<p>The costs of being a physician begin long before getting into medical school, as I stated. It really begins in childhood with learning as much as one can- doing the homework instead of just sliding by. Then- while most college students take average loads of average difficulty classes it means taking more classes and studying more than the average. It means giving up a lot of social time. Then the training. But, wait- there’s more- you never get to rest on your laurels. No matter how high powered or part time your practice is, in every field, you have to keep up. It does become easier with practice, but is forever there. </p>
<p>Time for nurses and other nonphysician medical personnel to jump in with their complaints- but they are too busy to or know the realities.</p>
<p>Many years ago there was a talk for physicians by a lawyer about malpractice. It came out that the lawyer was not bothered by malpractice- say if he didn’t dot his i’s or cross his t’s properly on a contract. He just resolved the issue financially and moved on. However, physicians do not just deal in a financial world. We feel it emotionally when things do not go right for patients- whether or not our care had a role in the outcome. Notice- the huge difference is that is isn’t about the money. There are intangibles involved (just as nurses are not in it for the money- they can often make a lot more with better working conditions).</p>
<p>We can go off on another offshoot. Once H gets Medicare and my Cobra runs out I, a physician, NEED Obamacare to have health insurance. I have at least one preexisting condition that even if optimized, would prevent me from being able to get health insurance under the old system. And, with the way things work, my fellow physicians couldn’t offer free care if their employers decided otherwise. I suppose I could go back to my childhood days when we never went to the dentist or let conditions get bad enough to require more, and more expensive, care. Raise my taxes, folks, so everyone can benefit. I only have one vote at the polls also.</p>
<p>wis75, I don’t think lawyers deal exclusively in a financial world, either. I’m sure they care about their clients (particularly in some practice areas), so that isn’t the exclusive domain of physicians.</p>
<p>Any comments on poor scheduling/time management of mental health practitioners? </p>
<p>I agree about lawyers. This particular one was donating time to discuss the then malpractice crisis with physicians. Most people, even in the business of making money, are not just about that and care about people they interface, including employees and clients. Outside of health care however usually money can take care of the problem- goods can be replaced et al. However, no money can correct many lost health issues, even if the best care is rendered.</p>
<p>I can see where time can get out of hand dealing with mental health issues. It is a lot easier to be brief and handle only the physical parts of a medical complaint- but how do you handle the patient that needs more time than allotted when time is the only way to help? Also I suspect those willing to go into a talking field are not abrupt and will easily do the extra social chitchat that can use time. Do patients accept a procedure as a reason for delays more than the need to talk more with a patient???</p>
<p>There are good and bad doctor patient fits. Some will love a style that others prefer to avoid. Some will bear with the style for the medical care benefits. Others are stuck because of their insurance choices. It is a lot harder to “shop” for medical care than most other services because you can’t just be a customer who walks in and out while trying to see if the practice is “right” for you. Very different than the customer viewpoint some would like to impose on this. </p>
<p>Emeraldkity, both ACOG and whatever-the-radiologist-association-is have come out strongly against the use of ultrasounds for “fun at the mall” purposes. So what on earth is your point?</p>
<p>Any business by definition has customers. They can be patients, clients, other businesses, etc. The problem with medical practice is that it is a mix of B2B and B2C model, where both B (insurance cos) and C (patients) have their specific demands and needs, and those demands do not necessarily overlap. So doctors have to deal with both!! Plus, the docs have to operate in a regulatory environment, and that eats up time and adds costs. Pizzagirl, your husband deserves a gold star for running his practice like he does! </p>
<p>Wis, anything that generates income is a business (not necessarily profits ). Don’t be offended by the term. It is what it is. Why is “business” anathema to some folks here? </p>
<p>Your example in post 323 is way off the mark, EK. Those ultrasounds are not being ordered by physicians. Someoe has gotten their hands on the technology and is misusing it. When I was a kid, my shoestore had an x ray machine where you could put your feet in and see the bones in your feet. It was ultimately removed when they realized the exposure to radiation was dangerous. There is a big difference between procedures ordered by drs for diagnostic purposes and those misused for fun and profit.</p>
