Professional Dystopia: The ObamaDoc
The EMR savings were based on false assumptions from an original Rand Corporation review, which admitted that these savings were hypothetical and based on those many assumptions. They even used a model saying that we would save money by not needing a dictation service, because the physician is now the data entry clerk!
The new ObamaDocs will be on salary for some large corporate entity — so no need to work extra hard. Did you know that as recently as 2003, some 70% of physicians were in private practice? That means a small business — a mom-and-pop shop where you knew the doctor, the receptionist, and medical assistant. Like the old-time pharmacist or grocer. You used to choose your physician; now you’ll just call the corporate headquarters and be assigned one. Never mind that you may not see him or her again for any emergency — the number of physicians in a private setting is now about 50%, and Pelosi and the president don’t want private practice doctors as part of their overall plan.
They didn’t count on a lot of physicians retiring early. A recent New England Journal of Medicine article cited a survey showing that roughly 50% of physicians would retire if there were a government health care plan, and 25% would retire with the existing plan just made into law. The 21% Medicare cut will eventually have to be implemented. Fifteen million new patients will be added to Medicaid. Obama intends for ancillary health care providers, such as nurses, nurse practitioners, aides, and assistants, to be the actual primary care providers, and for a physician to be a backup for only serious problems. There was not one iota of effort made to curb runaway legal expenses, such as defensive medicine, documentation, and malpractice costs. The majority of Americans did not want this outrageously expensive bill to pass. The numbers given the CBO were disingenuous at best — the real costs are somewhere around $2.8 trillion. The structure for funding this new law is a Ponzi scheme. Pelosi arranged for her and her compatriots to opt out of the new health care pool.
I don’t know about you, but I’ve had enough.
Sir:
Can you tell me where voters can get the full review and interpretation of the new ObamaCare Law. This 3000 page documents has enough weight to die of it’s own weight and scandal if people could actually see a decent analysis. I was at a gathering last week and an older lady insisted that “her” doctor said teh bill was great. Where does this crap come from?
Tommy Gunn
Doctor…we don’t need no stinkin’ doctors.
We will do it all with “Extenders” who we will license and like the Oral Surgeons “grant” them an MD by government fiat. One extra year of training beyond a Masters (two years) and we will give a PhD to Physicians Assistants and Nurse Practitioners. They can all be dumped into the “Doctor” pool with the Podiatrists and Optometrists and Psychologists (the most precise of the occult scientists). While we are at it…why not the Chiropractors…we can give them a license to prescribe, checked only by the EMR.
Pharmacists can just make virtually everything over the counter…they are all PharmD grads now with one extra year or somewhere maybe two. Type your symptoms into their computer and Obama will tell the dispenser what the choices are. No need to go to a real doctor…leave your symptoms at the Pharmacy in Publix before you get your groceries and your medicine will be ready at he checkout.
Fortunately, I do not intend to be the stable boy cleaning up after this crap…
In spite of the complete absurdity of the new ObamaMed plan, there are millions of Americans screaming out their support for this plan from their new god Obama. Any criticism or mild observation that deviates from the offical party line of the Pelosicrats will become punishable by the neo Law. Obamaites will be getting what they deserve and getting it good and hard; the best plan for the rest of us is to bone up on traditional remedies and become less reliant on this new government health giant. It would be wiser to avoid anything run by the New American World State government including its educational system and legal system. Withdraw Defend Survive.
Dealing with government paperwork is worse than a pain. At a meeting, the Fed’s representative said they don’t believe in honest mistakes, only fraud. When we get a patient with orders from their physician, we have to put the orders in the system. If they are Medicaid/Medicare, we have to put in an ICD-9 code. If the physician is vague, can’t read the writing, etc, we have to contact the physician for clarification.If they can’t be reached, the patient has to sign an Advanced Beneficiary Notice, which states that the tests may or may not be paid for and the patient will have to pay for it themselves. (Usually we can reach the physician the next work day but not always). Many times, the patients are elderly and very sick and this paperwork scares them. They think they can’t afford it so they decline the test and don’t receive the results. The physician gets mad we didn’t do it anyway and doesn’t care that we can’t legally do it without the correct data. It is frustrating all the way around because I didn’t go through four years of school to do this kind of paperwork, either.
