Where have all the doctors gone?

[Anonymous]

Anonymous wrote:Quality healthcare still exists but you have to know how to navigate the healthcare system.

Former physician here who went to top schools and training programs. I no longer see patients but rather do different work that is more interesting to me.

What is your Cliffs Notes version of the best way to navigate the system?

Once a doctor knows you were a doctor, you probably get different treatment than civilians.

[Anonymous]

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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.

What harm? Ignoring the problems is the true harm.

Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.

How about a D-dimer blood test?

[Anonymous]

We have a broken healthcare system and doctors are reaching the breaking point in many cases:

Since Obamacare, many more people have insurance, so many people are using the system and getting appointments.

Many more people are doctor shopping, looking for doctors who will prescribe self-diagnosed treatments. During the opioid epidemic, the number of people who started doctor shopping, looking for the doctors who would prescribe opiods. That then started the trend which continued during the pandemic with people looking for doctors who were willing to prescribe pandemic related medications. The upshot is that with insurance, many more people were willing to pay a co-pay just to see a doctor and try to get what they wanted.

Insurance is paying lower rates that do not keep up with inflation. For every insurance holding patient, doctors get paid less and less per hour due to the rates that insurance companies are paying for similar service. Worse, insurance companies require extensive documentation and so the doctors have to work more to document everything for the insurance companies, which again decreases their hourly income because they are getting less money for more work. I know some doctors who have added 2-3 hours of documentation to every work day. So they see patients for 8 hours and then spend 11 hours working every day.

Doctors have more and more no-shows and a no-show is essentially lost money. So, to combat no-shows, doctors add 2-3 more patients in an hour to ensure that when a patient fails to show, that they definitely have aother patient waiting and ready to see, so they don't lose money for lost time. This, however, increases the wait time for patients due to multi-booking. The alternative is not to overbook, but then to charge penalties to patients who no-show, but many patients complain about that, too. No-win situation for doctors.

More doctors are leaving private practice and looking for positions that pay more consistently and better. So, many doctors have left private practice and gone into hospital practice. I know several who created doctor services who provide specialty consulting for local hospitals, especially ones that do not have that specialty in their hospital. For example, my twins were delivered and monitored by a NICU practice that had 7 neonatologists who supported three hospitals that did not have on-staff neonatologists. The hospitals were spread around and they doctors rotated around and each essentially covered 3 days in each hospital, had a day or two off, then rotated to another hospital. With the doctors and the rotation, they had a more normal work schedule and they as a team covered the three hospitals which found it easier to contract out that work than to have doctors on staff. The contract agency handled all of their benefits and assorted staffing overhead.

I know several doctors who left private PCP to become concierge doctors. The concierge fees cover their basic expenses and ensure that they aren't making less and less per patient and per hour due to the overhead of insurance costs. They can spend more time per patient and not lose income. It's a much better deal for patients.

Essentially without fully socialized healthcare, the impact of Obamacare type insurance is more care available for more people at the expense of doctors. Doctors are finding ways to not bear the brunt of this and as a result, care for the masses is getting harder and harder to come by.

[Anonymous]

When we get access to the Med Beds we won't need doctors or dentists. And all of it for FREE.
We will even be able to cure anything through your laptop.

Did you know there exists a mouthwash you swig and it will regrow teeth while you sleep ?
We're getting that too.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

What harm? Ignoring the problems is the true harm.

Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.

How about a D-dimer blood test?

How sensitive and specific is that test for a pulmonary embolism? If it’s elevated, does that patient automatically get a pulmonary angiogram? What’s the next step? (Think of this as a learning activity)

[Anonymous]

Anonymous wrote:

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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.

How do you get care when your primary care refuses to help and you need referrals and even when you get them you see residents who know nothing.

Clearly you know better than they do so you should treat yourself.

If I could, I would have, which is why I need good experienced doctors. The doctors, that I schedule appointments with hide in their office never to be seen. You get to see a tech or nurse and a resident (who spends 5 minutes with you and then regurgitates things to the doctor which aren't the real concern and come back saying you are fine or a basic medication without testing). You really think that is quality medicine?

