Comments on: Questions about Doctors

By: bahmi

bahmi — Fri, 03 Jul 2009 19:29:06 +0000

Of course, doctors need the requisite background in basic science. If not used, one’s facility in calculus and quantum electrodynamics is likely to become rusty, hence why take courses like that in the first place? Arcane subject matter is all well and good, if you want to be a great conversationalist, but doctors need usable knowledge that keeps the rust off. I certainly don’t remember all the laws of James Clerk Maxwell,but why should I, heavens, I am a doctor.

By: Sue

Sue — Wed, 01 Jul 2009 21:05:43 +0000

Oh, and BTW, In Canada, $87 a month to cover 2 people who make over 30K a year. No co-pays, nothing to pay when you go to the hospital! Wait times are exaggerated and purely propaganda.
My aunt’s elderly father broke his hip a few weeks ago and was in and out of surgery within 24hrs..they kept him in the hospital for 17 days.
Dr’s in Canada make in excess of 200K and that is for a General Practice..not specialist.

By: Sue

Sue — Wed, 01 Jul 2009 20:57:06 +0000

While some label Canada’s system as “socialized medicine,” the term is inaccurate. Unlike systems with public delivery, such as the UK, the Canadian system provides public coverage for private delivery. As Princeton University health economist Uwe E. Reinhardt notes, single-payer systems are not “socialized medicine” but “social insurance” systems, because doctors are in the private sector.[21] Similarly, Canadian hospitals are controlled by private boards and/or regional health authorities, rather than being part of government.

By: liberal

liberal — Tue, 30 Jun 2009 19:46:06 +0000

IIRC Canada’s system is much more expensive than Britain’s, in terms of health care expenditures/GDP.

By: Tippy Golden

Tippy Golden — Tue, 30 Jun 2009 17:24:46 +0000

Uwe rocks!

By: rising dawn

rising dawn — Tue, 30 Jun 2009 02:16:18 +0000

I am a doctor. It was 80 hrs / week for me every week. Week, after week after week after week… Never made more than $45,000 a year. less than minimum wadge…

yes, we do work longer and harder.

By: Ramesh

Ramesh — Mon, 29 Jun 2009 06:03:20 +0000

Coming from outside into US, I find doctors as another businessmen. It was a shocking realization. I saw word ‘discount’(on insurance report) and till then I was under the impression word ‘discount’ applied to other businesses. I visit ophthalmologist, the main doctor answers to my questions like an attorney, as if I am going sue if he wavers. Doctors work like clock, their behavior makes very clear(to patient) that they are spending time!!!.

I think others also share responsibility for this state. How can doctors be immune when the society’s pulses are ‘profit’ & ‘earnings’?
People file frivolous law cases. Everyone makes mistake, penalty should be to punish without destroying and also should not be for profiting.

By: anne

anne — Mon, 29 Jun 2009 04:32:17 +0000

Thanks!

By: Debating the Public Plan

Debating the Public Plan — Mon, 29 Jun 2009 04:26:19 +0000

[...] Mankiw weighs in directly (as opposed to beating around the bush) on the public plan. Here’s the summary: Recall a basic lesson of economics: A market participant [...]

By: RobertL39

RobertL39 — Mon, 29 Jun 2009 03:23:53 +0000

Here’s the reference for the procedure/specialization article:

http://www.medscape.com/viewarticle/703324?src=mp&spon=14&uac=112796CY

Enjoy. Thanks for participating.
RDL

By: inside view

inside view — Mon, 29 Jun 2009 03:09:28 +0000

Indeed Robert, your analysis found the gap that I did not address. Only a physician who has worked in the system could come up with a comment such as yours, thank you for doing so.

Yes, I agree with you, if you are paying, you will not pay to overutilize! Self referral is a conflict of interest problem and can be quite easily changed by amending Stark II provisions in Imaging. Lab tests must have a similar amendment that can be put through. Many physicians will howl in protest but curbing self referral is the lowest hanging fruit I can think of in curbing overutilization.

Many of the physician commentators above and below, including Jim Gagne below make the same observation I have made about NPs and PAs. The lack of background intellectual training, maligned by more number oriented folk above, makes them “concrete thinkers” best suited to doing one particular task eg lactation training, maternal and child welfare, diabetes education etc. Often they do this better than the physician who takes a broader overview.

Your comment about “rustiness” or the lack of it intrigues me. I made the comment more by anecdote than analysis so I am interested in your source, so I can be more informed. I am hoping to contribute to this debate on a more formal level.

However, practicing outside one’s area of expertise is at a level I have not experienced before in the US. eg Psychiatrists owning cosmetic surgery centers staffed by PAs. Orthopedic surgeons owning MRIs and reading the images themselves to claim the fees and self diagnosing conditions that require surgery (very expensive surgery). Podiatrists performing tendon surgery instead of orthopedic surgeons.

Its scary. The public has no protection. Even the title “Doctor” does not mean MD, making it hard for the lay public to know whom they are seeing.

Also, the problem of “for profit” insurance companies, their expensive administrations and convoluted claiming processes must be addressed. Frankly they don’t contribute anything to healthcare and should be gradually, firmly and completely removed, replaced by not-for-profit companies.

By: Debating the Public Plan « The Baseline Scenario

Debating the Public Plan « The Baseline Scenario — Mon, 29 Jun 2009 03:01:57 +0000

[...] a comment » Greg Mankiw weighs in directly (as opposed to beating around the bush) on the public plan. Here’s the summary: Recall a basic lesson of economics: A market [...]

By: RobertL39

RobertL39 — Mon, 29 Jun 2009 02:49:36 +0000

I hope you don’t think I advocated ’specialist first’ care. I did not. What I tried to say is that sometimes the primary care doctor could make better use of the phone or e-mail rather than waste time with marginally helpful treatments. I was available by phone all the time, and one group used that to their advantage. The rest did not, and didn’t even change their practices when I outlined for them by e-mail a better way to handle those patients. I expect part of the resistance is their fear of being seen as ‘promoting surgery’. But the patient suffers as a result.
The story you relate sounds like one I heard Dr. Michael Pramenko tell on Science Friday.
On managed care, how about if your group collected the premium and did all the analysis and UR locally? It’s a much different scenario and can lead to very efficient care, like Geisinger and Group Health. If your group is on the hook for the hospital stay, I suspect the referrals would become much more appropriate. How can a primary care doctor want to both be in charge of referring his patients appropriately and also not want to be a gatekeeper. What’s the difference?
What kind of system did you work in before? I was in solo private practice and running an office took too much away from providing care.

By: Tippy Golden

Tippy Golden — Mon, 29 Jun 2009 01:31:52 +0000

Here’s the link.

By: Tippy Golden

Tippy Golden — Mon, 29 Jun 2009 01:30:13 +0000

Anne,I checked out the link Ted gave you to Uwe Reinhardt's Economix block. Uwe rocks! Check out this lecture if found. [youtube=http://www.youtube.com/watch v=KxkiWh60Otw&feature=channel]