I know where you are coming from, I am the Medicare Maven (which sometimes isn’t saying much) where I work and I spend more time reading their crappy manuals than actually sending bills to Medicare.
Obamacare is designed to push out Beverly Hills penthouse botox practices like Dr. Weiss’. He does not take medicaid and certainly does not need to worry about non-paying patients. He already employs a PA to handle the routine stuff.
For young docs today things are looking pretty good. Lots of jobs as hospital employee or big groups. No worries, fixed income, regular hours, time off, paid insurance and no expenses. Just make your minimum productivity goals and you are set for life.
If you are corporate, bland, impersonal, and unimaginative a young doc today has no worries. Incomes are good enough and the suits will keep writing the monthly check as long as you dont rock the boat. Finally a doctor can enjoy the fruits of his labor, the money that is, professional satisfaction is overrated.
Demand is going to soar and reimbursements drop. Times will be uncertain as the medical world udjusts to the seismic shifts underway. For the individual best advice is do not invest in equipment, offices, or time working on a partnership track. Get paid up front and let the suits worry about the rest. You will probably be somewhere else in 5 years anyway so pack light and mobile. Pick skills which are easy to market and move. Listen for the hoofbeats and go with the heard. Clock in and out on time. Settle for less and forget all those lofty and childish ideas you started with.
Don’t feel bad doc. You are fine and your patients love you, not that anyone cares about that. You are a cost center worth X RVU’s at Y expense. This is what your patients picked when they voted and there is nothing you can do about it.
Spindok
The price of health care, like everything else, is a function of supply and demand. Average physician income in the United States is twice Germanys and four times Sweden. American physicians have a lock on the certifying, licensing, and the amount of physicians created in the United States. It’s a market of planned scarcity. The AMA is a self policing physician’s cartel upon which other professions, like trial lawyers, seek rent from because of the failure of doctors to self police. Until that cartel is ended, you can expect increasing monopoly pricing and increased health care costs funded by government and third party insurance premiums. Since you didn’t mention any this, I thought I would, doctor.
So the AMA with declining membership that amounts to approximately 20% of all practitioners, if you believe them, is representative of all doctors? Give me a break. They certainly should be criticized though for a host of other reasons.
Glad to give you a break. I’m sure you’re right, just like the ABA( American Bar Association) membership probably amounts to only 20 percent of all practitioners. However, that doesn’t address the fact–supply and demand relationship– that lawyers and doctors together only represent 1 percent of the American population. Curiously, that contrived scarcity–which started with the progressive era reforms in the early twentieth century– has been managed by delegating a lot of former doctor and lawyer functions to underlings to help with demand while still charging full boat–or refusing to take medicare patients. Of course, high unit labor costs have always been an incentive to technological innovation too–as with computerized records. But the fact remains, if doctors, excuse the hyperbole, were produced on the scale of journeyman hamburger flippers, the price of seeing a doctor at a doc in the box would be comparable.
The scarcity of training positions for doctors has more to do with the incredible expense of training programs. Training lawyers entails throwing a lot of bodies into a classroom and then giving them periodic tests. Training doctors entails intense bedside teaching in a variety of specialties and modalities…even after the MD is achieved and a long residency period is entered. The Clinton administration, NOT the AMA decided in the 1990s that the country was endangered by an imminent oversupply of physicians. My primary care group has been trying to get a new partner now for five years and with nary a bite and an occasional interview. Within 7 more years all members in our group will be > 65 years old and will be disbanded. The end of a clinic established in 1952…
I used the AMA for the sake of argument, although they do have White House access. If we produced the Ford Tarus the way we produced doctors, the Taurus would not be market effective. American doctors do have an advantage in the globalization era, they don’t have to directly compete against Dr Feel Good in Sweden, earning four time less annual income on average. However, Jose mows Dr. Strangelove’s lawn and Carmelita makes his bed, and they don’t even need green cards to better keep the prices down for that domestic service to Beverly Hill’s tort lawyers.
Don, you’re clueless. Since I am a recent med school dropout pursued as second career, I’ll give you my take which is a hell of a lot more accurate than yours.
Good luck creating the incentive to forgo anywhere from 7-14 years without a real paycheck, walk away for your troubles with about 200K in debt, spent anywhere from 60-100 hours a week in the pursuit, and attract the best and brightest students while placing these demands.
