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Old 08-18-2012, 10:48 PM   #21
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I think increasing the number of Nurse Practitioners to deliver primary care is fantastic. My former SIL is a NP in a hospital setting (not primary care). She once said that when you consider the time and cost of training a NP has a greater return on investment than internal medicine or pediatrics.
I agree. A physician with an internal medicine specialty is overqualified for much of what he does, likewise a pediatrician. (Yes there are cases but only a few). I think we will move to where the NP is the gateway to medical care, referring up the chain as need be. (This is the model for the various clinics at drug stores and the like where the physicians guild permits). For a cold or a sprain etc, the treatment is standardized so it does not require 8 years of post bachelors study. Of course more medical schools should do like Europe and the UK and admit to a 6 year program right out of high school, eliminating the bachelors program completly
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Old 08-19-2012, 07:27 AM   #22
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Whenever this topic comes up, I'm always reminded of an old Tom Lehrer routine:

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Now, I'm sure you're all aware that this week is national gall-bladder week.
So as sort of an educational feature at this point I thought I would acquaint you with some of the results of my recent researches into the career of the late doctor Samuel Gall, inventor of the gall-bladder.

Which certainly ranks as one of the more important technological advances since the invention of the joy-buzzer and the dribble-glass. Doctor Gall's faith in his invention was so dramatically vindicated last year, as you no doubt recall, when, for the first time in history, in a nation-wide poll the gall-bladder was voted among the top ten organs.

His educational career began interestingly enough in agricultural school, where he majored in animal husbandry, until they caught him at it one day.

Whereupon he switched to the field of medicine, in which field he also won renown as the inventor of gargling. Which prior to that time had been practiced only furtively by a remote tribe in the Andes who passed the secret down from father to son as part of their oral tradition.

He soon became a specialist, specializing in diseases of the rich.
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Old 10-02-2012, 02:04 PM   #23
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Recent NY Times article that further discusses Drs being unwilling to accept insurance, and indicates access is increasingly moving in the wrong direction, especially if we consider all those who will gain overage under ACA

A Possible Price to Pay if Doctors Spurn Insurance - NYTimes.com
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Old 10-02-2012, 03:28 PM   #24
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From that article - parents paying $13000 out of pocket to secure the services of an OBGYN for baby delivery and prenatal care. Total cost (insurance plus our copay) for us for same services in May 2012 was $1800 (in a nice place but not high cost of living). Guess it pays to practice baby-deliverin' in the big affluent city!
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Old 10-02-2012, 04:36 PM   #25
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At some point we'll have a lot of doctors with nothing to do because there aren't enough well heeled patients and the "problem" will balance itself out.

In the meanwhile, is it really a problem that some people will be able to afford better care because they're wealthier? We get better everything else...
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Old 10-03-2012, 06:35 AM   #26
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Here in Mass, my Dr has announced that he will no longer be taking patients from the State "Exchange" type health insurance, (an affordable health insurance).
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Old 10-03-2012, 07:16 AM   #27
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In the meanwhile, is it really a problem that some people will be able to afford better care because they're wealthier? We get better everything else...
Not a problem if you are very wealthy, but since I will be eligible for medicare in a couple of years, I am worried there will not be enough Drs left that will accept it, unless you want to end up in some hospital clinic that has line going out the door.
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Old 10-03-2012, 07:29 AM   #28
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Whether it is health care, taxes or anything else, the "big lie" is that the rich will have to 'deal with it' like everyone else.

The one thing the rich have more than money is ... options.
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Old 10-03-2012, 08:47 AM   #29
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Not a problem if you are very wealthy, but since I will be eligible for medicare in a couple of years, I am worried there will not be enough Drs left that will accept it, unless you want to end up in some hospital clinic that has line going out the door.
As one who just applied for Medicare today ( ), I don't see any short-term problems. I've already checked with my PCP and specialists and they (or their practice) accept Medicare without question.

It might be that they go on volume (since I live in a state with a lot of old pharts, like me) and are willing to accept the lower payments.

I would suggest you ask your current providers if they accept Medicare (at this time). If not, you may want to change doctors to those that do before you take the plunge...

