Re: America's Affordable Health Choices Act of 2009 - The USCHO debates
The provision of public defenders for the indigent sure has driven down the fees lawyers charge.
Wins thread
I love the idea of serving the country- ie rural care, urban care, high areas of need to have debt forgiven. Of course you always have the chance you will get a slacker screwing off until s/he has fulfilled her/his obligation but their would still be more access. Requiring every resident to work for a stint in the public clinic sector would be something to consider. There are some models that do this and the care is excellent!
In nursing most schools used to require some time in the field before allowing the pursuit of a second degree. This has gone by the wayside as schools fight to survive in the glut of schools offering the degree. Theoretically it would be great to force a basic time of MDs being PCPs and then letting them specialize.The logistics of requiring that would make my head hurt. Also the time spent to get specialized is already huge.
To fix the system there would need to be a change in mindset in terms of finances and attitudes toward primary care from the top down . Top meaning the medical schools, insurance companies and even the patients. ( I can't tell you how many times the patient has the elitist attitude that they
need a specialist to have something simple done and go as far as complaining to the insurance company when they are told to get treatment at the primary office.)
In a perfect scenario (for profit or not), there would be reward for patient management and health promotion by the primary office. Tort reform would be nice. We waste resources because someone is loud enough about a test that to refuse puts you at risk, even if it isn't indicated.
Another observation that no one seems to be talking about- the current crop of MDs coming out have the mentality of entitled spoiled brats. (no strong feelings here
) I am sure not all of them, but my exposure is they want no on call, holidays off, shorter hours, larger paychecks than their work ethic can support and little intrusion into their personal life. They have an inflated idea of what they are entitled to when they look for a job- that is what previous generations worked up the ladder to achieve when they were in their 40s. This generation wants everything as they come out of the gate. This is not the life of a PCP. They aren't stupid to figure this out when they pick a specialty. Specialties tend to work in larger groups so have less call and more flexibility in things that conform to what they think they are owed.
Anytime I have been somewhere (all primary care) looking for a new doc it is avg 2-3 yrs to find one and their work ethic isn't that impressive when we get em. They are a commodity as there are so few of them and they know it. Unfortunately many practices cannot meet the demands and the remaining MDs get pretty burnt out.
They have softened up so much on what is required in residency that the Docs coming out are truly shocked at what is required of them. We have had a few that simply decide that they don't want to be a Doc anymore.
Where the system previously winnowed out these folks when the hours were ridiculous, now they get all the way thru and are truly baffled they need to work long hours.
