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If people took some responsibility and started eating healthier foods, started exercising, and slowed down a little, there wouldn't be such a need for doctors. Hopefully a depression will cut the workload of these physicians.

WASHINGTON (Reuters) - Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.

And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.

The 12,000 answers are considered representative of doctors as a whole, the group said, with a margin of error of about 1 percent. It found that 78 percent of those who answered believe there is a shortage of primary care doctors.

More than 90 percent said the time they devote to non-clinical paperwork has increased in the last three years and 63 percent said this has caused them to spend less time with each patient.

Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.

Seventy six percent of physicians said they are working at "full capacity" or "overextended and overworked".

http://www.reuters.com/article/newsOne/ ... CE20081118

Hasn't anyone told them that we all have a right to their services?

Endless bureaucracy, red tape, legal worries make their lives a bitch. Go back to simple transactions of health care for goods, cash and a long-term relationship with a self-employed doctor serving his community.

Some doctors in my local area are transitioning to what is now being called 'boutique' medicine.

They limit their practice to only "rich" patients who will pay a large yearly fee (like a retainer given to a lawyer) and in return these patients will receive personalized treatment. Doctors don't want to mess with the hassle of insurance anymore and this new arrangement lets them spend a lot more time with each patient.

This issue is something to think about when we consider any plans for universal healthcare. We have a shortage of primary care doctors now which is only going to get a lot worse in the future, given the trends. If we add millions of currently uninsured patients to the rolls, what doctors are going to be available to serve them?
Also, a lot of doctors don't want to accept Medicare and Medicaid because of the low reimbursement rates. Are we going to eventually try to 'force' them to do so? Then we'll see a flight of doctors across our borders for sure!

I think that you have to understand that the problems in primary care medicine are almost exclusively a government creation. Medicare assigns payment based on something called RVUs - Relative Value Units. For anything that a doctor can do, medicare has assigned it a value in RVUs. Medicare then sets a reimbursement rate per RVU which varies on a yearly basis. The RVU calculations are wildly biased towards procedures. If I take a mole off someone's back, that's the same number of RVUs as seeing 5 - 10 medical patients. Insurance companies pay more per RVU than medicare, but they use the same calculation. This is why our healthcare system is the way it is. Surgeons and anesthesiologists make big bank. Primary care docs get screwed. Even as a primary care doc, coming up with procedures to do is key to your economic survival. Sitting down to talk to patients doesn't pay the rent. Fixing it would be a very simple matter of congress telling Medicare to calculate RVUs in a way that's more even.

A doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

mattduke wrote:Hasn't anyone told them that we all have a right to their services?

Got socialism? LOL

frankthetank wrote:A doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

that's the way it is for some doctors in Canada.

when i was there in 2004, i paid $35 for an office visit, $55 for the act of filling out insurance paperwork. the doctor's office was in a building full of doctors & dentists, with a lab. simple blood test to measure your thyroid level - about $18.

frankthetank wrote:A doctor should be like a plumber. Just has a set rate, and you pay him that. No insurance necessary.

I can't begin to tell you how happy that would make me. Having to deal with insurance companies is a nightmare. Dealing with Medicare and medicaid is worse than a nightmare. It's hell on earth. Honestly, if the US ever gets single payer healthcare, I will probably either quit medicine or move out of the US. It would be like going to the DMV all day every day for the rest of your life. Screw that.

smallpoxgirl wrote:Primary care docs get screwed. Even as a primary care doc, coming up with procedures to do is key to your economic survival. Sitting down to talk to patients doesn't pay the rent. Fixing it would be a very simple matter of congress telling Medicare to calculate RVUs in a way that's more even.

The problem is that primary doctors (first contact doctors) are not making much input to treatment altogether.
All their use is in referring patient to specialist if alignment is serious enough.

Otherwise they have poor you, I really pity you job or alternatively they are a sort of "repetitive prescriptions suppliers", job, which can usually be done by automated services over the phone.

