Posted on 07/25/2009 10:45:06 AM PDT by Brilliant
Be a lot of people leaving the medical field, if ‘’health care’’ reform passes.
Your post was, in my opinion, a solid foundation for this point: we already have a good doctor shortage. Not in the sense of having a shortage of people who are certified to figure out antibiotic dosages, or administer shots or the like; we may or may not have enough of those people, with or without MD after the name. We do not have, not by a long shot, near enough people who can do the real work of doctoring. We do not lack for people who can calculate an antibiotic dosage for a red, swollen leg, for example, but we do lack people who can be relied on to see a swollen leg, and to accurately diagnose infection vs. deep vein thrombosis vs. muscular rupture vs. heart failure vs. tumor vs. lymphatic filariasis vs. burn vs. extravascular hematoma vs. other. Ascertaining the correct diagnosis is important, because the treatments for some of these conditions can increase the risk of death posed by others of those entities.
Some people think that such differentiation is easy because they’ve never had to do it. It’s those people, I wager, who think we can increase the supply of real doctors simply by increasing the number of people with “MD” after the name. It’s also those people, I wager, who believe that being a doctor consists solely of calculating antibiotic doses. That point is why I thought your post was such a good foundation for this post.
Some people think that differentiation of different diseases is easy simply because they’re good at it, and it’s hard to believe that others don’t have the same ability. A few months of clinical practice, and routinely being presented with people who’ve been obviously misdiagnosed and received counterproductive or dangerous “treatments” will disabuse anyone of such an idea. An afternoon spent reading studies of misdiagnosis rates may have the same effect, but really does not have as much impact.
What we really lack is not people with the credentials to be a doctor, but with the skills to be a good doctor. There may be a small shortage of the credentials, but handing out more of the credentials is probably pretty easy. There is a gigantic shortage of people with the skills / knowledge / intelligence to really be good physicians, and fixing that shortage is, I believe, not simply a matter of opening new medical schools, nor PA schools nor RN schools. The older I get, the more I realize that good doctors are mostly born, and only partially made. Regardless of how many schools, training programs, certification programs, or other we have, the fact seems to be that there are only a certain amount of potential good doctors in every generation, and there’s already plenty of spots for those few. Certainly, better identification of potential good doctors might be a good idea, but the number of raw med school spots is not the limiting factor.
Thing is, the people who could be good doctors generally don’t have to put up with the bad parts of the medical system in order to make a living. The existence of abusive training programs that encourage or require arguably criminal abuse or fraud to graduate is already a disincentive to become a doctor. Tacking on post-training lawsuits is another disincentive. Risk of infection, risk of violence in the workplace (visit your local large ER some night), and more are all disincentives. Paperwork requirements are both a disincentive to go into medicine at all, and, because they take up so much time, an effective reduction in the amount of actual medical care that can be delivered by the people who do decide to become doctors anyway. Potential good doctors see these things, and some decide to to something else.
If we want more actual good doctors, the only possible way is to make medical training and practice more appealing. If we do that, then the future will have fewer excellent financial analysts, lawyers, engineers, mathematicians, and others, but we can have more good doctors. Simply increasing the supply of MD / RN / PA licenses is not enough.
We don't need major health insurance reform. We need major tort reform, since insurance and 'defensive medicine' are a major piece of the excessive price of health care. Take away the cost of frivolous lawsuits and the price of medical care would drop significantly.
The only reform needed on the insurance side might be to block states from placing enormous restrictions on insurers as to what options they must or cannot offer. In some states, you cannot buy simple catostrophic medical insurance, because of state minimum coverage requirements. For example, Maryland requires alcoholism treatment be covered by insurance, and also requires coverage for "family planning" and hearing aids for minors. Now, if you're an unmarried male that doesn't drink, has no children, and isn't planning on siring a family, then you're being forced by Maryland to pay for coverage outside of what you need or want.
See above. Monday am quarterbacking--you gloss over the complexities.
If we have twice as many docs, there will be no decrease in costs. What doctors earn in fees is a tiny part of your costs. What costs is hospitalization, the infrastructure.
Primary care physicians are not even involved any more in hospitalized patients. That's generally for the "hospitalists"--largely foreign docs which are hired by the hospitals to work in house. Having more primary care physicians is a desirable thing, but what do you pay for an office visit? $75? What does it cost to have a gall bladder removed....$15,000. The surgeon gets a small fraction of that.
What role does the government play in restricting universities from offering a medical program?
And nets $20,000. 200,000 - 180,000 = 20,000. I would choose another profession if that were the case, but I'm thinking that this isn't quite the case.
No. You are making the mistake that they hope you will make. The NET is $200,000. $180,000= 90% of $200,000.
That’s why I say it’s sleight of hand.
You didn't say "net" - you said that they make $200,000 a year. Earnings are almost always expressed as Gross pay. Salaries, hourly wages, etc.
Now, if you're saying that they net $200K after taxes, insurance, and other deductions are removed from their pay, then that is a different situation.
Will the lawyers be able to sue under Obama’s plan? Who would they sue? Are the lawyers in favor of Obama’s plan?
