The PPACA Thread Part III - Let's have a healthy debate!

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

No it was part of my discussion prior to the bill's passage. We need less specialists and more GP's.

And there was an article recently that ER visits are up, not down.

Yes but its not the law's job to tell doctors what to specialize or not specialize in, so its kinda like saying its the ACA's fault because it rained yesterday.

FWIW my opinion is that alternatives like the CVS Minute Clinics will ease the burden on doctors for routine matters.

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Is that the latest right wing talking point? What happened to the death panels?

Those still exist, especially in the "expanded" medicare and medicaid.

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Yes but its not the law's job to tell doctors what to specialize or not specialize in, so its kinda like saying its the ACA's fault because it rained yesterday.

FWIW my opinion is that alternatives like the CVS Minute Clinics will ease the burden on doctors for routine matters.

Actually the law does say that in an indirect manner. People don't want to practice medicine because of the bureaucracy and cost to ensure compliance thereof; it just isn't profitable. And we're talking about the ones that actually know what the heck they're doing, not the money hungry do-everything-you-can "practitioners".

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

People don't want to practice medicine because of the bureaucracy and cost to ensure compliance thereof; it just isn't profitable.

Citation? Seriously.

Applicants are clawing hand over foot to get into medical school. For every applicant accepted to medical school, 10 are denied. Residency spots are more competitive than ever. This year's residency match had one of the highest match rates and set a record for the number of MDs who did not match (could not begin a residency). Show me these hordes of people that "don't want to practice medicine."

I have been reading through prior JAMAs and there have literally always been doctors that complain about the bureaucracy and cost, going back 100 years. This will never change and from what I can tell, it is not a significant deterrent. For every person you can show me that quit medicine early, I can show you 10 that would happily take their place.

[St. Clown]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Citation? Seriously.

Applicants are clawing hand over foot to get into medical school. For every applicant accepted to medical school, 10 are denied. Residency spots are more competitive than ever. This year's residency match had one of the highest match rates and set a record for the number of MDs who did not match (could not begin a residency). Show me these hordes of people that "don't want to practice medicine."

I have been reading through prior JAMAs and there have literally always been doctors that complain about the bureaucracy and cost, going back 100 years. This will never change and from what I can tell, it is not a significant deterrent. For every person you can show me that quit medicine early, I can show you 10 that would happily take their place.

Are these qualified people being denied residencies? If so, why are they being denied? I would have my suspicions from an economics perspective, but I'm curious as to what that possible reason would be from a medical perspective.

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

No it was part of my discussion prior to the bill's passage. We need less specialists and more GP's.

To add to that:
We do not necessarily need less specialists. There are many specialties that are seriously hurting in numbers. However, a portion of this pain (as well as the paucity of GP's) is not with overall supply, but regional location. The major difficulty is getting physicians to work in the areas that they are most needed (low income inner city and rural areas).

The rural areas can throw obscene money to attract physicians there but there are just not enough that want to live in that setting. For a case example, a state like Idaho has no training program for a specialty like neurology. Physicians are more likely to stay in the stay they train in, therefore Idaho has to fight an uphill battle to import the number of needed neurologists. You can easily make 50% more working in Idaho for the same work as say a saturated mid level city, yet they still have trouble attracting the number of needed physicians. So the problem now is for the people of Idaho. They either have to forgo care or make the jaunt to Salt Lake City (or other large medical centers).

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Are these qualified people being denied residencies? If so, why are they being denied? I would have my suspicions from an economics perspective, but I'm curious as to what that possible reason would be from a medical perspective.

Residency funding is tied to medicare. Congress has not increased the spots since the late 1990s (and knowing them, will not in the foreseeable future). More applicants to the same number of spots. As an aside, some states are getting around this by using state funds to fund primary care residency spots. The VA also has stepped up and funded a few spots here and there.

I cannot speak broadly about the quality of people denied but I know several people in my class and other classes who had to defer training because they were not able to secure a residency spot in the first go-round. These are people who had solid board scores and who I knew enough that I would feel comfortable sending a family member to them once fully trained.

The first people who got squeezed were the international medical grads (they now need ridiculous scores to even think about applying to a US residency). Next it was the DOs (not for substantial reasons, just set in stigma at some programs) and in the next 5-10 years more and more MDs will have trouble matching unless the spots are increased.

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Is that the latest right wing talking point? What happened to the death panels?

Where is he wrong?

[dxmnkd316]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Citation? Seriously.

Applicants are clawing hand over foot to get into medical school. For every applicant accepted to medical school, 10 are denied. Residency spots are more competitive than ever. This year's residency match had one of the highest match rates and set a record for the number of MDs who did not match (could not begin a residency). Show me these hordes of people that "don't want to practice medicine."

I have been reading through prior JAMAs and there have literally always been doctors that complain about the bureaucracy and cost, going back 100 years. This will never change and from what I can tell, it is not a significant deterrent. For every person you can show me that quit medicine early, I can show you 10 that would happily take their place.

