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Old 11-02-2014, 03:57 PM   #21
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Is becoming part of a large group considered a bad thing? Many other skilled, well-paid professionals work in large groups (i.e. megacorps) and it's considered 'normal.'

My primary care physician, who went concierge, was in the large group in our region. She spends lots of time with patients. The group told her that she could only spend 5-7 minutes on a visit and she had no control over her office staff who were hired by the megagroup. She fought with them a lot and finally went out in her own.

In New Mexico, PAs can now open their own offices without MD supervision. It is supposed to be because of their need for rural health care. My experience with a PA wasn't great, but I expect many are very good.


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Old 11-02-2014, 04:07 PM   #22
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In New Mexico, PAs can now open their own offices without MD supervision. It is supposed to be because of their need for rural health care. My experience with a PA wasn't great, but I expect many are very good.
As longranger noted most are good, some are great, some not so good. Same as any other profession.

We've had one experience with a PA, DW came down with shingles of course on a weekend. The PA was terrific with her. I was impressed.
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Old 11-02-2014, 04:53 PM   #23
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As longranger noted most are good, some are great, some not so good. Same as any other profession.

We've had one experience with a PA, DW came down with shingles of course on a weekend. The PA was terrific with her. I was impressed.
Glad to hear you have a good experience with a PA. How do you tell the difference between a PA and a Dr, if they all wear white coats?
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Old 11-02-2014, 05:37 PM   #24
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Read their name and title embroidered on the white coat. When you schedule and appointment and check in at a clinic you should be told the name and title of your clinician.
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Old 11-02-2014, 06:05 PM   #25
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I think the cost and personal adjustment to electronic medical records is also an issue for older physicians, I know my husband (an architect) rants whenever I upgrade his computer operating system and 'upgrades' to AutoCAD drive him to distraction.
I think we're married to the same guy. My husband hates computer OS changes.... and hates changes to Autocad.

To add to that - my husband worked with MANY architects who never bothered to learn CAD.... which is amazing to me. (And he's no spring chicken at age 62). I would imagine it's the same with some of the older doctors... Some never made the transition to computers.

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I don't think it is even a matter of earning a decent living. Running a small practice is effectively running your own business in a trade with considerable overhead, including insurance and regulatory compliance, and practicing medicine on the side. (Not the only one like this. Civil and structural engineering as independent practices have a fair amount of overhead as well, for example.)

With a larger group, folks with the appropriate business skills, including management, marketing, and regulatory compliance can be hired and shared across all the physicians as employees of the group. That can free up time and energy for the doctors to practice medicine as their primary activity.
I would act architects to this - significant liability insurance, marketing and administrative duties cut into the time available for actual architecture for folks in smaller practices.
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Old 11-02-2014, 06:50 PM   #26
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My husband still swears by AutoCAD 14 and swears at subsequent 'upgrades'. Beats drawing with ink on velum 'tho. He is 76 yo and still licensed. He too only works for family.

Older practitioners of any profession struggle with change in the way they serve their clients.
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Old 11-02-2014, 08:01 PM   #27
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A few years ago I had some strange sporadic left-sided "hollow" feelings in my chest. I was not on any meds (my HTN is borderline and has been classified by the cardiologist as "benign"). Well, I consulted my PCP first who referred me to the cardiologist. He ran a bunch of tests (all negative) and put me on Vasotec 2.5 mg bid. My father died from a heart attack in his late 70's and my older sister is on 3 meds for her HTN so there is some family history there. I see the cardiologist annually, he renews my medication and sends a report to my PCP. My PCP seems content to keep things this way so I am, too.
This personal and family history seems pretty routine as described. In most cases a family physician or nurse practitioner should be able to handle this type of care. The most likely reasons you were referred to a cardiologist was that there are plenty cardiologists in your area, and because of your personal preference.
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Old 11-02-2014, 09:58 PM   #28
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I think the cost and personal adjustment to electronic medical records is also an issue for older physicians...
The younger docs I know seem to be at least as PO'ed about their EMR's as the older docs. They grew up with computers and know what these machines SHOULD do. They seem to expect intuitive interfaces, reliability, and actual FUNCTION from these EMRs- performance like they came to expect in the video games they played growing up (OK, VGs they STILL play ).
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Old 11-02-2014, 10:28 PM   #29
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Obviously there are lots of opportunities for software vendors to sell upgrades.
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Our experience with doctors this year.
Old 11-02-2014, 10:57 PM   #30
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Our experience with doctors this year.

My son works for Cerner in Kansas City. He's a software architect and helps to design all these programs. The company is doing very well.


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Old 11-03-2014, 12:36 AM   #31
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We are on an ACA plan this year and so far no issues. We picked a plan our local hospital and regular doctor were on, plus one of the kids saw an eye specialist with no issues. Our old eye doctor was not on our new plan but her office manager gave us a couple of referrals, and we made sure from the insurance website they were on our plan.

