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

[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/uploads/2015/03/ADT2015_final.pdf

And the long 2014 match data: http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf

 

[joecct]

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

Logan's Run - Belgian style...
http://www.dailymail.co.uk/news/art...ousands-killed-despite-not-asking-doctor.html

 

[FreshFish]

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 suppose passing along the words of a physician then doesn't count??

My former personal physician did not "leave" medicine; however, he did close his practice and stop seeing patients explicitly due to the increased bureaucratic requirements (or so he said to me when we last met). He said he would really miss seeing patients as that was his favorite part of medicine, but he could no longer tolerate all the rules and red tapes that came between him and what was best for them.

He continues to work in medicine as a teacher.

 

[busterman62]

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

Logan's Run - Belgian style...
http://www.dailymail.co.uk/news/art...ousands-killed-despite-not-asking-doctor.html

Definition of Statistics: The science of producing unreliable facts from reliable figures.
Evan Esar

A very interesting subject but to reference the original work as "an academic report" is extremely generous. An "Op-ED Piece" would be far more accurate (One could argue that ALL articles referring to Medical Ethics are opinion pieces). The author is really arguing against a statement from the Belgian Critical Care Society. Surprisingly, his work admits that "the use of life-ending drugs with the intention to shorten life and without explicit request" dropped from 3.2% prior to the law to 1.7% after.

 

[Kepler]

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

A very interesting subject but to reference the original work as "an academic report" is extremely generous. An "Op-ED Piece" would be far more accurate (One could argue that ALL articles referring to Medical Ethics are opinion pieces). The author is really arguing against a statement from the Belgian Critical Care Society. Surprisingly, his work admits that "the use of life-ending drugs with the intention to shorten life and without explicit request" dropped from 3.2% prior to the law to 1.7% after.

Thank you. My quantitative methodology prof at Stanford is giving you a golf clap.

Well, she would be, but the one time I saw her put her money where her mouth was the result were hilarious. As a demonstration of expected value she bought everybody in our seminar (8 grad students) a $2 lottery ticket. The theory was a quick lesson.

4 of the 8 of us won, and the South Korean member of our cohort won $10k.

Anyway, the theory was sound.

 

[WisconsinWildcard]

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

I suppose passing along the words of a physician then doesn't count??

My former personal physician did not "leave" medicine; however, he did close his practice and stop seeing patients explicitly due to the increased bureaucratic requirements (or so he said to me when we last met). He said he would really miss seeing patients as that was his favorite part of medicine, but he could no longer tolerate all the rules and red tapes that came between him and what was best for them.

He continues to work in medicine as a teacher.

My line of argument was directly related to this post. Flag repeats this despite using only anecdotes...ones that he is slim on the details...but presents it as a widespread epidemic plaguing the practice of medicine.

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".

I was arguing against the blanket statement that "people" are not practicing medicine because it is not profitable/too much bureaucracy. I feel this is meaningless statement in this context because the following things could be said if you accepted the same level of evidence:
People are stopping the practice of medicine due to having children.
People are stopping the practice of medicine due to Parkinson's disease.
People are stopping the practice of medicine due to car accidents.
People are stopping the practice of medicine due to prison.

I have no doubt that there are physicians that have stopped primarily due to bureaucracy. But the more important question is do a significant amount of physicians stop due to bureaucracy. Or, even better, is there a significant reduction in work/years due to bureaucracy. Something causes a physician to stop. From the moment you start, it is a profession in constant flux. You have to keep running just to stay in one place. At some point, this may become more trouble than you wish and you may leave.

Bureaucracy is something to be concerned about...no doubt. It should be initiated carefully and with purpose. It should be constantly revised and the medical profession needs to work on this as a whole.

What I have not seen is the data showing that increasing bureaucracy has led to a significant reduction in physician work/years.

I know physicians that just cannot cut it with EMR (electronic medical record). Do EMRs cause people to stop practicing medicine? Of course. Do they cause a significant reduction in work years? I doubt it.

Not using an EMR significantly reduces my efficiency. I am the young guy on the block but someday...I will be cantankerous and blame a new technology as the "end of medicine." Just like every generation before me. In medical school, there was a group of physicians from a rural county that proposed resolutions each and every year at the state meeting that were basically "computers are confusing and the devil." You continue to adapt or leave.

If I had to guess, I would bet the physician you had was not at the beginning of his career...but who knows. He could be the 30 year old that can pay off his loans by teaching alone

 

[FreshFish]

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

I have no doubt that there are physicians that have stopped primarily due to bureaucracy. But the more important question is do a significant amount of physicians stop due to bureaucracy. Or, even better, is there a significant reduction in work/years due to bureaucracy. Something causes a physician to stop. From the moment you start, it is a profession in constant flux. You have to keep running just to stay in one place. At some point, this may become more trouble than you wish and you may leave.

Bureaucracy is something to be concerned about...no doubt. It should be initiated carefully and with purpose. It should be constantly revised and the medical profession needs to work on this as a whole.

What I have not seen is the data showing that increasing bureaucracy has led to a significant reduction in physician work/years.

What I am seeing and hearing and reading about is something different, and perhaps raises even more concern, and that is the consolidation of medical practices. My former physician's practice was a stand-alone group, now it is part of a much larger network. From an economic point of view, that makes sense, because all of the overhead regarding medical records is consolidated into one IT platform. To a certain extent there are advantages, I can now go on-line and view my chart myself, for example.