My brother just got accepted into a pilot program that's being rolled out across the US to get doctors into their specialty training faster. It's switching from a time-based education ("You need to go to school for 10 years to be a doctor...") to a competency-based education ("You must pass your tests, boards, etc."). I think he's cutting something like 2-4 years out of his entire process. I think he's going to be going into residency now after just under 2 (?) years of school. I'm not entirely sure of the process but it's really kind of cool and interesting approach.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Where is he wrong?

In just about everyone one of his dire predictions. A better question would be, in terms of this subject, when has he been right?

[FlagDUDE08]

Re: The PPACA Thread Part III - Let's have a healthy debate!

Citation? Seriously.

Applicants are clawing hand over foot to get into medical school. For every applicant accepted to medical school, 10 are denied. Residency spots are more competitive than ever. This year's residency match had one of the highest match rates and set a record for the number of MDs who did not match (could not begin a residency). Show me these hordes of people that "don't want to practice medicine."

I have been reading through prior JAMAs and there have literally always been doctors that complain about the bureaucracy and cost, going back 100 years. This will never change and from what I can tell, it is not a significant deterrent. For every person you can show me that quit medicine early, I can show you 10 that would happily take their place.

You asked this before. I'll give you the same answer. Posters on here that are actually in the medical field.

Medical school and actually practicing are two very different beasts. School is obvious because my generation was led to believe that you have to throw your money away at a college to get anywhere in life. Once they get into the profession, they find out that it isn't all it's cut out to be. And this is coming from one of my friends, who happens to be a nurse.

[Rover]

Re: The PPACA Thread Part III - Let's have a healthy debate!

You asked this before. I'll give you the same answer. Posters on here that are actually in the medical field.

Medical school and actually practicing are two very different beasts. School is obvious because my generation was led to believe that you have to throw your money away at a college to get anywhere in life. Once they get into the profession, they find out that it isn't all it's cut out to be. And this is coming from one of my friends, who happens to be a nurse.

And he probably keeps asking it because you keep giving the same nonsensical BS answer! In short, you have no citations to give except for a supposed friend who may or may not exist outside of your own mind.

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

You asked this before. I'll give you the same answer. Posters on here that are actually in the medical field.

I will drastically lower the bar. Show me a post from a physician on here saying they left medicine early because of the bureaucracy.

[DrDemento]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I will drastically lower the bar. Show me a post from a physician on here saying they left medicine early because of the bureaucracy.

I did not leave-entirely. But i most certainly altered what i do and how I go about doing it. But i have a distinct advantage over many since i have been in private practice, in one form or another, for over 40 years. In response to one of your previous posts-i have lost touch when it comes to some of the specialty residencies. Are the two most difficult to match still ophthalmology and dermatology as they were in my days?

[WisconsinWildcard]

Re: The PPACA Thread Part III - Let's have a healthy debate!

I did not leave-entirely. But i most certainly altered what i do and how I go about doing it. But i have a distinct advantage over many since i have been in private practice, in one form or another, for over 40 years. In response to one of your previous posts-i have lost touch when it comes to some of the specialty residencies. Are the two most difficult to match still ophthalmology and dermatology as they were in my days?

This is more what I suspected. Please do not let me put any words in your mouth and correct me if I am wrong but broadly, you had a full career and probably did not lose many practice years due to bureaucracy.

My response to flag was when he broadly implied physicians are no longer practicing medicine because of the bureaucracy. I freely acknowledge that it is a problem and something that should be perpetually refined (or challenged) but I have not seen any numbers that would leave me to believe we are losing significant physician work/years over the issue. I know plenty of docs who decided to hang it up once private practice became unfeasible or the role of government peeved them too much but these are physicians near the end of their career (65+), not newly minted physicians. From the conversations I have had with my elders, they could retire whenever they wanted and this provided the catalyst, but was not the sole reason or the majority (in most cases).

I do not doubt there are young physicians who have given it up, I just believe them to be in small numbers unless I see numbers otherwise. I know there are people who have chosen not to go into medicine for that reason, but there are plenty of capable applicants to take their place in medical school. Medicine will always be in motion and I suppose you just practice until the motion is too much, you have accomplished what you set out to do, or you die. I am young and naive (relatively) but I really fear the day when I do not love what I do (it truly is a privilege).

As for residency: Derm is still near the tops for competitiveness. I think ophthalmology is as well, however I have a skewed perception since my alma mater traditionally matches really well into that so I have heard relatively few who have failed to match.

Others are plastics and neurosurgery. The past few years have had relatively competitive general surgery and OB/Gyn matches (at least going by board scores). You can basically always match into family or internal medicine somewhere.

Here is the 2015 brief match data: http://www.nrmp.org/wp-content/uploa...2015_final.pdf

And the long 2014 match data: http://www.nrmp.org/wp-content/uploa...-Data-2014.pdf