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View Diary: What you should know about health insurance industry lobbyists and their lies (276 comments)

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  •  No, we don't. (5+ / 0-)

    We don't have enough doctors.  It will take some doing to have enough primary care doc's, NP's, and PA's to make sure everyone has a "provider."

    •  That's simple. (1+ / 0-)
      Recommended by:
      Alexandra Lynch

      Medical schools need to stop rejecting such a huge percentage of applicants.  I've known two people personally who had very high gpas, but the medical schools only take a few.  It's ridiculous.

      •  That won't work (0+ / 0-)

        That won't work because Medical school tends to cure most students of their desire to do primary care.  Just letting more people in won't do anything to make primary care a more attractive career option.  TO expand the medical school class size would require more faculty, more mentors, more resources, more money, etc.  At my school, every seat in the big auditorium where we took most of our 1st and 2nd year lectures was spoken for.  A bigger class size would have required extensive facility remodeling - (or satellite classrooms where students watched on video, but this doesn't appeal to me at all.  If I am paying $40K per year for med school, I want to be in the same room with my professors.)

        Also, med schools look for more than good grades - generally they want students who have good grades and test scores but also have shown at least a perfunctory interest in public service and have done some volunteer work, and/or research, etc.  

        That said, the difference between the bottom rung of most med school classes and the top rung of the rejected candidates is probably pretty small.

        Even if they could magically expand the class size immediatly - starting in fall 2009, and somehow convince more students to do primary care, that would give us a new crop of trained primary care docs in July, 2016.  Can we wait that long?

        •  I respect your experience, (2+ / 0-)
          Recommended by:
          Alexandra Lynch, Egalitare

          but I'm afraid I can't buy the concept that medical schools can't expand.  Of course they're limited in size and capacity now; that's how the system is set up.  Also, why the hell should anyone have to pay forty thou per year to get a medical education?  There's no reason on earth that ALL the insane dollar amounts associated with medicine can't come down.

          It's of great social value to have doctors, and plenty of them, and the cost of producing more of them should be subsidized by the people (i.e., the government).  The practice of medicine shouldn't be an exclusive, overpriced club.  And I don't buy the premise that the United States produces such a tiny fraction of people who are qualified, emotionally, socially, and intellectually, to become doctors.  Those I knew who were rejected were fine people.

          As to why more people don't want to be g.p.'s - remove the monstrous med school debt that almost requires a new doc to become a specialist so he can start raking in the big money right away, and maybe more people would be g.p.'s.

          As to your last question - can we wait that long? Hell, that's a reason to start reforming this idiotic system right away by opening the medical schools to greater enrollments.

          •  I didn't say they can't expand (0+ / 0-)

            I did not say they can't expand - I just said it would take resources that may not be readily available.  THe figure of $40K per year is what my alma mater, Albany Medical College, currently costs.  That is just the tuition, so one's total costs would be more.  I don't know why it is so expensive - we are all told that the tuition only represents a fraction of the cost of educating a physician, but you never exactly get an accounting of where your tuition dollars go.  I am going to have to start doing some resident teaching starting next summer, and that is not coming with any extra pay for me.

            The cost of my education was $160K, and it was paid by the Army over the years 1994 to 1998.  I did five years of active duty after my residency was over in exchange for that funding.  I think there should be more service contract options for med students - military and others.  I think any student should be able to get a gov't funded medical education, but they should have to serve in an underserved area for a period of time after they are trained.  

            A GP generally refers to someone who did a one year internship after med school, minimal training.  An FP - family practitioner - has done a 3 year residency in primary care, passed an exam, is board certified, and has to recertify every 7 to 10 years.  The two are not the same thing, so it is a bit insulting to call your family doc a GP - so don't.

            •  OK, did not know this (0+ / 0-)

              Up until recently, we had an absolutely stellar primary care physician. He's probably an FP rather than a GP, based on what you say. I miss him terribly. He took care of our diabetes care as well as our general primary care needs, and it was he who found my kidney disease back when it was just starting to become apparent, because he believes in doing regular labs on his patients and follows up with more if he has to. He'll take time to call me on the phone on a Saturday or Sunday to let me know the results of tests or plans to change my medication based on my current needs. He reads the current research, especially on diabetes and any complications resulting from diabetes, and is willing to discuss it with me and look into something that I come up with that he may have missed.

