Is anyone one a little concerned that the new healthcare reform could hurt you more than help you?

[Anonymous]

Try this - http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/?hpid=topnews

[Anonymous]

Anonymous wrote:What you're generally not going to get from an NP but you will from a good internist is any sort of outside-the-box thinking of diagnoses that aren't immediately apparent. Things that a physician only saw a few times during residency and that an NP would never have seen in 18 months of training. A rash that turns out not to be a superficial issue at all but actually the result of a far more serious underlying rheumatologic issue. Things that only become apparent when the right questions are asked and the right tests ordered by someone who has seen it all in training and as a result recognizes it when he sees it again. Seeing an NP for annual exams, etc. is great until something obscure is missed or mismanaged because of inexperience or a fundamental lack of knowledge. Then suddenly it's not so great. Sometimes it's already too late to go running to the back-up physician.

Sorry, I don't believe that all doctors have this kind of memory. (I lived with a doctor for several years, and she couldn't remember how to use the coffeemaker.) Good for you (and your patients) if you do. But I think that a sizable number of your physician peers don't remember something they saw once (or five times) in training. For every story of a life saved by a brilliant physician, there's another one about someone who suffered through a misdiagnosis (like my friend whose tumor in her lung was called pneumonia for several months).

[Anonymous]

Anonymous wrote:

Anonymous wrote:What you're generally not going to get from an NP but you will from a good internist is any sort of outside-the-box thinking of diagnoses that aren't immediately apparent. Things that a physician only saw a few times during residency and that an NP would never have seen in 18 months of training. A rash that turns out not to be a superficial issue at all but actually the result of a far more serious underlying rheumatologic issue. Things that only become apparent when the right questions are asked and the right tests ordered by someone who has seen it all in training and as a result recognizes it when he sees it again. Seeing an NP for annual exams, etc. is great until something obscure is missed or mismanaged because of inexperience or a fundamental lack of knowledge. Then suddenly it's not so great. Sometimes it's already too late to go running to the back-up physician.

Sorry, I don't believe that all doctors have this kind of memory. (I lived with a doctor for several years, and she couldn't remember how to use the coffeemaker.) Good for you (and your patients) if you do. But I think that a sizable number of your physician peers don't remember something they saw once (or five times) in training. For every story of a life saved by a brilliant physician, there's another one about someone who suffered through a misdiagnosis (like my friend whose tumor in her lung was called pneumonia for several months).

Eh, PP. My kid gets straight A's - near perfect grades, but he can't remember to do anything else. So what, she couldn't make coffee.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yeah I have to agree - we love seeing the NP at our pediatrician's office. Very qualified, she knows her stuff - which is more than I can say about some of the doctors there! My favorite is still when I brought my 2 year old in for a very red itchy eye with lots of gunk coming out of it. The doctor diagnosed an ear infection. Shockingly, the rest of us got pink eye within a few days. The NP cleared us all up.

The next time you need surgery, let an NP do it.

What are you, an idiot? Of course the MD will "do it", but they will be surrounded by nurses, nurse anesthetists, and probably assisted by a PA or NP.

[Anonymous]

Anonymous wrote:FYI everyone, the NPs ARE smarter. They make a ton of money, get a full night's sleep, don't pay malpractice insurance (the doctor gets sued), and all this with a master's degree.

a ton of money? who here considers under 100K a ton of money?

[Anonymous]

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Anonymous wrote:I'm worried that if more people get health insurance, they will start going to see doctors more and trying to get more access to health care. Good for them, of course, but we're going to need more doctors or else waiting times will get longer. especially if you want to switch to a new doctor.

Of course, it may mean less time in the emergency room when you have a true pediatric emergency because there won't be a guy ahead of you with the sniffles who decided to come ot the ER because he doesn't have a primary care physician because he lacks health insurance.

And all those new primary care physicians are going to come from where? I made my "well woman' appointment and the earliest date was 12 weeks! Before "reform"! So much for using my birthday as a reminder for a well woman appt ... way off the calendar schedule now.

Create the market and they will come. And there will be a much larger use of nurse practitioners and physician assistants as well. Lots of new career opportunities.

You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.

I absolutely agree with this. Two of my doctors have already stopped taking all insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:FYI everyone, the NPs ARE smarter. They make a ton of money, get a full night's sleep, don't pay malpractice insurance (the doctor gets sued), and all this with a master's degree.

a ton of money? who here considers under 100K a ton of money?

Me. And 84% of the US population.

[Anonymous]

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Anonymous wrote:I'm worried that if more people get health insurance, they will start going to see doctors more and trying to get more access to health care. Good for them, of course, but we're going to need more doctors or else waiting times will get longer. especially if you want to switch to a new doctor.

Of course, it may mean less time in the emergency room when you have a true pediatric emergency because there won't be a guy ahead of you with the sniffles who decided to come ot the ER because he doesn't have a primary care physician because he lacks health insurance.

Actually we will likely all spend MORE time in the ER because they will be inundated by newly insured patients who want to see a physician but can't find primary care physicians to see them. As a physician, every physician I know is wondering who the heck is going to take care of the newly insured? And this is the hot topic in the editorial sections of most journals and on physician geared websites/message boards. Most hospitals are prepping for a deluge of new ER patients.

This is the most oddest argument I have heard against health reform. No that you do not have the "you do not have insurance" excuse, you and your fellow doctors will just have to work a little bit harder (sorry about that tee time you will have to miss). Isn't that the reason you went to medical school - to treat the sick.

