Where have all the doctors gone?

[Anonymous]

Anonymous wrote:

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.

This reminds me of Seinfeld’s “ because the mail never stops”
[youtube] https://www.youtube.com/watch?v=LL6ubXD9ZjY[/youtube]

[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.

Yes, people are trying to self advocate because care has become so abbreviated and disjointed

But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie

[Anonymous]

Anonymous wrote:

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.

And then you come and post “where have all the doctors gone” lol

[Anonymous]

Anonymous wrote:

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.

Yes, people are trying to self advocate because care has become so abbreviated and disjointed

But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie

IF the disorder is rare , found in 1 in a thousand people. Meant to add.

[Anonymous]

Anonymous wrote:

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.

Yes, people are trying to self advocate because care has become so abbreviated and disjointed

But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie

This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113

[Anonymous]

Anonymous wrote:

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.

3 or 4 patients per hour isn't very many. In an office settings most doctors will see at least that many.

A PCP might be able to make a similar amount switching to telehealth, but even that isn't clear. There are different billing levels for visits, and telehealth effectively limits you to the lowest one. And almost any specialist would take a huge pay cut.

[Anonymous]

Anonymous wrote:

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.

Perhaps you should just skip doctors and treat yourself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

3 or 4 patients per hour isn't very many. In an office settings most doctors will see at least that many.

A PCP might be able to make a similar amount switching to telehealth, but even that isn't clear. There are different billing levels for visits, and telehealth effectively limits you to the lowest one. And almost any specialist would take a huge pay cut.

It’s 15min per patient including documentation, prescriptions, etc And it’s ALL DAY so all of those “quick” portal questions you send also need to be addressed. If you have a 3k patient panel and each one sends 3 portal messages a year that’s 9k portal messages over 365 days. You do the math.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Perhaps you should just skip doctors and treat yourself.

Exactly. Quit complaining and start taking the prerequisites for medical school, then take the MCAT, find an open spot, finish medical school, pass boards, match into a speciality and finish residency since you can do it better than every single person. Stop wasting time! It will take you about 10-12 years to prove how much better you are!!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Perhaps you should just skip doctors and treat yourself.

I've tried as I cannot get quality health care. Sadly it hasn't worked.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Yes, people are trying to self advocate because care has become so abbreviated and disjointed

But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie

This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113

And what do you think the morbidity and mortality would be if every patient who might, on a very off chance, have a PE is given a pulmonary angiogram which is the gold standard for diagnosis?

Or even “just” a chest CT?

I’m not talking about cost, even. Or availability of practitioners and machines to run all these tests on every single patient with some shortness of breath. I’m talking about harm to patients that results from doing the test.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

3 or 4 patients per hour isn't very many. In an office settings most doctors will see at least that many.

A PCP might be able to make a similar amount switching to telehealth, but even that isn't clear. There are different billing levels for visits, and telehealth effectively limits you to the lowest one. And almost any specialist would take a huge pay cut.

It’s 15min per patient including documentation, prescriptions, etc And it’s ALL DAY so all of those “quick” portal questions you send also need to be addressed. If you have a 3k patient panel and each one sends 3 portal messages a year that’s 9k portal messages over 365 days. You do the math.

Our doctors office doesn't answer email. The nurses or techs do. They don't even see them.

[Anonymous]

A lot of people went concierge over the past few years. Every time I find a doctor I like through INOVA, they go INOVA VIP which is a few thousand a year that I'm not willing to pay. It has happened to me three times!! I finally just switched to One Medical and am very happy with them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Perhaps you should just skip doctors and treat yourself.

I've tried as I cannot get quality health care. Sadly it hasn't worked.

Don't give up so easily. It sounds like you shouldn't see doctors anymore.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

3 or 4 patients per hour isn't very many. In an office settings most doctors will see at least that many.

A PCP might be able to make a similar amount switching to telehealth, but even that isn't clear. There are different billing levels for visits, and telehealth effectively limits you to the lowest one. And almost any specialist would take a huge pay cut.

It’s 15min per patient including documentation, prescriptions, etc And it’s ALL DAY so all of those “quick” portal questions you send also need to be addressed. If you have a 3k patient panel and each one sends 3 portal messages a year that’s 9k portal messages over 365 days. You do the math.

Our doctors office doesn't answer email. The nurses or techs do. They don't even see them.

And that probably makes a lot of patients really mad. “Can’t I just ask my doctor??? Can’t you just send the message along to them?” And I don’t disagree. But patients sometimes expect too much from doctors who are practicing in the system we have. And expecting the doctor to be able to see a patient every 15 minutes, finish the charts, send the scripts, coordinate care with the specialists, and answer 30ish portal questions each day, is not realistic. But since it’s your health/ your most valuable commodity/ of course you want your doctor to do all that and more for you. It makes total sense. But they can’t.