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Access to Drs may change?
Old 08-15-2012, 02:03 PM   #1
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Access to Drs may change?

This article discusses the possiblity that access to Dr care is likely to get worse in the next few years due to shortages, basic supply/demand argument. As mentioned, I am also starting to see some these conciegre medical services cropping up in my town:

Why the Doctor Can
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Old 08-15-2012, 03:18 PM   #2
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It is an odd situation. There is a cap on the number of residencies, in that Medicare will only reimburse teaching hospitals for a certain number of student doctor residencies each year. The teaching hospitals don't generally get reimbursed for "extra" residents. The number of resident slots paid by Medicare has been roughly 100,000 since the Balanced Budget Act of 1997.

http://en.wikipedia.org/wiki/Residen...dency_programs
http://www.ama-assn.org/resources/do...by-day-gme.pdf

I suppose we could go all free-market and charge the students for their residency (just add it all onto the medical school loans...).
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Old 08-15-2012, 05:11 PM   #3
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Lost my primary DR this year. Wonderful young man. Decided to take his family to less of a populated area. We had some interesting conversations and it was great to get his point of view. The people who work in the medical profession are not drones to serve the public.

I guess we will see.
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Old 08-15-2012, 07:01 PM   #4
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Our family doctor pioneered a sort of "concierge lite" system about three years ago. AFAIK, he was the first one in the area to do this, but others are copying him. He charges just $350 a year per person, each January. For this payment, what you get are:
1. any paperwork you need (doctor's notes for work or school, etc.).
2. same day appointments when you need one.

When I asked him how it was going on my last visit, he was ecstatic about it. He did it in the first place because his workload was wearing him down, and this cut his patient load down to a very manageable level, while keeping his gross income where he needs it. The best part is "now I actually like just about all my patients, so it's a pleasure to come to work every day."
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Old 08-16-2012, 06:52 AM   #5
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A Dr in our town just stopped accepting insurance. Instead, you paid about $40 per visit.

Dr found that she could make more money that way instead of paying 3-4 insurance administrators to figure out how/what to charge/benefits/ work through the insurance maze etc. etc.
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Old 08-16-2012, 10:41 AM   #6
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Who knows what will change, but it's clear the practice of medicine in the USA will have to change sooner or later. We're the only developed country that hasn't faced up to it at all yet, and we pay dearly for middling outcomes as a result with more uninsured than any other country. What we have is just not sustainable, eventually we'll have to look at it with the objectivity citizens and subsequently politicians have refused to engage in.
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Old 08-16-2012, 10:58 AM   #7
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Quote:
Originally Posted by marko View Post
A Dr in our town just stopped accepting insurance. Instead, you paid about $40 per visit.

Dr found that she could make more money that way instead of paying 3-4 insurance administrators to figure out how/what to charge/benefits/ work through the insurance maze etc. etc.
As someone who has rock solid insurance (TriCare) I actually like this approach. Seems like it's quite workable for all but the poorest people. However, is there a point at which he does accept insurance? Forty bucks here... forty bucks there ... over a year= not so bad. But what if you get all sicked-up and start running up big bills and also have to stop working...?

Even easy, convenient, low fees can pile up over time
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Old 08-16-2012, 11:22 AM   #8
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Originally Posted by razztazz View Post
As someone who has rock solid insurance (TriCare) I actually like this approach. Seems like it's quite workable for all but the poorest people. However, is there a point at which he does accept insurance? Forty bucks here... forty bucks there ... over a year= not so bad. But what if you get all sicked-up and start running up big bills and also have to stop working...?

Even easy, convenient, low fees can pile up over time
With another trend it becomes less of an issue, the trend being that if you go to the hospital the primary care doctor is not involved in the treatment. As we move to the nurse practitioner model, this will go further. After all for a lot of things we see a physician for does it take 8 years after a bachelors degree of training? Of course the other thing that is starting is moving to direct admission to a 6 year medical school program from high school, as is typically done in Europe.
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Old 08-16-2012, 11:37 AM   #9
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The bottom line though, as the article points out, is that healthcare will get worse for those that presently have it. And the costs will rise.

It's just supply and demand with doctors and patients reacting to the situation.
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Old 08-16-2012, 11:54 AM   #10
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If more people have regular access to all kinds of care that might lead to better preventive care and also more efficient use of all health care services, and improve productivity all around.
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Old 08-16-2012, 11:55 AM   #11
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The bottom line though, as the article points out, is that healthcare will get worse for those that presently have it. And the costs will rise.

