Alarmed by a shortage of primary care doctors, Obama administration officials are recruiting a team of “mystery shoppers” to pose as patients, call doctors’ offices and request appointments to see how difficult it is for people to get care when they need it, reports NYT.
The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.
Don't be surprised if the "results" of this survey will imply that more government control of the sector is required, including making it mandatory for doctors to accept government healthcare programs. And that newly graduated medical students be required to "serve the country" by being required to practice for a period in a region of the country where no one wants to go.
Bottom line: If you are a physician under 45, you should be packing now, and pick up your practice somewhere in South America, or perhaps the Caribbean.
(HT2AngryTipster)
In reality, there is no place on this planet for a Dr. to go from here. Heading to any of those places you listed would never produce the kind of income Doc's make here even with all of the government intervention. The reality is that the Docs have no place to go other then to find a new profession.
ReplyDeleteWhat if you're a 2nd year medical student?
ReplyDeleteIf you haven't seen the Burzynski movie about the doctor who has successfully cured the most terminal cancers, it is a must see, and still available to view free on their website for an uncertain amount of time longer. https://www.burzynskimovie.com/
ReplyDeleteIt is the most powerful argument against the FDA and government/Big Pharma control of the medical industry ever by far.
@ Anonymous of June 27: The key for doctors is to figure out the purchasing power parity -- what seems like a 'low' income somewhere else is relative to local prices. And perhaps more importantly, income in dollar terms may very well decline relative to other currencies given the trend in the dollar and the possibility of further dollar depreciation in coming years.
ReplyDeleteDon't rule out an increase in the Medicare tax to deal with the horrible problem of the poor being neglected that they discover.
ReplyDeleteLook at all the good little commies defending the government in the comments under the NYT story. Here's an example:
ReplyDelete"[Stealth surveys] are about building medical care availability for that 98% of the American population that doesn't own 85% of America's wealth. Physicians who turn prospective patients down solely because there isn't enough money in treating them do not deserve to be treated in an open, honest and candid manner."
In other words, doctors should be slaves and work for nothing. How dare they not sacrifice themselves and their families to The Plan.
Commies believe that when their centralized plans don't work, reality has to give way. Liquidate a few million people if that's what it takes.
Doctors are not the only ones who should get out of the U.S. while they still can.
So the government is going to spend $300+ million to set up false appointments. Another government asinine solution to prevent sick people from getting an appointment to see a doctor.
ReplyDeleteI think in this case, Life should follow what passes for Art in this country. The show Royal Pians comes to mind...if I were a Doctor (yuck!by the way!!), I'd be a Concierge doctor. There are many ways to go about it, but I think what's needed is "Business Plan Innovation." I put it in quotes becasue it's not my idea...I agree with it but it's the idea of Glenn Hutchins of Silver Lake Partners. It can be applied on a small scale and it's high time. Basically, it means we change how we are going about billing, paying et al. For example, if a community got together to pay a GP a certain yearly wage and split the cost between them. Some Doctors in the Waldorf Community already practice this way.
ReplyDeleteQuantella Owens
Hopefully most doctors did not get into their practice with the main purpose to maximize their income like the average businessman.
ReplyDeleteHopefully most MD's have their priorities right. Healing the sick IS what medicine is primarily about. Pumping the maximum income out of exercising their chosen trade is way down in the list of objectives.
I suppose it is not easy for most money-focused businessmen to understand that, and it's a very good thing [for the rest of the citizenry] they are not providing medical services!
Health care is much cheaper in many other countries and better in several. If I were a young doc I'd head for foreign lands. True you don't make as much as you would in the US, but the taxes and regulations are far lower. And, in fact you can live better, have less stress and practice medicine instead of paying bureaucrats. I know several docs who have done just that and have never regretted the move.
ReplyDeleteWho says their main purpose is to maximize income?
ReplyDeleteBut let's not punish them either. They go through 8-12 years of post high school education, residency, 40 hour shifts, a helluva school debt and massive malpractice insurance payments to practice and then they have to get more BS harassment from Obama & Kompany? Give it a rest.
