Posted on 12/22/2017 3:03:10 AM PST by buckalfa
Those with experience like mine, will have, over the years, received far more care and advise from nurses than physicians. That said, on another note, doesn’t the military allow Docs in without having completed a residency?
Sorry for the double post.
We’re in rural WV and I work for a FQHC (in a non-clinical role).
Finding and recruiting MDs and DOs who are willing to live and work in a rural area is becoming increasingly difficult even with competitive salaries.
In our state, PAs and NPs can practice routine primary care, under the guidance of an MD or DO. They are limited in what they can do and what they can prescribe and as the patient care gets more complicated, the MD or DO takes over more and more of the care.
We’d like to have more actual physicians, but they don’t want to come here, so this is the best we can do and still provide care without the patients having to travel to metro areas.
The weird thing is a lot of NPs end up getting PhDs in nursing, which makes addressing them a little awkward. Calling someone “doctor” in a clinical environment implies MD/DO, but they really are doctors, even if not “doctors”.
More “Third Worldization”; when income and profits are punished, who is going to invest years of their lives and tens of thousands of dollars in job training?
Here in NJ we are replacing most American professionals with foreigners - regardless of the field. The remaining Americans end up as departmental or company scribes because some things aren’t accepted in Spanglish or Engrish yet...
The best “health plan and treatment” is to stay healthy. Good luck.
Diagnose yourself from WebMD, and only see the witch doctor to get a prescription. I know this isn’t a good idea, but then again, so is trusting the judgment of an untrained Third World shaman...
The residency is where you actually learn to practice medicine. It’s not like 1950.
So why couldn't interns and residents go through that experience offering clinic medical care? Perhaps a whole new structure.....degree, intern in hospitals, residents in clinics, with a few years of clinic supervision before moving on?
One thing is for sure. The nation cannot keep paying for such expensive, intensive medical care as so many people choose now. Besides the expense, there's an issue spotlighted by the opioid crisis that a lot of people no longer take any individual responsibility at all for their individual health and healing.
Primary care is a mess no doubt about it. Those who would like to
Can’t afford to go to rural areas My daughter will graduate next year with north of 250k in loans then do at least 3 years of residency making about 45k per year After that she can finally start to make some ground up but will be too far in debt to consider a more rural area...
The residents do offer medical care. Every residency has a medical clinic usually for indigent patients where the residents provide medical care under the supervision of their attending (teaching) physicians. However all care is reviewed they are not on their own
A goodly portion of the “Doctor Shortage” particularly specialists is the result of Hillary Care. Rather than encouraging planting of more flowers along the nation’s freeways or bake some cookies, Hillary was destined to solve the nation’s medical crisis. Nobody was quite sure of what the crisis was, but the high cost of medical care was due to an excess of physicians. Although Hillary Care was never completely implemented, the Clinton administration was successful in reducing the number of Americans entering medical school by limiting the availability of government loans. That is why we now have a shortage of heart specialists and practically all of those are immigrants.
I think it’s also not just about cost.
In my experience, being an MD is more than a full time job and becoming an MD is an all-consuming process. A lot of them, when they get out of med schools, have only one marketable skill.
Here in the sticks, you can’t just hire someone to mow your lawn or fix your house or even service your vehicle. Many of our latest hires drive Mercedes. I don’t begrudge them that at all, but the little garages around here wouldn’t have a clue on how to repair them, if they even had a source for the parts. Now you’re looking at a 90 minute drive to the closest Benz dealership. It’s “only” an hour if you have a Ford.
Most people are very self-sufficient here because they have to be. That doesn’t work if you don’t have the time or don’t have the skills to do all those peripheral tasks needed to live “out here”. We only have one restaurant in town - a little pizza place. If you aren’t able to get home and make your own dinner, you’re going to be eating a lot of pizza.
A lot of homes don’t have mail delivery, so you have to go to the post office regularly. Oh, and the post office closes an hour for lunch. God help you if you want to eat organic or have special dietary requirements. It’s a very difficult existence if you work long hours or you’ve become used to a metro lifestyle.