My husband did say that our regular doctor moved to larger office building with staff and waiting room shared by many doctors, which probably makes financial sense but did seem less personal than his old two doctor office.
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Old 11-03-2014, 01:10 AM   #32
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Answering Buckeye from a post earlier today I had no specific number in mind for a "decent living". Using todays grads who come out with $150,000 or more of debt and finish training at an average age of 33-35, low six figures seems like a reasonable minimum in a low cost of living area for a general practitioner. In expensive cities and desirable suburbs reasonable is probably closer to $200,000 to start. It needs to be that high as a sheer matter of practicality if the MD wants to ever provide a home for a family, have kids etc..

$200,000 or more is serious good income for anyone but for high achieving, hard working people who run deep in the red for at least 10 years after getting a college degree they have some serious catching up to do to financially. Even if they are LBYM and disciplined immediately they have lost a lot of years of compounding. Most have also sacrificed much of their opportunity to socialize, travel and party which makes it real hard to LBYM immediately for many.

My cohort had it easier for sure. Much less debt., slightly shorter training times and lower cost of living with absolute non inflation adjusted wages similar to today or higher. So 30 years ago, in retrospect many Drs were seriously overpaid. Now the question most health care practitioners ask is how can inflation adjusted salaries fall in an industry that has grown as fast or faster than any other sector in the economy. Clearly most of those $$ are not making it to the level of patient care.

Electronic medical records are in general a deterrent to productivity for Drs. PA's, nurses etc.. of all ages. Some systems are much better than others and yes there are some older MDs who simply refuse to put in the effort to become proficient with EMR.
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Old 11-03-2014, 07:02 AM   #33
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Re: Doctors... keeping fingers crossed, but see handwriting on the wall. Just began uncovered "facility charge". OK with PA.

Best protection... using the internet to know more about particular health problems than the doctor does.
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Old 11-03-2014, 08:01 AM   #34
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Electronic medical records are in general a deterrent to productivity for Drs. PA's, nurses etc.. of all ages. Some systems are much better than others and yes there are some older MDs who simply refuse to put in the effort to become proficient with EMR.
This makes me laugh so hard!

I was a VP of a 600 employee nursing department in a stand-alone pediatric hospital for many years. When electronic records were initiated in the hospital in about 1994-1995, I expressed concern about my department's productivity, and manpower availability to manage the system.

I was told that the system would increase our productivity, and I would be able to decrease positions. I think the IT department really believed that!!!! Amazing.

Back to the intent of the thread....I think physicians are struggling in general. I live in central Florida where many PCP's and specialists have stopped accepting new patients with medicare. There are long waiting lists to get into the practice of a physician who does take medicare. Reimbursement does not match the expectations of physicians, and some are bitter. I'm hoping we see some very significant changes to our health care system within my life time.
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Old 11-03-2014, 10:44 AM   #35
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I think student debt is a huge issue, particularly for health care providers. It wasn't always that way.
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Old 11-03-2014, 10:51 AM   #36
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Best protection... using the internet to know more about particular health problems than the doctor does.
Still gonna be a problem,. I have been doing this for years but all any doctor wants to talk about is cholesterol and another disease that's heavily advertised on TV. My actual problem? Here, try this drug.What the heck. Almost killed several times by reactions to drugs I was given for diseases I never actually had. Clearly in bold face on the package insert. Diagnosis: I just happen to get a new disease within 3 hours of taking the drug. No medical reason to think the drug caused anything.

Try to tell a doctor you can't take this or that or don't actually have the symptoms of the disease he keeps trying to tell you you have. Rolled eyeballs. Like a bowling alley on a Friday night.

Just last month the doctor wrote a prescrip for 2 antibiotics that would kill me. He has my medical alert card and all the data and I'm right in front of him wearing the bracelet. Good ting I wasn't unconscious
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Old 11-03-2014, 11:28 AM   #37
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Still gonna be a problem,. I have been doing this for years but all any doctor wants to talk about is cholesterol and another disease that's heavily advertised on TV. My actual problem? Here, try this drug.What the heck. Almost killed several times by reactions to drugs I was given for diseases I never actually had. Clearly in bold face on the package insert. Diagnosis: I just happen to get a new disease within 3 hours of taking the drug. No medical reason to think the drug caused anything.

Try to tell a doctor you can't take this or that or don't actually have the symptoms of the disease he keeps trying to tell you you have. Rolled eyeballs. Like a bowling alley on a Friday night.

Just last month the doctor wrote a prescrip for 2 antibiotics that would kill me. He has my medical alert card and all the data and I'm right in front of him wearing the bracelet. Good ting I wasn't unconscious
Get a new doctor.
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Old 11-03-2014, 11:35 AM   #38
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Get a new doctor.
+1
Had one like you describe, run away while you still can.

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Old 11-03-2014, 12:43 PM   #39
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Get a new doctor.

This is the new doctor. Every one for the last 17 years. Unfortunately they are all alike. Or at least all the ones I've had any contact with. Marcus Welby and his like seem to be all gone or very well hidden.

My position on these things now is: I am paying for access. That's it. Since they won't let me prescribe drugs or own an X-Ray machine and all that stuff all I want is the tests, the pics, the video, the data. In short, my current status. I'll do the rest. That way if it gets effed up at least I can say I did it myself and not lay there being done unto by someone whom I will have to pay and then pay the system in perpetuity to treat more intractable results of unfortunate sequelae acquired while trying to "lower my risk" of something.
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