Systemic Failures EVERYWHERE.
The answer?
MORE system!!!
8-12 years of grueling studies at the very least weed out many "quick-buck businessmen" who should never practice medicine since they do not have what it takes. Unfortunately it does not weed all of them!
ReplyDeleteA medical practice is about what a particular community needs. People need medical services everywhere. When USA MD's emigrate, the USA will have to call on Chinese, Indian and other MD's to come over and treat US patients.
A doctor who moves to where a doctor's life is easier solves part of his own little problems but the community he leaves behind has a huge problem now.
Yes a doctor's life is complicated enough and does not need more hassles from bureaucrats. Yet most understand the higher calling of their profession. Some doctors who could practice where their personal lives would be easy, CHOOSE to practice in communities where they experience a lot more hardship than the average doctor because that's where the needs are. Those are the ones who understand there is more to a fulfilled life than making a lot of money!
"Healing the sick IS what medicine is primarily about."
ReplyDeleteI agree, but the metastasizing bureaucratic regulatory system that is US health care prevents them from doing that. When doctors require 2 full time employees just to deal with government mandated paperwork, the costs are passed on to each consumer. In a free-market, prices would be far lower and quality would be far higher.
"Pumping the maximum income out of exercising their chosen trade is way down in the list of objectives."
No, but as anon@822PM points out, they are often in deep debt during the first decade or two of their practice, so even a marginal decline in wages could result in a drastic drop in take home pay. The current legal framework means that malpractice insurance drives up the costs even higher.
All of the red tape that people like anon@753PM support just makes things worse. You should read up on basic economics before commenting on an economics forum, or you might appear foolish or stupid.
They are not your slaves, they are free people, and if they are smart they will look for less regulated, less bureaucratic, less litigious regions to practice medicine. The end result will be an overall drop in the quality of care for all citizens.
But, that is the case with ALL government intervention- it always produces unintended side-effects that negate any good that the regulation tries to create, distorts the price system, and makes everyone in the country poorer in the process.
I read through all of the comments and I had to say it. Most of you are all very misinformed. My wife works in the medical industry. This country does not need health care reform it needs Health care insurance reform. I told her to write a book, she doesn't think it would be healthy.
ReplyDeleteMedicare pays a Dr. $10 to $12 for an office visit. I wonder why doctors don't want to see medicare patients?
When a Dr. works on a Medicaid patient they know it is charity work.
Health Insurance companies are not much better. First they do everything possible to not pay a claim. If they do pay it, it is not anywhere near what was billed. Here is a great example.
Patient is in surgery, he gets a shot, shot gets billed out for the medication in the shot, the needle, and administering the shot. The insurance company would only pay four cents for the administering and refused to pay for the drug or the needle. Happens all of the time.
Insurance companies are getting rich, not doctors. By the way patients are not billed for a covered medical expensive that is not paid by the insurance. The only loser is the doctors practice.
SOMETIME BACK THE 1970'S A PASTOR TOLD HIS CHURCH WHEN THE GOVERNMENT FINALLY TAKES OVER HEALTH CARE,YOU WILL HAVE TOO KNOW HOW TO FIND HEALING FOE YOURSELF.HE WAS STATING HOW IT COULD BE,WHEN THE GOVERNMENT HAS TAKEN CONTROL OVER HEALTH CARE SYSTEM.WHEN OBAMA HAS HEALTH CARE WORKERS,CHECKING ON DOCTORS TO SEE WHICH DOCTOR IS TAKING THE GOVERNMENT'S HEALTH CARE PLANS OVER THOSE THAT ARE PRIVATE HEALTH CARE PLANS. SOMETHING LIKE THE OLD CHECKERS IN THE RED LINING CASES IN REAL ESTATE.THEY WENT TO SEE WHO WAS CAUSING RED LINING IN THE LOCAL NEIGHBORHOOD. SO THE OLD TACTICS FROM RED LINING, WILL BE USED IN THE UP AND COMING IN YOUR NEW HEALTH CARE PLANS FROM THE GOVERNMENT.