Common alignments will resolve themselves without any treatment at all and moderately serious ones can be resolved by patient or family, who go to Wall Mart and buy first guess OTC antibiotic.
The same holds true for patients who have already diagnosed details of alignment and who can buy his monthly treatment in pharmacy without any further need for assistance except of annual checks.
And sending women to a doctor for monthly prescription of contraceptives is utter nonsense, unless there is an underlying problem requiring frequent checkups.
In normal situation Annual or even even longer clearance to buy agreed contraceptives is good enough.

So don't be surprised that first contact doctors are not valued much in insurance schemes.
You are a doctor yourself, so perhaps you can comment on it.

I was working in pharma btw.

smallpoxgirl wrote:I think that you have to understand that the problems in primary care medicine are almost exclusively a government creation. Medicare assigns payment based on something called RVUs - Relative Value Units. For anything that a doctor can do, medicare has assigned it a value in RVUs. Medicare then sets a reimbursement rate per RVU which varies on a yearly basis. The RVU calculations are wildly biased towards procedures. If I take a mole off someone's back, that's the same number of RVUs as seeing 5 - 10 medical patients. Insurance companies pay more per RVU than medicare, but they use the same calculation. This is why our healthcare system is the way it is. Surgeons and anesthesiologists make big bank. Primary care docs get screwed. Even as a primary care doc, coming up with procedures to do is key to your economic survival. Sitting down to talk to patients doesn't pay the rent. Fixing it would be a very simple matter of congress telling Medicare to calculate RVUs in a way that's more even.

What's different with HMO's?

Government is controlled by the large HMO's.

You got it bassackward.

EnergyUnlimited wrote:And sending women to a doctor for monthly prescription of contraceptives is utter nonsense, unless there is an underlying problem requiring frequent checkups.

I don't agree with that at all. It's nonsense unless you happen to be the one who ends up having a stroke because the pills drove your blood pressure up and you didn't realize it because you never saw a doctor. That doesn't mean you have to be in the doctor's office every week, but getting checked once a year to make sure you're not having problems from your pills is a very good idea.

I think primary care is potentially MUCH more cost effective than secondary care. Realisically, who's doing you more good? The primary care doctor that manages your cholesterol medicine so you don't have a heart attack? Or the cardiac surgeon who does your heart bypass? It's not glamorous. Nobody's rushing up tell the primary care doc "Thank you so much, you saved my life!" I'd sure rather not have the heart attack in the first place though.

Sumthing is fooken wrong!

I got's me a receipt right here in my grubby little paws from when I fooked up my elbow when a kid.

Itasca Clinic

August 3, 1964

Elbow Xray = $8
Office Vist = $5
Sling = $.25

Total fooken bill was $13.25

X'plain pleaze.

smallpoxgirl wrote:I can't begin to tell you how happy that would make me. Having to deal with insurance companies is a nightmare. Dealing with Medicare and medicaid is worse than a nightmare. It's hell on earth. Honestly, if the US ever gets single payer healthcare, I will probably either quit medicine or move out of the US. It would be like going to the DMV all day every day for the rest of your life. Screw that.

Ithink, there is something sick with American or Western European medicine.

I think, it has much to do with system being infested by lawyers and impractical ethics comities.

Give you 2 examles:

1. Moderately troublesome wisdom tooth extracion.

UK:
either 2 years of waiting on NHS or GBP 2000 for private extraction with required backing of hospital, should things go wrong.
All that after 6 weeks waiting.

Poland:
GBP 10 for extraction + GBP 50 as an insurance, if some further attention in private dental clinic is needed.
"Insurance" arranged over the phone directly with private clinic just before extraction in dental surgery.
Waiting time about 30 minutes.

Worked well for me.

2. Allergy desensitization treatment:

UK:
available on NHS above age of 14.
Younger child has to suffer.
Excuse: Risk of death (anaphylactic shock).
Private treatment: available for younger children, ~GBP 200 per once a month visit and GBP 2500 for initial consultation.

