dumb doctors

[Spanky]

Here is an interesting article from the Medical Journal of Australia about change in demographic of doctors and nurses and their transition to retirement. eMJA: Baby boomer doctors and nurses: demographic change and transitions to retirement

 

[Meadbh]

Here is an interesting article from the Medical Journal of Australia about change in demographic of doctors and nurses and their transition to retirement. eMJA: Baby boomer doctors and nurses: demographic change and transitions to retirement

Excellent article, thank you Spanky. The situation in Australia mirrors that in north America. Baby boomer nurses in particular are leaving the profession just as the wave of baby boomers needs more health care. Expect nurses' earnings to rise with demand over the next few decades. And many different models of care will be explored.

 

[Martha]

With prescription narcotics the fastest growing drugs of abuse I don't see OTC pain killers in our future.

DD

I don't either. I said it more for emphasis than as a desire for easy to get oxycodone.

 

[REWahoo]

My wife finally made the diagnosis--chiggers. She's a doctor, but a PhD in education. But thanks to the internet and some online photos, the symptoms and pattern were a dead match.

The confusing thing is that I had been to central Oregon and Southern Idaho at the time the bites occurred. This was fairly far north for chiggers, and probably a South Dakota doc wasn't familiar with them. Guess the little buggers are moving north.

Yep. It's all those folks who head south for the winter and haul back all sorts of hitchhikers when they return home. Seen any scorpions?

 

[Milton]

My experience with doctors here in the US is that a large portion of them are "large hat, no cattle".

Same goes for many other professionals in private practice, e.g. dentists, lawyers and accountants. One would think the latter profession in particular would know better, but no ...

 

[bosco]

Yep. It's all those folks who head south for the winter and haul back all sorts of hitchhikers when they return home. Seen any scorpions?

fortunately, chigger larvae die from human blood.

Didn't see any scorpions. But I figured John Day Oregon and Twin Falls Idaho weren't very far 'south.' Guess I need to revise my sense of geography

 

[barbarus]

I don't either. I said it more for emphasis than as a desire for easy to get oxycodone.

Perhaps one of the physician-members would like to comment on the substantial undertreatment of pain here in the USA.

And listen to Dr. Rich's advice on antibiotic abuse. He's giving sage advice. If you have not yet, you will soon hear stories about MRSA or their flesh-eating step cousins.

Probably getting off-topic for an ER forum, but then again, no.
Most of us would prefer to retire both pain-free and alive.

B. the U.

 

[DblDoc]

Your reference, doctor?

Heres some numbers for you. I also see it daily in my practice...

Reuters Health

Thursday, September 6, 2007


WASHINGTON (Reuters) - More young U.S. adults are abusing prescription medications, particularly painkillers, according to the government's annual report on substance abuse released on Thursday.
Overall, in 2006, 22.6 million people -- 9.2 percent of Americans ages 12 and up -- either abused or were addicted to drugs or alcohol in the prior year, according to estimates in the report from the U.S. Substance Abuse and Mental Health Services Administration.
That is up slightly from an estimated 22.2 million people, or 9.1 percent of the population, in last year's report.
The 2006 report found that non-medical use of prescription drugs, mostly pain relievers, among young adults increased from 5.4 percent in 2002 to 6.4 percent in 2006.
"The abuse of prescription drugs for non-medical reasons is of increasing concern," agency chief Terry Cline said in a statement.
"These are potent drugs that can have serious and life-threatening consequences if misused. Parents in particular need to be aware of this problem and take steps to prevent these medications from falling into the wrong hands," Cline added.
The agency said 3.2 million Americans were dependent on or abused both alcohol and illicit drugs and 3.8 million were dependent on or abused illicit drugs but not alcohol.
Another 15.6 million were dependent on or abused alcohol but not illicit drugs, the agency added.
The report showed that fewer adolescents ages 12 to 17 said they had used illicit drugs in the prior month -- the rate dropped from 11.6 percent in 2002 to 9.9 percent in 2005 and 9.8 percent in 2006.
Current marijuana use among those ages 12 to 17 dropped from 8.2 percent in 2002 to 6.7 percent in 2006, with the decline seen particularly among boys, according to the report.
The agency also found that the level of under-age drinking among those ages 12 to 20 remained unchanged since 2002, at 28.3 percent in 2006. The legal age for drinking alcohol in the United States is generally 21.
The findings were based on responses given by about 67,500 people to a government survey.

Reuters Health

DD

 

[DblDoc]

Back to the OP I have an interesting anecdote. One of my colleagues, who seemed to be getting his financial ducks in a row listening to Dave Ramsey DVD's, considering downsizing his house etc, bought himself a new iphone today. I guess he is still living the dream...

DD

 

[Meadbh]

After the burst of the dotcom bubble, a surgeon of my acquaintance who makes at least $500K annually began to ramp up his surgery slates at the expense of aftercare of his patients. His operating income was insufficient to meet his (extravagant) [-]needs[/-] wants. His sloppy practices led to complaints and disciplinary action with his professional licencing body and his healthcare organization. This is not medical professionalism.

 

[Nords]

... to ramp up his surgery slates at the expense of aftercare of his patients.

I understand the dictionary definitions of the words, but what exactly does this phrase mean? What does a doctor do to get accused of this behavior?