So you actually think that when your primary care doctor isn't taking new patients or is booked for 3 months it's because he/she is out golfing and/or slacking off? No, we all have more patients than we know what do with right now. At present I work 12 hour weekdays plus 4 hours every other Saturday. But perhaps you would prefer that I work around the clock. I could see patients all evening and night as well as all day!! See my children? Sleep? No, that would be selfish in your eyes.

Or perhaps losers like you could go to medical school if it's such the life of leisure that you imagine.

I have little sympathy for you, PP. And I'm glad you are not my doctor (yes, I'm sure you are not). My doctor turns away patients when his practice is full. He gets enough rest and sees his family. Yes, he has to work some weekends and evenings, but he's not worn down to the bone, nor is he overwhelmed by patients. You obviously don't know my doctor. Health care reform will not affect the hours my doctor works, which are longer than say, a teacher's hours, but he gets paid a lot more than most teachers.

Capitalism works on a supply and demand system. More patients, more doctors, more jobs. It will take time for the system to adjust, but adjust it will. And it won't be on your poor tired back, PP, because you can choose not to see so many patients or work so many hours. Spend time with your kids. Make less money. It's a choice.

In response to the OP's question, we have great insurance, and we're going to pay more for it under the new program. Yipee!! I am so happy we will pay a teensy bit more for our health insurance if it means that my self-employed BIL can now get insurance for a pre-existing condition. He and his family have been living in fear that his condition will return and bankrupt them all. He can afford the premiums, but all insurance companies he's applied to have turned him down. Until now. Hurray!! He's going to apply as soon as he can. And no insurance company will be allowed to turn him (or anyone else with a pre-existing condition) down again.

Unfortunately, I don't think the pre-existing condition clause kicks in for adults until 2014. It's effective immediately for children. Hope he can hang on.

[Anonymous]

But they are implementing a high risk pool as a temporary program before 2014 for people like the pp's BIL.

[Anonymous]

You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.



I absolutely agree with this. Two of my doctors have already stopped taking all insurance.

Ok . . . so the system is so broken, doctors are self-selecting out. Yet you oppose attempts to fix it? Tell me, what would you prefer? What is your solution? What do you think would work better?

[Anonymous]

How is this not caring? I am currently seeing patients every 7 minutes in primary care. Would you want me to increase that to every 4 minutes?
It is not an issue of not caring. It is simply an issue of not having enough hours in the day.

Try and find a primary care physician. There's a post every other day on these boards from people unable to find one who is accepting new patients. And it's not because we're uncaring or sitting on our behinds or taking Fridays off. I'm working 10 hour days every day and I'm still booked solid for the next 3-4 months (as is every colleague I know).

I'm not being uncaring in stating that that the newly insured won't be able to find physicians. It's just the reality.







PP, ignore that fool, I am a doctor too, and completely get where you are coming from. That poster probably has never said than you to anyone from techs to nurses to doctors who took care of her/him.

Only a fool would refer to a nurse or a tech as a physician. What do you expect people to do? Isn't this why you went into medicine? If you don't want to practice go do research.

[Anonymous]

Anonymous wrote:
In response to the OP's question, we have great insurance, and we're going to pay more for it under the new program. Yipee!! I am so happy we will pay a teensy bit more for our health insurance if it means that my self-employed BIL can now get insurance for a pre-existing condition. He and his family have been living in fear that his condition will return and bankrupt them all. He can afford the premiums, but all insurance companies he's applied to have turned him down. Until now. Hurray!! He's going to apply as soon as he can. And no insurance company will be allowed to turn him (or anyone else with a pre-existing condition) down again.

PP, I'm so glad that your BIL is going to be able to get health insurance now! This is really good news!

[Anonymous]

This bill is really great for kids born with developmental and physical disabilities like cerebral palsy, autism, and down syndrome. Insurance generally covers just rehabilitative services, not habilitative. If you get in a car accident, you can get therapy to help you walk again, but if you are injured during birth insurance won't cover a dime for the same types of therapies. Now that will change.

[Anonymous]

Anonymous wrote:This bill is really great for kids born with developmental and physical disabilities like cerebral palsy, autism, and down syndrome. Insurance generally covers just rehabilitative services, not habilitative. If you get in a car accident, you can get therapy to help you walk again, but if you are injured during birth insurance won't cover a dime for the same types of therapies. Now that will change.

This is in PART why parents sue the doctors. Even when the parents and lawyers know that the problem had nothing to do with the obstetrician, they need money to care for the child.

[Anonymous]

Anonymous wrote:

You and your shiny new health insurance are welcome to see a NP (with 18 months post undergraduate training) for your primary care. I (and I wager anyone with decent insurance or more importantly cash) will happily stick with seeing my board-certified internist (with 7 years post undergraduate training). I see a 2 tier system quickly emerging much as it has in England. Frankly it has already started happening in the DC area where many (most) of the top doctors don't take insurance at all.



I absolutely agree with this. Two of my doctors have already stopped taking all insurance.

Ok . . . so the system is so broken, doctors are self-selecting out. Yet you oppose attempts to fix it? Tell me, what would you prefer? What is your solution? What do you think would work better?

I'm not proposing a fix, I'm just listing a probable consequence of the passed legislation. Doctors barely have enough time to spend with patients now. What do you think will happen when several million more patients are dumped into the system? The uninsured will definitely benefit from this bill but everyone else with insurance will see their premiums and taxes go up and their service go down. There will also be rationing. If that's what people want in order to provide insurance to all, that's fine, but please be honest about it.