Why are you still going to large academic institutions then? Go to a private practice.

DP. If you have something unusual, that's where the best doctors will be.

[Anonymous]

Anonymous wrote:When we get access to the Med Beds we won't need doctors or dentists. And all of it for FREE.
We will even be able to cure anything through your laptop.

Did you know there exists a mouthwash you swig and it will regrow teeth while you sleep ?
We're getting that too.

Ma'am, this is a Wendy's.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

How do you get care when your primary care refuses to help and you need referrals and even when you get them you see residents who know nothing.

Clearly you know better than they do so you should treat yourself.

If I could, I would have, which is why I need good experienced doctors. The doctors, that I schedule appointments with hide in their office never to be seen. You get to see a tech or nurse and a resident (who spends 5 minutes with you and then regurgitates things to the doctor which aren't the real concern and come back saying you are fine or a basic medication without testing). You really think that is quality medicine?

Why are you still going to large academic institutions then? Go to a private practice.

DP. If you have something unusual, that's where the best doctors will be.

Of course , but the poster saying the attending only pokes her head in for half a second to say they’re sending a scrip doesn’t sound like she has a zebra case of anything

[Anonymous]

Anonymous wrote:

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Anonymous wrote:I think many do not take Insurance..they just cater to those who can pay out of pocket.

Very, very few. How out-of-touch do you have to be to think many people can pay out-of-pocket?

I don't need many people. I just need some. I don't take insurance though some of my patients self submit the bills. Life is so much better. It's the future for those that can afford it. Others will wait to see the doctors that take it.

I'm not saying there are no doctors that do that. But the number of people in a position to pay for doctors like that will always greatly limit the number of doctors that can do it.

You must not be from DC or the close-in adjacent streetcar suburbs. It is nigh impossible to find a good doctor who does not charge concierge fees.

[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.

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

i have NEVER seen a doctor for 30 minutes. i have waited in a room for an hour or the waiting room for an hour. the actual seeing the doctor takes probably 5 minutes! even for my mom with cancer. appointments take all day but the actual time you see the doctor is minimal, maybe 10 minutes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:When we get access to the Med Beds we won't need doctors or dentists. And all of it for FREE.
We will even be able to cure anything through your laptop.

Did you know there exists a mouthwash you swig and it will regrow teeth while you sleep ?
We're getting that too.

Ma'am, this is a Wendy's.

Underrated comment here. Nice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think many do not take Insurance..they just cater to those who can pay out of pocket.

Very, very few. How out-of-touch do you have to be to think many people can pay out-of-pocket?

I don't need many people. I just need some. I don't take insurance though some of my patients self submit the bills. Life is so much better. It's the future for those that can afford it. Others will wait to see the doctors that take it.

I'm not saying there are no doctors that do that. But the number of people in a position to pay for doctors like that will always greatly limit the number of doctors that can do it.

You must not be from DC or the close-in adjacent streetcar suburbs. It is nigh impossible to find a good doctor who does not charge concierge fees.

Mine doesn't. Nor does our pediatrician.

Regardless, there's a big difference between charging a concierge fee and not accepting insurance at all.

[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.

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.

i have NEVER seen a doctor for 30 minutes. i have waited in a room for an hour or the waiting room for an hour. the actual seeing the doctor takes probably 5 minutes! even for my mom with cancer. appointments take all day but the actual time you see the doctor is minimal, maybe 10 minutes.

You think doctors are only seeing patients all day?

[Anonymous]

Insurance greed + private equity and corporations buying up all the medical practices = rotten deal for doctors and patients

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

What harm? Ignoring the problems is the true harm.

Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death.
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it.

How about a D-dimer blood test?

How sensitive and specific is that test for a pulmonary embolism? If it’s elevated, does that patient automatically get a pulmonary angiogram? What’s the next step? (Think of this as a learning activity)

A D dimer can be elevated for many many reasons. Usually doctors use the wells criteria to determine how/ if to test for a PE.