Just my $.02.
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Old 10-03-2012, 09:18 AM   #30
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As one who just applied for Medicare today ( ), I don't see any short-term problems. I've already checked with my PCP and specialists and they (or their practice) accept Medicare without question.

It might be that they go on volume (since I live in a state with a lot of old pharts, like me) and are willing to accept the lower payments.

I would suggest you ask your current providers if they accept Medicare (at this time). If not, you may want to change doctors to those that do before you take the plunge...

Just my $.02.
I am not worried about what it is today, but there seems to be a trend emerging that this could be a problem in the future. How long that future is in years, I do not know, but it is a concern given the $ sqweezing that is going on and will continue to go on. Also, you need to consider the geography one lives in and the lack of growth in producing new Docs and/or retaining the ones currently practicing.
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Old 10-03-2012, 09:30 AM   #31
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I have no idea if there is or will be a shortage of doctors, nurses, or any other health care service provider. One thing in clear abundance here in the US, for now and apparently forever, is the steady stream of experts that analyze and predict upcoming crises, shortages, and other reasons to be fearful.
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Old 10-03-2012, 09:35 AM   #32
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Whether it is health care, taxes or anything else, the "big lie" is that the rich will have to 'deal with it' like everyone else.

The one thing the rich have more than money is ... options.
I agree completely. I'm just puzzled as to why its a big deal when its health care, but not anything else. Unless you're socialist in nature, someone having a monetary advantage over another is pretty much standard fare.

We live in nicer homes, drive nicer cars, have many option as far as what to do with our day, and more money to pay expensive doctors.

As I mentioned earlier, when the high end doctor outfits run out of well heeled patients, they're going to have to rethink their strategy and take people on medicare or with less money. While the quality may not be as good on the lower end, everyone is entitled to work more and make more money and get better, more expensive care if thats what they want.
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Old 10-03-2012, 09:40 AM   #33
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I have no idea if there is or will be a shortage of doctors, nurses, or any other health care service provider. One thing in clear abundance here in the US, for now and apparently forever, is the steady stream of experts that analyze and predict upcoming crises, shortages, and other reasons to be fearful.
This is why I quit reading and watching the news. They should just drop the 'news' pretense and call it the "booga booga time to get scared hour". Cars and homes on fire, people getting shot and killed, rapes, and all sorts of things exploding or going wrong. None of it affecting me whatsoever. None of it anything I could do anything about. None of it educational, entertaining, funny or inspiring. In short, useless information designed only to create fear and discomfort. I decided I didn't need that.

There are plenty of doctors for everyone now. While some might think they'll shrink their practice and only service deep pocketed patients, there's a limited amount of those. In any case, if there is a doctor shortage then more people will move into that profession.

I am however waiting for the usual government intervention. We'll spend millions regulating stuff, then we'll pay doctors to not see patients, then we'll create 12 layers of bureaucracy that'll gobble up tax dollars. And nothing will be any different.
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Old 10-03-2012, 10:56 AM   #34
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Where I live, we have a three tiered system:
1. Public- which at a small cost allows treatment at all state owned hospitals. This is available to all who work and pay into the system. It takes a day (waiting in line) to make an appointment and treatment is usually several months away.

2. semi-private- These are private clinics where you pay a small monthly cost ($75.00 for a family) and you can get unlimited telephone consultations, free emergency care, 3 visits a month to a specialist etc.etc but you can only use the doctors who work there.

3. Private- This is a major health policy ($160 monthly) and covers everything and you are free to go to any of the private hospitals in town.

My family is covered by the first two and when I turn 60, we will pick up the third option as well. In addition you can pick up special cancer insurance ($30.00 monthly) which will cover any cancer treatment not covered above.

My private hospital (1 block away) features nurses and doctors who are 7th day Adventist's and are the most caring practitioners I have ever seen. I regularly run into them on the street and have real personal contact with them. They have called the house and even stopped by (when my son was sick) with nothing mentioned or expected monetarily.