There are also more than a few cultural barriers.
The problem is the supervision. When you come out of medical school you have facts coming out of your “whatever” but you have no clinical judgement.
The internship is a hierarchy where the intern gathers facts and handles routine orders and treatments according to a strict protocol but for the first months everything is reviewed by a higher level resident and by an attending as needed. Over those first few months the intern learns perspective and hopefully clinical judgement.
No one should practice medicine without an internship. In medical circles everyone knows “Don’t get sick in June”; that’s when the new interns start.
Most hospitals run clinics exactly as you describe with the interns interviewing & examining the patients, the residents approving the evaluation & treatment plan, & staff on site or by phone for oversight. Many of the front line hospitals were forced out of business by Hillary Clinton’s first push at single payer and the bureaucratic oversight that grew up afterwards. Worcester Ma, where I trained lost it’s charity hospitals, NY lost St Vincent’s and hundreds more fell across the country. The regulations,cost & time involved and the meddling with optimal care designed to reduce care and save $ decimated our saftey net.
We need innovations and loss of red tape. Standard of care should not be determined by insurance companies with a financial motive, it should be determined by patients and doctors with reference to a cost benefit. That is the good thing that has come out of this mess. The costs of treatment are no longer irrelevant to patients and they are motivated to make decisions that take costs into account. I don’t mean that I want people not to be able to afford care but its good for them to question generic vs brand name, the chance of improvement with a particular therapy, why is this cost out of line with another physicians.
The devolving of oversight to the state level with the increased competition and incentive to come up with a State tailored solution is a very encouraging avenue in my mind.
I think foreign doctors weaken our system unless they have fellowships or residencies here. MD is not a black box, their training is not equivalent and causes substandard care in many cases. Dumbing down doctors is not the answer. Physician assistants and nurse practitioners are an important piece of the puzzle. They are exceptionally well trained for what they do (single bad apples excepted in all cases).
Doctors without internships are in no way equal to NP or PA graduates. Why do we need an uncharted untested pathway when PA & NP exist for primary care and as physician extenders?
As long as there are limitations as to what surgery they can do I’ve no problem with this. A PA or a resident can handle internal medicine problems as well as a full termed resident qualified M.D. Its the surgery and specialties that need to make sure they don’t extend their practices into those realms. I’ve noted that osteopaths overextend their qualifications in the specialty services.
That may be but you may have a skewed population. Hubby and I are both physicians in a major metro and I drive a Honda. 4 kids 2 currently in grad school....
If a PA or resident can handle internal medicine as well as can then I guess I need to hang it up and go away. I work with a PA who is a great individual - and has nowhere near the knowledge or experience I do. Ditto residents. But if you want someone who is under qualified to work on your health your car or your house that is your choice
I experienced it first hand when I had physical therapy for my shoulder. Because I'm not insured for that, I gave close scrutiny to my care and the costs. It was an open environment. I was surrounded by patients whose prescribed care was what the insurance company would cover, no more, no less. I wouldn't know how to begin doing the math of how much more it cost me by not being insured. Less visits, my discount for same-day payment vs copays for the insured, using common sense when it was my money. (No way was I paying for their "warm up" time on a stationery bike). I really do think I benefitted from being more of a partner in decisions than having some PT assistant read from a handbook.
When clinics were still around before HMOs started regimenting care, I preferred that style of medical care. When I've needed care, I have more choice by not having an assigned doctor or an insurance company making decisions. Anecdotal...when my dislocated shoulder needed someone to put it back in place, the people in the ER were glad that they could call in the best person to do it, rather than have to figure out what choices were covered. And I got to choose which hospital to go to....I went to the one with a reputation for English-speaking health care professionals.
This is very much the consequence of the least clinically talented people in medicine making their mark on the profession as administrators and outcomes analysts. It's not universally true that they're not/weren't good clinicians, but this is generally true. Your 4 years of medical school (proceeded by 4 years of excelling as an undergraduate), followed by 3 years of residency is just part of it. You also have a wealth of clinical experience beyond residency, and no PA is going to approach what you know and can provide.
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