ReplyDeleteThe American Health care system is crazy! I used to say when I worked in hospitals "The insurance tail is wagging the medical dog." The Government is tinkering with a broken system. Americans spend a higher percentage of their income on healthcare and get poorer care by a lot of basic metrics.
ReplyDeleteWhatever the drawbacks of a single payer system, they don't compare with the crazy commercial patchwork we have now. Americans are brainwashed to thinking this is the big bad bogeyman, Socialism. Yet Canadians in a recent poll, when asked if they would prefer their system or the US one, voted 99% to keep theirs.
This bizarre hybrid system continues to create more problems as it goes on. Doctors can be as venal as anybody else, and medical corporations can be voracious and predatory. It is human nature for behavior to be shaped by economic forces. Financial distortions and pressures in the system will distort both individuals and businesses. Time for a rethink I think.
Obama's plan needs the money that now is given to
ReplyDeleteMedicare participants as their supplemental insurance . Then his healthcare panel will decide if you deserve to have a bi pass or not depending on your influence on society and your age . It's not a perfect plan but it will make sure that people will die sooner thus lessening the burden on Obama's healthcare . He will smile while saying you have been passed over for that life saving operation and basically condemning you to death .
Cuts in Medicare reimbursements, especially to specialists who see Medicare patients, have been so severe already (20 to 40%) that many private practies are closing. It is impossible to pay office overhead given the reimbursement level.
ReplyDeleteDoctors will no longer take on the financial risk of opening or expanding practices.
Medicare patients are really in for it. More than $500 billion will be transferred from Medicare to Medicaid over the next decade. Reimbursements for Medicaid will be twice what they will be for Medicare. This means that people who have been paying Medicare taxes for more than 40 years will find their access to health care severely diminished. The specialists that they need will disappear. The Obamacare bill says that all doctors will be paid the same. No one in their right mind will stay in school from age 18 to thirty-one to be paid like an internist, who goes to work three years after medical school, not seven. It just too hard.
The business about improving the quality of care is crap. Most board certified physicians are bound by the standards of care of their specialty and they are terrified of malpractice suits. They communicate frequently and abundantly about patient care. Do not believe the propaganda.
During the past year, many medical practices have teetered on the edge of bankruptcy. The doctor haters love it. But what the government is doing should frighten many people. They have no respect for investment and its responsibilities.They do not understand that service contracts and leases have to be paid. You could be next. Central planning knows no bounds. Even if the bill is overturned by the Supremes, nothing will stop the regulation writing of the bureacracies that have nearly destroyed the country. Neither
Congress nor any administration cares what they do. They are in control. If you are paid to write regs, then you will write regs.
Most doctors work like dogs and are heavily indebted. They would be better off going to work for Goldman Sachs where secretaries make more than most of them do.
Anon@1044PMJune30-
ReplyDeleteI agree, the insurance companies have distorted the market, but the only reason insurance companies operate the way they do is because of the regulatory and tax framework of the US.
Yes, the insurance companies are part of the problem, but only because they have encouraged regulations that they thought would help them, only to end up screwed like everyone else when the regulation causes horrible side effects.
Since health care insurance paid by an employer isn't taxed, it is often offered as a "bonus". Since people with 3rd party payer health insurance see the doctor far more frequently than necessary, further distorting the system. Reimbursements are less than full payers, and since hospitals/doctors must make up the money they are losing on Medicare/aid patients (and the uninsured) they jack the prices up.
A fully free-market, no regulation, no insurance system would be far superior. If health care and cost were proportionally related, then why is it cheaper to fly to Costa Rica and spend a week (in a nice private hotel/hospital) to have surgery than it is to have it done in the US? Why have LASIK and cosmetic surgery (2 practices rarely covered by insurance) dropping in price y/o/y, while other costs rise?
The answer is the strangling regulatory system. Abomonationcare is just going to make it far, far worse.