With the exception of certain specialists, doctors don’t make near what you think Don. I know. I weighed the economic factors against consequences and ObamaCare and said, “to hell with this…”
We have entire counties in my state without one primary care physician right now Don. What do you think is going to happen when we cut wages by half as you insist?
so let me see if I understand this right. If you double the graduation rates from medical schools or even double the current amount of medical schools, your unit costs double also? Gee, what a sweet monopoly pricing deal, no matter the supply, the price of your medical degree stays the same!
So are you proposing we double our medical schools, double our graduation rates, expand our residencies two fold, and lower the cost of graduate due to I assume economies of scale? Super! Good luck! You’ll find you have problems with available slots for third and fourth year students, but I certainly wouldn’t object, and I believe I speak for all medical students.
However, you retort still missed the bigger point.
Unless you also wish to halve the required years of medical training, you still have seven to eleven years of lost wages. You willing to forgo less training? Then if you wish to lower wages as well, which I took as your personal objection, how are you going to provide incentive to the best and brightest, because only about 3-5% of college students deemed capable of the medical school curriculum? I believe the current wage is already depressed due to Medicare, Medicaid, and the like. Your supply and demand doesn’t hold water.
Trust me, knowing a doctor’s schedule, empathy and service only carry one so far. Doctors deserve to be well compensated.
When you can provide me an answer, I’m all ears.
Well, there goes House… gov’t would never let him get away with any the stuff he does on that show any more. But, seriously, what the @#%& was the AMA thinking? That they’d be praised and cared for in the old age by the new progressive order by destroying their profession with their support of healthcare reform? Doctors with a frickin’ deathwish?
In the Great Helmsman’s great country, physicians were vermins preying on the needies. There were boards made up of healthcare workers to determine how much the healthcare professionals would be paid. Since everyone was working the same number of hours, my aunt, a nurse, who was on the board was paid more than my uncle, a physician. The useless physicians who preyed on the poor were sent to re-education camps to get rid of their poor-preying mentalities. The heartless physicians were replaced with “bare-foot doctors” mass-produced by the state.
A decade or two later, my other aunt, the physician’s new wife was giving birth. The doctor told her to have an abortion because the baby had no brains. How would he know? He felt it. My physician uncle refused, The baby was born live and healthy. It turned out the so-confident “bare-foot doc” felt the baby’s toes where the head was supposed to be and decided the baby lacked a skull.
Grim picture, Dr. Weiss, but an all-too accurate one, I’m afraid.
Jump to the future:
It’s 2035, and former president Obambi is being interviewed at his winter home in St. Kitts.
“Mr. President,” the reporter asks, “How does it feel to know that because of what is known as ‘Obamacare’, countless thousands have died for lack of timely and professional medical care?”
Former Dear Leader exhales a massive cloud of cigar smoke, swallows a large mouthful of Henri IV Dudognon Heritage Cognac, then chuckles.
“It feels pretty damned good. Everyone is finally equal, thanks to me.”
Don is a moral and economic genius, just like Chairman Obama.
We’ll have equally good care to that which Chairman Mao foisted on the people.
Hey Don, you moron, how many years of schooling does it take to flip the burgers, and what are the consequences of poorly flipped burgers? How many years of sleeplessness does it take to learn to tell when the timer goes off or the beef is brown?
Every flippin’ socialized medical care system is on the way to going broke. The NHS is a clusterf**k, Canadians come here, or are pressuring their own govt. to let them have legal private care, and we still have the best care in the world. Oh, you want to quote the asinine and wrong UN stats that say that’s not correct? Since they are based on most other countries using a different definition of infant mortality than we do…they don’t count a child as “alive” for those purposes until 24 hours have passed…and we also take care of the widest array of cultures and races in the world, including crack-addled and alcoholic moms, and a lot of 16 year olds (don’t tell me it’s a stereotype, I see it all the time).
Don, you couldn’t be more wrong if you tried.
The AMA, btw, is like the AARP…it has become an org. that cares only about its officers, who make millions off the ICD codes; they have the monopoly on them, and make a cut on every single code used. Obama threatened their monopoly, which is why they sucked his you-know-what and went with Obamacare. It was purely about the money. They don’ represent any 20%, either, it’s supposedly no more than 17%, and dwindling quickly.