What Happened to Doctors?

[Anonymous]

My 14 yo has been having recurring, severe bouts of stomach pain/diarhea for three months after a one-day stomach bug. Ped is out of ideas, referred us to a pediatric gastro. First available appointment with an in network doctor? August 25.

[Anonymous]

Anonymous wrote:Where did all the doctors go, though? Did they go into other scientific fields like research?

I'm not talking about those who were unfortunately lost to covid.

My husband's PCP closed their office. He's searched for him to find out where he went and can't find anything. My husband received a letter that said due to rising healthcare costs, effective blah date, the practice would cease operations. Shouldn't he be able to still find him via Google? Like to whatever practice he may have joined. But he can't. So odd.

Maybe they moved out of the DMV like so many other people did. We moved and I have no problem getting in person appointments. Even same day sick visits.

[Anonymous]

Anonymous wrote:OP, I agree with you. For what we pay in insurance costs and out-of-pocket costs, it feels like we get such poor quality of care. And maybe it's wrong of me, but it feels like such a money grab sometimes. I never know what question at an appointment will get the visit billed differently so there's a $$ co-pay, and it varies with different providers.

I work in healthcare and please be assured, it is a complete money grab.

An unintended consequence of the ACA is that it became prohibitively expensive for doctors to operate private practices, and so they are either shuttering their offices/retiring or selling their services/practices to large healthcare organizations (like the one I work for). Clinical staff is suspicious and resentful of administrative staff, whom they see as out of touch with the day-to-day operations.

My boss, a VP, is candid about the fact that the system is intractably bloated, but everyone at the top gets a piece, so don’t expect any meaningful changes anytime soon. Everyone is in on it, and we all know, and we all get paid, and because this is America no one will stop us.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Let’s be honest: most docs trained in the last few decades don’t know what they are hearing through a stethoscope unless the diagnosis is “death.”

We have a problem here and it’s a lot bigger than in-person visit availability.

You sound crazy.

Actually not. Older doctors know how to do, and value, information from hands on exams. Many younger doctors just run a lot of tests that would not be necessary if they conducted an informed hands on exam.

I had this happen with an older teen. Dozens of doctors who spent like one minute doing a hands on exam. They dismissed symptoms as psychological, passed her along to another doctor, or made her undergo expensive tests that showed nothing.

I finally got her to an older doctor who spent twenty minutes doing a hands on exam, and he diagnosed her on the spot. Ran a total of three very simple blood tests to confirm.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don’t trust any Doctor Who is younger than 50

So you don’t trust the bulk of women & POC doctors?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I feel sorry for the sick and poor in rural areas. We have it pretty good in the DMV compared to most areas.

My parents are in rural PA and they actually have an easy time finding doctors--both primary care and specialists. The DMV is hard because the cost of running a practice is so much higher (rent, salaries, even utilities).
Physicians are reimbursed the same in both places but their overhead is twice as high here.

Danville?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Long story, but I am very familiar with current med school admissions and the types of people that admissions committees are favoring. Let’s just say that, if you think doctors are bad now, be afraid for the future. Very afraid.

Yep. Holistic admissions.

What does this mean? What kind of people?

Poor URMs who may not have the chops.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, I agree with you. For what we pay in insurance costs and out-of-pocket costs, it feels like we get such poor quality of care. And maybe it's wrong of me, but it feels like such a money grab sometimes. I never know what question at an appointment will get the visit billed differently so there's a $$ co-pay, and it varies with different providers.

Then you have misplaced anger. Your problem is with the insurance companies.

I think this is another reason docs are jumping ship. Patients take out their anger on them when it should be directed towards insurance companies. Patients are paying insurance companies more, insurance companies are paying doctors less plus they’re requiring loads of additional paperwork and complicated billing structures for basic care.

Doctors are not allowed to unionize, they cannot demand that the government reign in the unethical insurance companies, they could not demand PPE during the pandemic, they have to work inflexible schedules with less and less staff and money.

Young docs don’t start working until they’re almost 30, missing out on years of earnings and savings, then they’re saddled with debt.

-not a doctor but my best friend is and I’ve witnessed first hand how these past few years have impacted her life.

Doctors can unionize. And those in private practice ultimately decide what insurance they'll accept.

Residents have at UMich.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I feel sorry for the sick and poor in rural areas. We have it pretty good in the DMV compared to most areas.