              He's still in practice. The only thing standing between me and Charles and regular appointments with Dr. I. is money. Dr. I. changed practices last month, and the new practice, across the hall from the old one, doesn't take our insurance as a preferred provider as of 01/01/09. If we were to see Dr. I. now, our insurance would cover 50% of the appointment. I have Medicare, and the new practice does take Medicare, but the other insurance is still primary and will be until June 2010. So I would get 50% coverage from Charles's employer group insurance and 20% coverage from Medicare.

              (There is a 30-month coordination period between your other insurance and Medicare if you have Medicare because you're on dialysis but are under 65, where your other insurance pays 80% and Medicare pays 20%. The for-profit dialysis clinics have been trying to convince Congress to expand that to 42 months. They say it benefits the patients. No, it benefits THEM, because they can charge the other group or private insurance whatever that insurance company will pay, and I have seen figures from other dialysis patients that have gone as high as $35,000/month.)

              Of course, starting in June 2010, I can go see Dr. I. again no matter what other insurance I have, because I'll still have Medicare and it will become primary. I'll have lost a year and a half of being followed by him, and he'll have to get notes from the other doctor he recommended we seek out; it won't be anywhere near as good as if he had been following me the whole time. We need to get an endocrinologist, too, to replace his work with us on diabetes care; it's going to take the work of TWO doctors to replace what Dr. I. has done for us for years.

              Want to be a living kidney donor? I need one from someone with a bloodtype of B or O. Drop a note at riverheart.livejournal.com.

              by Kitsap River on Mon Jan 26, 2009 at 09:29:41 AM PST

              [ Parent ]

    •  Thanks A.G, appreciate this (0+ / 0-)

      That is the one thing about this move right now, the push for single payer, I want this to happen, but if there was a massive overhaul now, I fear that it could fail and make people scared of "nationalism" even more than before, when they shouldn't when the government does it correctly.

      UPS, Fedex, U.S Post Service can't give you the whole delivery like TWD

      by sluggahjells on Sun Jan 25, 2009 at 08:12:54 PM PST

      [ Parent ]

      •  There are some other ways to ease the shortage (0+ / 0-)

        of providers.

        There are a host of older providers like myself who are not currently in practice for a variety of reasons.  In my case, I have been creating medical information systems for the past 10 years, after 20 years spent in primary care.

        It would require a little effort to get back up to speed but it's not something you forget how to do after all the training and experience.

        Denial - it's not just a river in Egypt.

        by Imavehmontah on Mon Jan 26, 2009 at 04:56:57 PM PST

        [ Parent ]

        •  This is great (0+ / 0-)

          I was sitting at home thinking how we could quickly get more primary care doc's in the workforce - as we will need to if every American is going to have a primary care doc or other provider.  The only idea I came up with was to find doc's who are willing to come out of retirement or non-clinical jobs and start practicing again.

    •  Which is why... (0+ / 0-)

      Which is why I am now determined to become a PA (eventually) so that I can do my small part to help alleviate the lack of primary care providers. And in a single-payer model, PAs and NPs will probably be even more necessary, because we will want to make sure that every single person has good access to a primary care provider. It needn't necessarily be someone with an MD for many ordinary things, but an MD will be available should s/he be needed.

      Yeah, I was going to go into teaching, but a lot of teachers - teachers who like teaching - talked me out of it due to job prospects and petty politics.

      Want to be a living kidney donor? I need one from someone with a bloodtype of B or O. Drop a note at riverheart.livejournal.com.

      by Kitsap River on Mon Jan 26, 2009 at 09:14:40 AM PST

      [ Parent ]

      •  Go For it - (0+ / 0-)

        I am still nuts enough to think that any job in medicine is a priviledge, and I encourage you to go to PA school or even consider med school.  But it is also sad to me that good teachers who love teaching discouraged you from becoming a teacher.  

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