Poland:
Available in national scheme after lengthy bureaucratic procedure aimed at discouraging non acute cases.
Private:
Easy, widely available at any age at monthly cost GBP 20 and initial consultation and diagnostic fee GBP 50-100.
One of my sons already benefited of it. He is desensitized against particular allergens.
I had to acknowledge in writing that I accept small risk of death and I would not take legal action against physician (with PhD in allergology and 30 years of practice), should such unfortunate event occur.

Outcome: 1 child cured (desensitized) without unnecessary development of asthma and many years on steroids.

smallpoxgirl wrote:

EnergyUnlimited wrote:And sending women to a doctor for monthly prescription of contraceptives is utter nonsense, unless there is an underlying problem requiring frequent checkups.

I don't agree with that at all. It's nonsense unless you happen to be the one who ends up having a stroke because the pills drove your blood pressure up and you didn't realize it because you never saw a doctor. That doesn't mean you have to be in the doctor's office every week, but getting checked once a year to make sure you're not having problems from your pills is a very good idea.

So did you read my post well?

EnergyUnlimited wrote:And sending women to a doctor for monthly prescription of contraceptives is utter nonsense, unless there is an underlying problem requiring frequent checkups.
In normal situation Annual or even even longer clearance to buy agreed contraceptives is good enough.

I think primary care is potentially MUCH more cost effective than secondary care. Realisically, who's doing you more good? The primary care doctor that manages your cholesterol medicine so you don't have a heart attack? Or the cardiac surgeon who does your heart bypass? It's not glamorous. Nobody's rushing up tell the primary care doc "Thank you so much, you saved my life!" I'd sure rather not have the heart attack in the first place though.

You are right and wrong at the same time.
Primary care compounded with inadequate diagnose is often leading to lengthy, expensive and unnecessary treatment.

On the other hand you can sometimes spot potentially lethal alignments and initiate life saving investigations.

vision-master wrote:Sumthing is fooken wrong!

I got's me a receipt right here in my grubby little paws from when I fooked up my elbow when a kid.

Itasca Clinic

August 3, 1964

Elbow Xray = $8
Office Vist = $5
Sling = $.25

Total fooken bill was $13.25

X'plain pleaze.

On the gold standard at 1oz / $35, that cost you .378 ounces. An ounce today will run you $800, which gives you a $300 office bill for your elbow.

EU, I couldn't agree more about the prescriptions.

My dad is forced to pay $25 a month in co-pays (plus gas, wasted time, etc.) in order to go to his doctor to get his prescriptions renewed.

He's been on Lescol for the last decade.

Why can't he just buy a year's supply of the drugs at a time? Alternatively, why can't he just buy this stuff straight from a pharmacist?

I understand putting a barrier between consumers and Oxycontin. But who gives a damn about cholesterol medicine? Why is this something that primary care doctors need to be involved with on a monthly basis?

Once the doctor has decided that you should be on a drug, you shouldn't need monthly checkups to get it renewed. Your cholesterol level doesn't drop off a cliff after one month of using the medication. Acid reflux disease is a chronic condition. It's not going to suddenly disappear one day.

And if your condition changes, you can go to your doctor. But wasting the doctor's time with writing prescriptions does a huge disservice to society.

Let them quit. They'll be trading their services for chickens soon enough.

Tyler_JC wrote:And if your condition changes, you can go to your doctor. But wasting the doctor's time with writing prescriptions does a huge disservice to society.

I am somewhat cynical here:

It does a great and often vital service to a doctor.

Dreamtwister wrote:They'll be trading their services for chickens soon enough.

Using mattduke's calculation above, the doctor should be able to charge at least 60 whole chickens for one fooked up elbow. That, of course, assumes the demand for whole chickens remains level. Something's out of whack here (not just the elbow)...