Where have all the doctors gone?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.

What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.

Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.

None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.

If you saw 16 patients like that each day, every day, you would definitely find it miserable.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.

What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.

Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.

None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.

If you saw 16 patients like that each day, every day, you would definitely find it miserable.

Let's be frank about this. It isn't 16 patients. It's 16 patients in person, plus the 4 phone calls and 5 portal messages from patients each of whom has just one simple question but also by the way while I have you on the line a few other things, plus figuring out the preapprovals for another couple of patients. Which would be fine, but of course none of this comes to you in an organized way -- it's just people who are scared and suffering, so of course they don't ask the real question (is it cancer? is he having seizures?) until the very end of an unrelated visit, or someone else has already made you run over an so this person is tight-lipped and angry because "doctors these days" and "I should charge you for my time," and it's not like you even disagree with them but there is this avalanche and it just keeps coming every day every day every day.

16 patients like this, plus.

[Anonymous]

Anonymous wrote:My PCP went concierge. I begrudgingly pay the $2000 fee because she is really responsive and good at coordinating the rest of my care.

I had three specialists retire in the last year. All Boomer-age. So I’m assuming that some of this is just the effects of the Boomers aging out of the workforce, like people have been saying for years.

And I imagine patients are awful because people are generally awful.

I don't think the concierge model would help me. There's no way my PCP is going overrule my specialists with my rare condition. She knows I know more about it than she does. (I've had doctors and dentists leave the room to go Google it because they don't know what it is.) I'm not sure what I'd get from $2000 concierge fee just to renew two prescriptions a year.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think a lot went to telemedicine.

No, that doesn't pay very well. That is almost always done as a side job when it is done outside their normal practice.

It pays the same.

[Anonymous]

Anonymous wrote:They quit because people kept showing up to appointments with stacks of self identified pub med articles demanding they be evaluated.

Some of us are desperate for help and most doctors do the bare minimum and we suffer unnecessarily.

[Anonymous]

Anonymous wrote:

Anonymous wrote:They quit because people kept showing up to appointments with stacks of self identified pub med articles demanding they be evaluated.

Some of us are desperate for help and most doctors do the bare minimum and we suffer unnecessarily.

You can see as many doctors as you want.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think a lot went to telemedicine.

No, that doesn't pay very well. That is almost always done as a side job when it is done outside their normal practice.

It pays the same.

Not even close, particularly if you're in a specialty area. The pandemic-era billing policies are gone, so reimbursement for telehealth is back to being terrible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:They quit because people kept showing up to appointments with stacks of self identified pub med articles demanding they be evaluated.

Some of us are desperate for help and most doctors do the bare minimum and we suffer unnecessarily.

I can tell you're one of the patients driving doctors out. So many patients mainly need to see a psychologist, but instead pester their PCPs and specialists.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.

What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.

Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.

None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better.

If you saw 16 patients like that each day, every day, you would definitely find it miserable.

That's 30 minutes a patient and usually a nurse and other staff do most of the paperwork.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:They quit because people kept showing up to appointments with stacks of self identified pub med articles demanding they be evaluated.

Some of us are desperate for help and most doctors do the bare minimum and we suffer unnecessarily.

I can tell you're one of the patients driving doctors out. So many patients mainly need to see a psychologist, but instead pester their PCPs and specialists.

If you are a doctor YOU need to leave the profession and you are harming people who do have health issues and it's not mental health.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:They quit because people kept showing up to appointments with stacks of self identified pub med articles demanding they be evaluated.

Some of us are desperate for help and most doctors do the bare minimum and we suffer unnecessarily.

You can see as many doctors as you want.

Not when you have managed care. You need a referral and you don't get to pick your doctors except if you are referred out. I usually don't even get to see board certified doctors, just residents as the doctors are always in hiding.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think a lot went to telemedicine.

No, that doesn't pay very well. That is almost always done as a side job when it is done outside their normal practice.

It pays the same.

Not even close, particularly if you're in a specialty area. The pandemic-era billing policies are gone, so reimbursement for telehealth is back to being terrible.

No, the one I use has 3-4 appointments an hour per doctor. They get paid decently when they have zero overhead and working at home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.

What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing.

Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting.

Is this the norm or just an increase of this? Social media doesn't help, I guess. I'm on 2 medical sites, largely just to see in large what people are doing to manage a syndrome on a day to day lifestyle basis, not for medical advice or anything, but I see people really admonish other's treatment plans with dumb comments about what they should have gotten, or that their doctor is "poorly informed" - eye rolling stuff like that. So I imagine this ends up in the office. Dr. Google.

[Anonymous]

My GP also went concierge. My ob/gyn went to a gyn specialty and no longer takes regular patients. Of the new ones I've tried to get into they no longer take new patients. So I have to go to a nurse practitioner. Not happy.

[Anonymous]

Sounds like the US is being forced into socialized medicine.