One obvious concern is data security, it seems like we cannot keep determined hackers out of anything these days.

A bigger concern is what you might call the decline in genetic diversity. As long as the environment is stable, a decline in genetic diversity doesn't manifest itself, but during unstable times or periods of rapid change, a lack of genetic diversity manifests itself as the inability to adapt, there just isn't enough variation available. I know that this is a mixed metaphor that doesn't quite convey what I am trying to get at.

Doctors in my experience want to practice medicine, and their rational response to demands for more and more paperwork is to outsource, which in turn leads to an even larger and more rigid bureaucracy. Bureaucracies do not like technological change, bureaucracies like order and stability, and keeping up with constantly changing technology requires attentiveness and hard work, neither of which are bureaucracies noted for.



So, on the one hand, we have really exciting, very promising new medical technologies in the pipeline....and on the other hand, we are facilitating the spread of bureaucracies that by their nature dislike changing their ways.

 

[FlagDUDE08]

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

What I am seeing and hearing and reading about is something different, and perhaps raises even more concern, and that is the consolidation of medical practices. My former physician's practice was a stand-alone group, now it is part of a much larger network. From an economic point of view, that makes sense, because all of the overhead regarding medical records is consolidated into one IT platform. To a certain extent there are advantages, I can now go on-line and view my chart myself, for example.

One obvious concern is data security, it seems like we cannot keep determined hackers out of anything these days.

A bigger concern is what you might call the decline in genetic diversity. As long as the environment is stable, a decline in genetic diversity doesn't manifest itself, but during unstable times or periods of rapid change, a lack of genetic diversity manifests itself as the inability to adapt, there just isn't enough variation available. I know that this is a mixed metaphor that doesn't quite convey what I am trying to get at.

Doctors in my experience want to practice medicine, and their rational response to demands for more and more paperwork is to outsource, which in turn leads to an even larger and more rigid bureaucracy. Bureaucracies do not like technological change, bureaucracies like order and stability, and keeping up with constantly changing technology requires attentiveness and hard work, neither of which are bureaucracies noted for.



So, on the one hand, we have really exciting, very promising new medical technologies in the pipeline....and on the other hand, we are facilitating the spread of bureaucracies that by their nature dislike changing their ways.

One other thing to remember is that all of these administrative costs, whether in-house or outsourced, are just that: costs. They are passed on to the patient.

 

[Kepler]

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

Maybe the GOPers aren't being total tools over Obamacare, and deliberately trying to screw people for their own short term political end. Maybe they simply don't understand the numbers.

 

[ScoobyDoo]

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

Maybe the GOPers aren't being total tools over Obamacare, and deliberately trying to screw people for their own short term political end. Maybe they simply don't understand the numbers.

It never ceases to amaze me how they have no alternative. None. I don't get it. The way government is supposed to work is through a series of alternative policy proposals. They've offered ZERO alternatives.

 

[FlagDUDE08]

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

It never ceases to amaze me how they have no alternative. None. I don't get it. The way government is supposed to work is through a series of alternative policy proposals. They've offered ZERO alternatives.

Perhaps the reason they are suggesting no "alternative" is because they see no issue with the system as it was before the PPACA. The biggest issue with progressives is that they believe change must happen (heck, it's part of Dr. Day's warning), but there is another option that they never consider: Leave everything as is and change nothing.

 

[ScoobyDoo]

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

Perhaps the reason they are suggesting no "alternative" is because they see no issue with the system as it was before the PPACA. The biggest issue with progressives is that they believe change must happen (heck, it's part of Dr. Day's warning), but there is another option that they never consider: Leave everything as is and change nothing.

Uh, huh. 44 million uninsured people isn't a problem. No coverage for pre-existing conditions isn't a problem. Every other civilized nation on the planet kicking our asses on those two points isn't a problem. Maybe your rightie geniuses should use your status quo bull**** when it comes to fighting wars in the Middle East?

 

[FlagDUDE08]

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

Uh, huh. 44 million uninsured people isn't a problem. No coverage for pre-existing conditions isn't a problem. Every other civilized nation on the planet kicking our asses on those two points isn't a problem. Maybe your rightie geniuses should use your status quo bull**** when it comes to fighting wars in the Middle East?

If that sort of health stuff is so important to you, and you think it's better somewhere else, move to that somewhere else. Either that, or go to state where you get what you want, say, Massachusetts; heck for you, I'd suggest somewhere REAL close to BU. The reason it works there and not here is scale. Perhaps your history classes didn't go into detail about why the standard of living in the USSR was so poor and why it ultimately ended up failing.

 

[joecct]

Uh, huh. 44 million uninsured people isn't a problem. No coverage for pre-existing conditions isn't a problem. Every other civilized nation on the planet kicking our asses on those two points isn't a problem. Maybe your rightie geniuses should use your status quo bull**** when it comes to fighting wars in the Middle East?

Having insurance <> access to adequate healthcare.

 

[ScoobyDoo]

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

Having insurance <> access to adequate healthcare.

True. But not having insurance equals potential disaster. So it's step one.

A better step would be actually spending the money and resources on finding cures. Frankly I'm convinced that those dollars are kept down on purpose because chronic care makes a lot of people a lot of money.

 

[unofan]

Having insurance <> access to adequate healthcare.

It's still better than not having insurance, though.