Something tells me that if State Legislatures wanted to, they could mandate and fund additional seats. Similarly, Congress and the US Dept. of Education could apply pressure in this direction.
I don’t think you can say that what the cost of hospitalization is. When you get the bill, the itemization means only one thing: That is what the hospital thought they could bill for a particular item without drawing the attention of the gatekeeper. For example, if the bill says that they are charging you $50 for cotton balls, chances are that it did not really cost $50 for cotton balls. Chances are that they are trying to allocate to “cotton balls” other expenses that the gatekeeper won’t let them charge. You can look at the total bill, but even that does not get you the true cost because some of the expenses are billed directly by the physician and other providers.
All I can say is that this idea that reducing the number of doctors will reduce costs has not worked. They’ve been doing it for 50 years or more, and the problem has become progressively worse. Basic economics tells you that if you increase supply, the price goes down. I’m aware that the health care industry has argued that supply and demand works backwards in the health care industry, but history has not borne out their claims, and that is why we now have a catastrophe as a result of their efforts to reduce the number of doctors. And it’s not just the number of doctors. It’s also the number of nurses, and health care professionals of all kinds. Even physical capital must first go thru a certificate of need bureaucracy before it is permitted.
This is what happens when you let government run an industry. And that is why I commonly point out that the problem with the health care industry is not that we don’t have enough regulation. The health care industry is one of the most heavily regulated industries in the nation. It’s already pretty much run by the government. It’s certainly not an industry controlled by free market forces. To the extent that the industry does not obey the laws of economics, it is generally because of the heavy-handed regulation. So it’s ironic that those who oppose market reforms would use the failure of the industry to respond to free market stimuli as an excuse for opposing market reforms.
We are going to end up a nation of Attorneys and fast food workers. Idiocracy is here.
I’m just telling you what these guys who make the argument say. You don’t think the average doctor makes only $20,000 a year do you? When they say “income,” they mean AFTER you’ve deducted the malpractice premium, so technically what they say is true—but it’s misleading because the average person jumps to the conclusion you jumped to. Like I said, sleight of hand.
If effective doctors are born and not made as you suggest let’s just abandon hope, eh? BS. And yes diagnosis is hard.
That said, I’d like to use an analogy from a troubled industry to make my point. Car manufacturing. Seems far off from medical practice? It is, but the point is still the same. Government regulations, tort laws, union politics and short run optimizing management combined to destroy the industry in the US. IF the car companies had more profits, they could have invested in better parts and engineering which would have made better, longer lasting cars. Instead the short run profit maximizers killed the industry. And the politicians stuck us with the costs.
How to extend this analogy to medicine? Reduce regulations which limit physicians treatment options and drive up costs. Pass (as the state level, this ain’t a federal issue) tort reform laws so that hard working and otherwise honest physicians aren’t sued into poverty for taking reasonable risks - and fraud isn’t covered by this. Train more paraprofessionals to take the burden off MDs - let them do the high value add stuff. End the deductability of medical insurance as a business expense and institute medical savings accounts to reduce the role of insurance companies in paying for medical services and in mandating care. That way we apply market forces to a) increase the supply of medical workers to cut costs (and no the demand for medical services does not have a flat or positive slope) b) take away incentives to practice defensive medicine (which would otherwise drive up costs) and c) cut out the middlemen in the transaction.
Or we go for single payer medical and drive the country into bankruptcy.
Thank you for your service. One of my best friends was an AF Doc, and got a similar deal. And, no, TANSTAAFL. 8 years is a long time.
Maybe for your family. You quickly learn there is no such thing as a routine case.
“To the extent that the industry does not obey the laws of economics, it is generally because of the heavy-handed regulation.”
Medical tourism here we come. Travel to sunny Mexico to get your dentures made. Get a checkup while you’re at it!
Spoken like someone who wants to up the price. 95% of everything is routine, be it medicine, mechanical problems, or software. It’s only in the 5% where a professional can make a difference over a technician. With one exception, EVERY doctor I’ve ever encountered was a cook-book technician with a title.
And in my family, we NEEDED a good doctor, and none we could find did more than scattershot diagnostics, while my daughter’s condition worsened. Only by my wife’s and my research, did we identify the problem, point out the correct diagnostic test, and actually get the problem fixed.
It took two years of our research to FIND it, and yet 5 separate highly-paid specialists, including those at 2 major teaching hospitals didn’t find it. We talked a nurse-practitioner into ordering the test. . .and there it was.
Our case wasn’t “interesting” enough to the real experts to take it, and the “professionals” had no clue.
Your right, I just want to jack up the price. I need a new Mercedes - mine is 6 months old already.I sincerely wish you well with your nurse practitioner and internet connection. Obviously you know better than anyone with a medical degree.
I have seen multiple routine cases that extended care providers have treated in a cookbook fashioned, and made the patient temporarily better but totally missed the underlying problem.
Wasn't really too bad at all. I spent four of it in graduate medical education, three years in an overseas station (Puerto Rico) and one teaching in a residency training program. All in all, it was an equitable arrangement.
I have good memories and it helped me see my profession in a little different light than if I would have trained in a civilian program and taken a job from there. I guess I learned a bit more about the sense of "mission" and that it wasn't all about me.
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