 

[MikeD]

Back to the OP I have an interesting anecdote. One of my colleagues, who seemed to be getting his financial ducks in a row listening to Dave Ramsey DVD's, considering downsizing his house etc, bought himself a new iphone today. I guess he is still living the dream...

DD

He saved $200.00!

Mike D.

 

[Meadbh]

I understand the dictionary definitions of the words, but what exactly does this phrase mean? What does a doctor do to get accused of this behavior?

Rushing patients through the office, inadequately documenting their procedures, failing to visit them post op, not being available when paged, dumping on his residents, being discourteous to patients and team members......thought he could get away with it because of superb technical skills in short supply (NOT!)

 

[DblDoc]

Unfortunately the system is set up to promote this. Procedural medicine such as surgery is highly compensated for the procedures, not for post-op care or office visits. A surgeon would make significantly more money if they spent each and every day in the operating room and never saw a patient in clinic either before or after the surgery...

DD

 

[Rich_by_the_Bay]

Unfortunately the system is set up to promote this. Procedural medicine such as surgery is highly compensated for the procedures, not for post-op care or office visits. A surgeon would make significantly more money if they spent each and every day in the operating room and never saw a patient in clinic either before or after the surgery...

Yes, a common lament at the lunch table. If I spend 45 minutes with a diabetic discussing lifestyle, adjusting insulin, detecting small problems that can easily become big (a small sore on the foot; a subtle vision complaint, selectively doing a cardiac stress test, etc.) on a good day I may get reimbursed $200 gross (forget expenses). If my ophthalmologist buddy down the hall does a 45 minute cataract extraction she may get reimbursed $2000. My services extent good quality life by a few years. Hers do the same for vision.

Both are valuable services, I believe. Still, I have made a good living and had a fulfilling career. But as we face health care reimbursement issues, these discrepancies probably will need to be addressed.

 

[Nords]

Both are valuable services, I believe. Still, I have made a good living and had a fulfilling career. But as we face health care reimbursement issues, these discrepancies probably will need to be addressed.

It think the discrepancies have already been addressed by the fact that neither of you has switched jobs.

I know you're just using this as an example, but it's a good opportunity to look at the issues in any career-change debate.

Financial: I understand the reimbursement numbers, but what about take-home pay after equipment, support staff, & malpractice insurance? You can probably practice your craft for decades, what about her? I don't have any idea about the costs but I know that focusing on annual income is a risky approach.

Qualitative: While salary gets a lot of attention, there's also the intangibles like quality of work and quality of life. Even if you accepted the higher reimbursement you might be miserable in some other field... or miserable with work in general.

Rich, it'd be a lot harder to replace you with a robot or outsource you to Bumrungrad... but just about any neophyte can open a LASIK clinic these days and that trend will accelerate. Considering the competitive changes in the last decade, if I was a surgeon I'd be looking for a sideline.

When I learned that I wouldn't be a submarine XO, at 12 years of service with eight more years before retirement vesting, I thought my career had slammed into a brick wall. I spent the next eight years in training commands while exploring just about every alternative the Navy had to offer-- and not realizing that I'd already found it. Despite all the choices, it came down to the fact that I was comfortable with who I was and what I was doing, and I didn't want to leave that behind just for the possibility of finding something better. Although it was better than the alternatives, eight years later I still hadn't found my "Aha!" career so I ER'd...

I've had a lot of "Aha!!" moments during ER.

 

[Meadbh]

It think the discrepancies have already been addressed by the fact that neither of you has switched jobs.

I know you're just using this as an example, but it's a good opportunity to look at the issues in any career-change debate.

Financial: I understand the reimbursement numbers, but what about take-home pay after equipment, support staff, & malpractice insurance? You can probably practice your craft for decades, what about her? I don't have any idea about the costs but I know that focusing on annual income is a risky approach.

Qualitative: While salary gets a lot of attention, there's also the intangibles like quality of work and quality of life. Even if you accepted the higher reimbursement you might be miserable in some other field... or miserable with work in general.

Entry and exit costs are high. It's not that easy to switch jobs. To train to be (for example) a brain surgeon can take 10-12 years (of residency hell) after med school. In comparison, a Family Physician can train in as little as two years. To some extent, the higher reimbursement for procedural specialties reflects that differential investment in skills.

Expenses of doing business vary greatly by private vs. public, how much "stuff" you need (psychiatrists obviously don't need much as much equipment as opthalmic surgeons) and by whether you practice in an academic setting. For example, I am an intensivist practicing in tertiary care hospital settings and do not have an office practice. There is no office overhead and I don't have to buy intensive care equipment. I can predict my earnings and plan accordingly. If I were in private practice I would need a business plan like every other small entrepreneur in the service industry.

Regarding quality of life, that's a personal preference. Many surgeons love what they do and it's right for them. There are probably just as many specialists in less physically demanding fields who are bored, frustrated, burned out, etc, and would like to make a change. No job is perfect!

 

[HFWR]

No job is perfect!

Nuff said...

 

[DblDoc]

Yes the grass is always greener on the other side of the fence.

I still like what I do despite the increasing inefficiencies being built into the system. Unfortunately I see the entire US health care system getting alot more broken before a real attempt at fixing it is made. In the meantime we will continue to make good $, some specialties more then others, and many of us will not save or invest it wisely.

DD

 

[Ed_The_Gypsy]

Several times I have investigated other lines of work and self employment. I never found anything that paid anywhere close to what I was used to and usually required very long hours. Engineering ain't so bad after all.