<p>And are some medical procedures sometimes overprescribed? Sure - because many Drs feel the need to practice defensive medicine in this increasingly litiginous society. Not every person complaining of a headache needs a CT scan, but you dont want to be that patient with the tumor or the aneurism that is missed.</p>
<p>Sounds like you are more comfortable with your alternative medicine and therapeutic marijuana approach. Fine. But dont disparage the physicians in the meantime.</p>
<p>Nrdsb4- to answer your questions about ultrasounds, and medical tests in general, is that every test is a risk/benefit measure. You assess the risk of the test against the benefit. For instance, amniocentesis carries significant risks, so it isn’t offered in general to young healthy women who have a very low risk of having a child with genetic problems. After a certain age in the mother, the risk goes up to the point where the risk of amnio is less than the risk of finding something genetic. At this point, the mother has a choice. Some women would choose not to terminate a pregnancy- and could refuse the test. Another mother might make a different choice and want the test. A mother with a family history of potentially lethal genetic illnesses might want the test. There could be many reasons, all different and personal that would make parents lean to one side or the other. For some families, peace of mind that the baby is OK is a reason. </p>
<p>There are no known risks of harmful effects of ultrasound to the fetus or mother, but medicine is a constantly evolving science- what we know today, we will know more tomorrow. Since ultrasound seems to be very safe, the benefits of using it to asses the health of the fetus are many. However, doing ultrasounds at the mall for fun and games is using a medical test for no medical benefit. Doctors shouldn’t condone this kind of thing.</p>
<p>Years ago, before ultrasound was as useful as it is today, I knew of two very religious families for whom terminating a pregnancy was out of the question. They refused ultrasounds. Now though, some conditions can be treated if discovered by ultrasound so perhaps they would have chosen one today. For one family, everything was fine. Sadly, for the other, the infant had a life threatening birth defect and did not survive. Still, they would have not done anything different. They did have healthy children after that, and I think chose ultrasound because it gave the mother peace of mind during her pregnancies, and that is worth the risk of a test too. </p>
<p>I agree, I can’t imagine that any of them would think the mall ultrasounds are a good thing. Those weren’t around when I had kids, so I have no idea who does them or how they are done. I have seen some “mall” cosmetic"medical" offices (weight loss ) that to me seem to be out of bounds of what I think of conventional medicine. </p>
<p>Rather than blame doctors for these mall businesses, understand that there are all kinds of people in every profession. The mall businesses are for profit, and they offer a service that people are free to buy. Even if many doctors don’t condone this, in a free market and free society, they are not able to just shut them down. If the businesses are not ethical, then the medical boards and legal system could intervene, but doctors as individuals are not in a position to regulate them.</p>
<p>But I didn’t ask about doing ultrasounds at the mall for fun and games. I asked about the safety of doing one or two per pregnancy specifically to test for genetic abnormalities. As I suspected, there are no known risks to bouncing sound waves off babies in utero, so that is where the risk/benefit ratio may land squarely on the side of testing, particularly for families who have a risk of such problems occurring. The benefit of knowing in advance, and possibly being able to treat the baby for such problems could clearly outweigh the (as of now unknown risk) of doing the ultrasound.</p>
<p>Sorry, the mall reference was because I think the topic was brought up earlier. So far, ultrasounds have been very safe when used as they have been as far as I have heard. </p>
<p>Back to the notion that doctors make so much money even now, think of the debt that these doctors bring to the table. It’s much more than the average college grad carries. Tack on the exorbitant med malpractice insurance and the reduced payment for services many doctors are receiving, this is no longer a profession one can assume will provide a big income. Relative to the work it takes to get to the point one is actually making money, one conclude that there are easier ways to make money than being a doctor.</p>
<p>The med school debt is a sunk cost and therefore it does not matter whether one practices medicine or not after going to med school. The malpractice insurance is a cost of doing business and eats into the earnings. A lot. 10 years ago my friend, an ob/gyn, was telling me that her malpractice insurance was $150k and that was good since she had not any claims yet. I cannot even imagine what Pizzagirl’s H is paying nowadays!!!</p>
<p>I don’t really know the exact amount, but I think it’s in the $200k ballpark for 1 doctor, 25 years with a spotless record. He might have to have separate coverage for the staff (those who do procedures, like the mammogram tech or those who draw blood), but I’m not sure. </p>
). 
Don’t be offended by the term. It is what it is. Why is “business” anathema to some folks here? </p>