I have been blessed with great genes and never visit a doctor, but if I ever get sick I am looking forward to the new 17 story tower they constructed with Pacific Ocean view rooms that could compete with the Marriot hotel down the block.
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Old 10-03-2012, 02:51 PM   #35
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This is why I quit reading and watching the news. They should just drop the 'news' pretense and call it the "booga booga time to get scared hour". Cars and homes on fire, people getting shot and killed, rapes, and all sorts of things exploding or going wrong. None of it affecting me whatsoever. None of it anything I could do anything about. None of it educational, entertaining, funny or inspiring. In short, useless information designed only to create fear and discomfort. I decided I didn't need that.
Heh! "If I don't watch the news, how will I know what to be afraid of?"

http://www.collegehumor.com/article/...o-be-afraid-of
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Old 10-03-2012, 02:55 PM   #36
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My extremely unscientific opinion, having spent plenty of time in doctors' and hospitals' waiting rooms is that most doctors and hospitals would soon be out of business if they did not accept Medicare and Medicaid. If not out of business, their incomes would be drastically reduced.

Let's face it. Who needs the most high dollar medical care? Old people and poor people.
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Old 10-03-2012, 04:03 PM   #37
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This is why I quit reading and watching the news. They should just drop the 'news' pretense and call it the "booga booga time to get scared hour". Cars and homes on fire, people getting shot and killed, rapes, and all sorts of things exploding or going wrong. None of it affecting me whatsoever. None of it anything I could do anything about. None of it educational, entertaining, funny or inspiring. In short, useless information designed only to create fear and discomfort. I decided I didn't need that.

There are plenty of doctors for everyone now. While some might think they'll shrink their practice and only service deep pocketed patients, there's a limited amount of those. In any case, if there is a doctor shortage then more people will move into that profession.

I am however waiting for the usual government intervention. We'll spend millions regulating stuff, then we'll pay doctors to not see patients, then we'll create 12 layers of bureaucracy that'll gobble up tax dollars. And nothing will be any different.
+1.
I could not have worded it that well.
Soon I will get to where the question will be what is TV


By the way, welcome back CFB.
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Old 10-03-2012, 05:27 PM   #38
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One data point:

We visited FIL in Houston recently. He had recently visited his primary care doctor to get a referral to a dermatologist to check out a funny-looking spot on his face (he had skin cancer on his nose removed a few years back). The PCP told him what it was and that he didn't need to see the dermatologist. FIL insisted and PCP said the wait for an appointment would be at least 3 months. PCP had tried to get an appointment for his mother with a dermatologist who was a personal friend and it still took almost a month.

FIL is fine - but that still sounds disturbing.

Again, just one data point, though...
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Old 10-03-2012, 08:02 PM   #39
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DW and I have gone to the same dermatologist for years. We go at the same time for our yearly check ups. No PCP involved. We both have a couple of spots he is watching. So far all our visits have been routine. He may freeze a spot or two. his receptionist will not let us leave the office until we make the next yearly appointment. I don't know how long it would take to get an appointment if we called cold.

Ou dermatolgist (and most dermatologists around here) does not accept Medicare assignment. In other words we have to pay at our appointment and we are reimbursed by Medicare in a couple of weeks. We WOULD have a problem if we could only go to a dermatolgist who would accept Medicare assignment.

Neither traditional Medicare nor my MegaCorp Medicare supplement require me to have a PCP.
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Old 10-03-2012, 09:08 PM   #40
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This is why I quit reading and watching the news. They should just drop the 'news' pretense and call it the "booga booga time to get scared hour". Cars and homes on fire, people getting shot and killed, rapes, and all sorts of things exploding or going wrong.
Actually if you take the motto of TV news it makes sense "If it bleeds it leads" and example is all the hub bub over a potential bacon shortage, when one is talking about a 15% increase in the price.

At worst one will go to the clinic at Wal-Mart or other store or the local hospitals clinic, with electronic medical records and what I believe is coming to fix mal-practice, national standards of care, where they are followed it is by definition not malpractice, the idea of a unique doctor patient relationship will go away. (Anyway I may see my physician 30 mins a year so there is not much of a relationship)
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