Interesting comments from all of you who have peripheral understanding of US health care, especially the "hypnotherapist" from LA who bashes the system while charging patients for hypnosis to treat their problems. As a practicing Orthopedic Surgeon I have an intimate understanding of what we're up against. The main problem with our system is a lack of normal market pressures that the best, leanest areas of the market possess(computers, cell phones, etc). While these products have become cheaper and better, health care costs continue to rise because there's no competition and no pricing pressure from consumers. A patient who injured their knee yesterday expects me to order them a $900 MRI today, because it's all free to them. Patients with health savings accounts, with money coming more directly from their pockets wait a couple weeks to see if it gets better(most do). This is the crux of the problem. If health care was purchased like computers or cars, the cost would level out to what consumers feel the product is worth and competition would improve the quality. This isn't rocket science. Unfortunately, Obama's taking things exactly the wrong direction by removing any remaining market forces. The resulting system will be 2 tiered with everyone having access to basic health care(Canadian level) and those who can afford it will get what they have now, the best medical care in the world.(Arab sheiks go to the Mayo clinic for care not to London or Montreal). One last thing, don't worry about US docs, especially surgeons like myself, we make plenty of money and can pay off our debts with no problem. We can't be replaced by someone with less training/education, unlike the Goldman Sachs secretary or trader. Bottom line is that politicians that limit access to me, won't be re-elected.
ReplyDeleteGood points, Dr D, but those new docs just entering the field (especially GPs) will find "making plenty of money" a hard row to hoe when their salary is set by clueless committee commies in DC while they still have to pay off hundreds of thousands in loans.
ReplyDeleteYou are absolutely right about the lack of pricing pressure, and the instant availability of "free" medical care (either from 3rd party insurance, or state mandated subsidized insurance) will mean longer wait times and poorer care in the long run.
Please feel free to add more of your insights- some of the posters here still seem to think that if we just give the government "a little more power" things will get better. Please disabuse them of that moronic notion.
Dale, I agree that GP's will be in trouble under Obamacare, which I'm hoping (probably naively) will be repealed or diminished. If the dems get what they want, most people will get their primary care from PA's and nurse practitioners and not a doctor, which may not be the end of the world since a lot of this could really be done by a nurse. This is just one of the ways they'll slowly lower the quality of care and people that can't afford better will have to accept it. We all accept the level of service we get at the post office and DMV because we have no alternative. Playing the devil's advocate, the thousands of loans may go away under more socialized medicine. In Canada and the UK this cost is largely covered by the system. The real problem is that if your a smart kid in college, you can make more money and have more autonomy avoiding medicine, and this will eventually affect the quality of our physicians. This is definitely seen in mature socialized medicine systems. In the UK, most of the docs are from the middle east and received their training there. I've never heard of a single doc trained in the US going to Canada or the UK to practice( plenty go the other way). If you know of one I'd love to talk to them. I'm open to considering other systems, it just that there's so much history of the free market working better than systems that work against basic human nature.
ReplyDeleteI THINK THE OBAMA HEALTHCARE PLAN STINK'S.ALSO, I CAN'T BELIEVE ALL OF THE POLITIONS, BOTH SIDES, ARE ALLOWING THIS TO HAPPEN. ANY PLAN THATS PUT TOGETHER MUST START IN THE HOUSE AND NOT IN THE PRESIDENTS OFFICE.
ReplyDeleteImplementing stricter policies to our medical doctors may not be a good idea. This may only create an stigma that being a physician is not a profitable career to take.
ReplyDeleteWhy are we putting too much pressure to our physicians. I think they have to be given the freedom to choose their paths as long as they are not violating any laws.
ReplyDeleteThat's another factor affected with the health care system he proposed. It's going to be hard for these young doctors, that's why they should consider leaving the country.
ReplyDeletehealth insurance plans
Let's not forget that doctors(who spend $100K plus to get through medical school plus who've dedicated an extra 7-9 years of their lives past college to getting an MD degree)may decide to form a UNION to protect their rights. It's been talked about for years, and this may be the last straw.
ReplyDelete