It's just supply and demand with doctors and patients reacting to the situation.
Get worse is right. The big concerns to me are even if you have medicare coverage, will there be any physicians left who will accept it, and if they do, how long will you have to wait to see them.
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Old 08-16-2012, 01:06 PM   #12
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Originally Posted by DFW_M5

Get worse is right. The big concerns to me are even if you have medicare coverage, will there be any physicians left who will accept it, and if they do, how long will you have to wait to see them.
That is what concerns me long term. I really don't envision health problems until I am 65 which is 17 years from now ( at least I hope). At first, I was against a voucher system, but if Medicare tries to treat everyone by squeezing the doctors, the plan may eventually help fewer people. I might be warm to an idea of getting some voucher money and then applying it to health insurance that a good doctor may actually accept.
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Old 08-16-2012, 01:28 PM   #13
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If more people have regular access to all kinds of care that might lead to better preventive care and also more efficient use of all health care services, and improve productivity all around.
Over the long term things will work their way out.

Over the near term what you post is not likely at all.
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Old 08-16-2012, 01:40 PM   #14
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I have wondered if a de facto dual health care system would emerge like exists in some places. The cheap/free kind that takes government backed insurance (in whatever form that exists in going forward) and a second kind that brings a higher level of service, better access and a wider variety of treatment options, but at a higher price (private insurance or steep out of pocket payments).
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Old 08-16-2012, 01:45 PM   #15
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I have wondered if a de facto dual health care system would emerge like exists in some places. The cheap/free kind that takes government backed insurance (in whatever form that exists in going forward) and a second kind that brings a higher level of service, better access and a wider variety of treatment options, but at a higher price (private insurance or steep out of pocket payments).
That's the plan. Undercut the private healthcare system so that only those with gobs of money can afford anything except the government option. Incentivize company-paid health insurance to move to the government option.
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Old 08-16-2012, 02:22 PM   #16
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This an old article from 2005 that discussed this problem coming. The AMA had been pushing the idea of a surplus of doctors and got Med schools to limit applications and the government to cut back on residency funding. AMA trying to keep salaries high

USATODAY.com - Medical miscalculation creates doctor shortage
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Old 08-18-2012, 04:44 PM   #17
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My wife is a physician so I'm pretty up on some of these issues. Here are some more factors that are making things worse that weren't discussed in the article.

1. The percentage of female doctors is increasing. The number of female med school graduates has gone from 30% in the early 80s to about 50% today. That is obviously progress of a sort. However female doctors are statistically less likely to practice medicine for as long as male doctors and when working are more likely to work fewer hours or part time positions. I know a number of my wife's female colleagues who are working half-time and who have taken extended periods of time off for raising a family. And one who has just walked away from the profession to stay home with her kids (who have special needs) while her physician husband continues to work. By contrast I don't know a single male doctor under 60 in my wife's circle who has ever taken extended time off or who has ever worked less than full time. Simply stated, on average, male doctors over the life of their careers will see many thousands more patients than female doctors. So if the total number of doctors remains constant, the increasing percentage of female doctors means less productivity from the medical profession.

2. The number of medical schools and residencies has simply not kept up with increasing population. The bigger problem is the number of medical schools. When is the last time that your state opened a new medical school? The number of residency positions is much higher than the number of US medical graduates which means the harder to fill residency positions (mostly primary care positions in large urban hospitals) are filled almost exclusively by foreign medical graduates from places like India, China, and Mexico.

3. The number of specialties is increasing. As medical technology and science continues to advance it just means that there are increasing opportunities for doctors to specialize in narrow profitable niches to utilize new technologies and science. That further reduces the pool of doctors available to do primary care.
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Old 08-18-2012, 04:57 PM   #18
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My PCP has a concierge model, but also has the old model, too. He was "in network", but now is "out of network". Not a big deal as his charges are not onerous. He has not bulked up his practice in the 18 years we have been seeing him, but appears to prefer to keep a constant number of patients. Same day or even walk-in appointments are easy to get. He has the gift of gab, so will talk your ear off at the end of an annual physical, but you can return the favor and talk his ear off as well. OTOH, he parcels out care to specialists, but isn't that what you want?

As for the article, it is just spreading fear, uncertainty, and doubt. I'd like to see if any of the predicted certainties come to pass. I have my own doubts about those predictions.

As for the AMA, they are just making sure that more foreign-educated physicians get to practice in the US. I suppose there is nothing wrong with that.
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Old 08-18-2012, 05:44 PM   #19
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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.
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Old 08-18-2012, 10:12 PM   #20
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Here in WA we have a service called Qliance. Pay about 75/mo and get unlimited primary care visits, basic diabetes management, etc. they charge extra for labs, but the rates are reasonable. When we lose our megacorp insurance someday, I'd seriously consider that program plus a high deductible plan for catastrophic illness.

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