My parents are in rural PA and they actually have an easy time finding doctors--both primary care and specialists. The DMV is hard because the cost of running a practice is so much higher (rent, salaries, even utilities).
Physicians are reimbursed the same in both places but their overhead is twice as high here.

Danville?

Yeah they must live near Geisinger. Even a few miles away it’s not easy to find a doctor. My friend is a doctor there and had four job offers out of the gate. Every time he wants to take an extended vacation, he quits the job and comes back to a new one.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, I agree with you. For what we pay in insurance costs and out-of-pocket costs, it feels like we get such poor quality of care. And maybe it's wrong of me, but it feels like such a money grab sometimes. I never know what question at an appointment will get the visit billed differently so there's a $$ co-pay, and it varies with different providers.

I work in healthcare and please be assured, it is a complete money grab.

An unintended consequence of the ACA is that it became prohibitively expensive for doctors to operate private practices, and so they are either shuttering their offices/retiring or selling their services/practices to large healthcare organizations (like the one I work for). Clinical staff is suspicious and resentful of administrative staff, whom they see as out of touch with the day-to-day operations.

My boss, a VP, is candid about the fact that the system is intractably bloated, but everyone at the top gets a piece, so don’t expect any meaningful changes anytime soon. Everyone is in on it, and we all know, and we all get paid, and because this is America no one will stop us.

I'm also in healthcare (doctor). It's nothing to do with the ACA (which helped many of my previously uninsured/underinsured patients get better care). It's because of the corporatization of health care. I agree with the rest of what you say.

[Anonymous]

Anonymous wrote:Agree it has gotten ridiculous. We are lucky - we have a great pediatric urgent care near us and they’ve become our go-to over the pediatrician for anything symptomatic. Ped is not helpful except for getting shots.

Same with us. We go to the ped for well-child checks and that's it. When the kids are actually sick, we take them to the pediatric urgent care. I've tried calling the regular ped and it's tough to get anyone to answer the phone, then when they do, they need to triage to decide who actually gets an appointment. It's become a PITA in to get a sick visit there. The ped urgent care is low hassle, we've never had to wait long, and the quality of care is good.

[Anonymous]

Anonymous wrote:Long story, but I am very familiar with current med school admissions and the types of people that admissions committees are favoring. Let’s just say that, if you think doctors are bad now, be afraid for the future. Very afraid.

What types of people are admissions committees favoring? My cousin just graduated med school and is intelligent, normal, humane. But I have no idea what her med school classmates and neither does she as going through med school during covid it was difficult to form friendships.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Was healthcare not for profit in the 80s and 90s?

It was. But at that time only doctors could own medical practices. Then the rules changed and PE and other investors got into the business. Your money is now supporting an additional layer of people getting rich.

Which additional layer are you talking about?
Admin bloat?

Private Equity firms.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, I agree with you. For what we pay in insurance costs and out-of-pocket costs, it feels like we get such poor quality of care. And maybe it's wrong of me, but it feels like such a money grab sometimes. I never know what question at an appointment will get the visit billed differently so there's a $$ co-pay, and it varies with different providers.

I work in healthcare and please be assured, it is a complete money grab.

An unintended consequence of the ACA is that it became prohibitively expensive for doctors to operate private practices, and so they are either shuttering their offices/retiring or selling their services/practices to large healthcare organizations (like the one I work for). Clinical staff is suspicious and resentful of administrative staff, whom they see as out of touch with the day-to-day operations.

My boss, a VP, is candid about the fact that the system is intractably bloated, but everyone at the top gets a piece, so don’t expect any meaningful changes anytime soon. Everyone is in on it, and we all know, and we all get paid, and because this is America no one will stop us.

I'm also in healthcare (doctor). It's nothing to do with the ACA (which helped many of my previously uninsured/underinsured patients get better care). It's because of the corporatization of health care. I agree with the rest of what you say.

I am a doctor and I disagree with you, ACA was the inflection point where it went south.

[Anonymous]

Anonymous wrote:Its become a factory line since obama care kicked in. welcome to a somewhat world of socialized healthcare that docs need to process as many as possible to turn a profit.

also dont forget, inflation has gone nuts but the insurance reimbursement to doctors has stayed constant so they cant afford to hire staff. Its really a sh*t show.

Its about to hit dentistry next.

But we wouldn't want to go back to the status before the ACA - some people literally could not get insurance because of pre-existing conditions and could not pay the out of pocket cost.