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

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

joecct said:
Hey Doc (and other medical pros) - this really can happen?

http://m.washingtonpost.com/news/mo...-evil-twin-complete-with-bone-hair-and-teeth/
Click to expand...

That article was a struggle to get through (I hate they way the media sensationalizes things like this) but essentially, yes.

She had a teratoma http://en.wikipedia.org/wiki/Teratoma. The main thing about a teratoma is it is polydermal, or contains more than one type of embryonic tissue. This allows the tumor to develop many types of tissue (like skin, hair, teeth, muscle, nervous tissue, even internal organs (rarely)) but I have not heard it referred to as a "twin" as it is an entirely different process than an actual twin (or parasitic twin which is an actual embryo). Most are found elsewhere in the body but it is possible to have one in the brain.

Reading between the lines (or not), most neurosurgeons she saw thought the risk was too high for surgery and with most things, if you shop around long enough you can usually find someone who is willing to take on that risk of surgery. Hopefully it all works out and they were able to get all of the offending tissue.
 
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Re: The PPACA Thread Part III - Let's have a healthy debate!

joecct said:
Hey Doc (and other medical pros) - this really can happen?

http://m.washingtonpost.com/news/mo...-evil-twin-complete-with-bone-hair-and-teeth/
Click to expand...

WWC is spot on-a teratoma. I had heard one of the ways to diagnose this type of thing was to place an ice cube over it and see if you can hear the teeth chatter.;) There are a lot of fascinating odd medical presentations but the press usually does not have enough knowledge and certain does not take the time to carefully research and present all the information. They most often just publish the sensational parts.
 
Rover said:
Is that the latest right wing talking point? What happened to the death panels? ;)
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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.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

joecct said:
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.
Click to expand...

We could incentivize GP, but instead we'd rather incentivize billionaire's and oil companies.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

joecct said:
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.
Click to expand...

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

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

FlagDUDE08 said:
People don't want to practice medicine because of the bureaucracy and cost to ensure compliance thereof; it just isn't profitable.
Click to expand...

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

WisconsinWildcard said:
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.
Click to expand...
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.
 
Re: The PPACA Thread Part III - Let's have a healthy debate!

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

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

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

WisconsinWildcard said:
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.
Click to expand...

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.
 
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