly (and rightly) featured this young man on their website and in their materials.</p>
My take on this comment is that it doesn’t matter whether the physician was trained at Harvard or Guadalajara. They all collect the same reimbursement rates from Medicare Within that region-- it varies by state). You can charge all you want if you are a hoity toity doctor in a fancy schmancy practice. But if you accept Medicare you can only collect the same pittance as the doctor on the wrong side of the tracks. Thats the “flat” part of reimbursement. Not hard to understand. </p>
<p>Oh, and in some fields, the doctors must formally “opt out” of Medicare if they want to charge the patient for a service. They cannot simply say “I dont take Medicare”. They must go through the process of formally “opting out” every 2 years. They cannot collect private payment from a Medicare eligible patient, even if they are not listed as a medicare provide4r, unless they opted out. Stupid rule, but thats the rule.</p>
<p>I never suggested, in any post, that fee schedules, were part of my evaluative criteria. Anyone can bring that in if they wish, but that’s an entirely different discussion. There’s no relevance between fee schedules and comparative “prestige,” excellence [insert your own preferred word].</p>
<p>And if you want your physician to take a whack at the pancreatic cancer of one of your parents, are you suggesting it doesn’t matter? You’d just as soon let the oncologist trained in Guadalajara take a swing as the one from Harvard?</p>
<p>Uhm, for those referring to Final as “her” - she is a guy.</p>
<p>Also, some food for thought.</p>
<p>“An argument isn’t just contradiction.”
“It can be.”
“No, it can’t. An argument is a connected series of statements intended to establish a proposition.”
“No, it isn’t.” (Much later)
“Argument is an intellectual process. Contradiction is just the automatic gainsaying of any statement the other person makes!”
(short pause)
“No, it isn’t.”</p>
<h1>623…so your take was that “it doesn’t matter whether the physician…” is from X or Y in terms of Medicare reimbursement, and that that proposition naturally leads to the conclusion in the comment you responded to which was “This is evidence that medicine is “flat” in terms of prestige”??? So, you are endorsing that one implies the other?</h1>
<p>I probably will regret dipping my oar into this sea of contention, but having served on medical school admissions committees, I thought perhaps my views might have some merit.
In my opinion nearly all the medical schools in North America offer an excellent education in basic medical knowledge and practice. With relatively minor differences they provide essentially the same curriculum. Through a process of self-selection and strict prerequisite requirements, candidates for admission tend to be of high quality across the board. The four years of medical school are intense in ways that no-one who has not been through the process as a student or close family member can ever understand. In this process interest, ability, and excellence provide direction towards specialization. It is at the level of specialization, i.e., residency, that meaningful discussion of the relative merit among programs some makes some sense. However, I would venture that any experienced physician you might ask will be able to name a colleague from an obscure program who is tops in his or her field. In my case I would name a brilliant diagnostician whose medical degree is from a university in Zambia.</p>
<p>Kennedy, do you have any thoughts about any of the other posters?</p>
<p>And I’m not sure how you get that out of 629. There is vigorous straining to agree with and respond to posts and questions that don’t follow at all. And then…did you find the questions in 624 unfair or irrelevant to the preceding discussion?</p>
<h1>631…Fair enough, but it sounds like, regardless of their place of origin, you do think “tops in his or field” is something that exists? Do you think Medicare reimbursement is relevant to the question of whether physicians can be of different quality?</h1>