What Happened to Doctors?

[Anonymous]

Anonymous wrote:

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

it was but it was the dr's profit. they were small businesses run by the doctors. Now they are conglomerates - the actual practice is owned by a business and the show is controlled by insurance companies. Its so difficult to bill correctly that a lot of physicians just sold their practice to management companies- so they are employees, plus the practice of defensive medicine.. it puts the dr's needs above the patients.

This so captures it

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The entire healthcare system is screwed and US healthcare is the worst out of any industrialized country in the world. I've gotten far better care before in Thailand.

I haven't seen a real MD for primary care in like 20+ years because they're impossible to book or get into a practice with as a new patient. It's been NPs the entire time.

PCPs barley follow your health. I really have no idea if I have major health issues. I mean my blood work showed that my cholesterol as a little high and my blood pressure was slightly elevated, but my NP PCP didn't prescribe anything. I haven't gone in 2 years. Am I supposed to even go regularly? I dunno, the PCP doesn't follow up and barely knows my name.

Other times I've had to go to a specialist, and it's been the insurance company denying and denying. Or when I've gone I've gotten zero bills mailed to me the entire time only to find out years later I've been sent to collections for unpaid bills. Wut? How can I even pay a damn bill of you don't even send it to me?

US health scare is an absolute joke. It significantly reduces the quality of life in the country by a massive percentage. Insurance companies shouldn't even exist and they are in charge of determining your healthcare, not doctors. Insurance companies and litigation basically burnout doctors who spend more time with that crap than actually doing medicine.

And no, I refuse that concierge crap. That smacks of privilege, and we simply don't have thousands of dollars laying around to throw away on a country club model just to have access to appropriate healthcare. The whole system is sick.

Sorry to break it to you...you get what you pay for.

I already pay thosuands of dollars per year for insurance, a$$hole.

How much more do I need to pay inorder to get appropriate care then?

I guess healthcare is now only reserved for the wealthy 1% elite who can fork over tons of more money for a concierge treatment?

What a fantastic way to destabilize a country. Don't surprised in a few years when the masses get so pissed off they start putting the heads of the rich on pikes lining the highway.

The problem is private equity getting involved in healthcare. It's untenable and shouldn't be allowed.

This. It’s the finance aholes in PE, not the doctors. The PE people are buying up practices and they do not give a flying F about patient care.

[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.

This. Also it’s a terrible ROI. I’m HYP and only the idiots went to med school. Like the ones who clearly got in as recruits and/or legacies for fake sports like fencing and crew.

I work a few hours a day and don’t make significantly less than a specialized physician from the best schools. And I never had to work a 30 hour shift.

You make mid six figures working a few hours per day? What do you do?

[Anonymous]

Anonymous wrote:

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.

This. Also it’s a terrible ROI. I’m HYP and only the idiots went to med school. Like the ones who clearly got in as recruits and/or legacies for fake sports like fencing and crew.

I work a few hours a day and don’t make significantly less than a specialized physician from the best schools. And I never had to work a 30 hour shift.

You make mid six figures working a few hours per day? What do you do?

That poster probably runs a PE firm.

What I think the poster doesn't get is that PE firm managers benefit from being in a temporary, regulatory-powered bubble. Once stupid hogs make enough trouble, the regulations will change, and the bubble will pop.

Some really clever people who made a fortune might do OK, but a lot of other people will be in prison, or broke and mostly unemployable.

[Anonymous]

Doctor here. Before and after Obamacare.
Obamacare kind of stunned us for a bit because no one knew how reimbursement would change, so it really hurt hiring and the job market for 5+ years while everyone hunkered down.

However, I think that bigger problems are PE (as noted by others) or - in a hospital setting - the layers and layers of administrators with their hands out needing to be “fed.” Their job is often to watch the bottom line, not to ensure or optimize patient care. Some of this I think (but I’m not sure) was helped along by Obamacare because the legislation included confusing regulations, so more admins were hired to help with that. And whenever there is a regulatory change the MBA buzzards come out, looking for a creative new way to make money.

The administrators are really over the top. It’s bizarre, someone with an undergrad business degree gets to really influence how we practice - we all wonder why they can’t get charged with practicing medicine without a license.

For instance, we are incredibly short-staffed and had a great candidate interview for a job opening. We all interviewed him and agreed it would be a great fit, but one if our hospital admins said that he had “reviewed the applicants CV and just wasn’t all that impressed by him” so he put a stop to it. But the guys CV was amazing! So it’s this admin with a bachelors degree versus 10 doctors who want this person hired. Obviously, the real reason the hospital admin “wasn’t impressed” is because paying another doctor would cost the department money. He just wants to save money by being continually understaffed. That admin is actually visibly excited when someone quits (usually citing burnout or exhaustion). It saves money!

And these business types don’t care about long-term thinking and thoughtful growth. Doctors tend to stick around due to our non-competes (which I don’t think should be legal, but I digress), so we want to build something sustainable. But the admins get to jump ship whenever they want to a shiny new job. So they just want to save money NOW, with no regard for the future. And this really hurts us.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The entire healthcare system is screwed and US healthcare is the worst out of any industrialized country in the world. I've gotten far better care before in Thailand.

I haven't seen a real MD for primary care in like 20+ years because they're impossible to book or get into a practice with as a new patient. It's been NPs the entire time.

PCPs barley follow your health. I really have no idea if I have major health issues. I mean my blood work showed that my cholesterol as a little high and my blood pressure was slightly elevated, but my NP PCP didn't prescribe anything. I haven't gone in 2 years. Am I supposed to even go regularly? I dunno, the PCP doesn't follow up and barely knows my name.

Other times I've had to go to a specialist, and it's been the insurance company denying and denying. Or when I've gone I've gotten zero bills mailed to me the entire time only to find out years later I've been sent to collections for unpaid bills. Wut? How can I even pay a damn bill of you don't even send it to me?

US health scare is an absolute joke. It significantly reduces the quality of life in the country by a massive percentage. Insurance companies shouldn't even exist and they are in charge of determining your healthcare, not doctors. Insurance companies and litigation basically burnout doctors who spend more time with that crap than actually doing medicine.

And no, I refuse that concierge crap. That smacks of privilege, and we simply don't have thousands of dollars laying around to throw away on a country club model just to have access to appropriate healthcare. The whole system is sick.

Sorry to break it to you...you get what you pay for.

I already pay thosuands of dollars per year for insurance, a$$hole.

How much more do I need to pay inorder to get appropriate care then?

I guess healthcare is now only reserved for the wealthy 1% elite who can fork over tons of more money for a concierge treatment?

What a fantastic way to destabilize a country. Don't surprised in a few years when the masses get so pissed off they start putting the heads of the rich on pikes lining the highway.

Pay more, obviously what you pay is not enough..average person pays equally or more for their car on a monthly basis. What’s more important, your health or a fast depreciating asset?? Lol people are looney, priorities buddy

What a really dumb take.

DoN’t YoU KnoWz u CoUlD hav HeALthCARe iF uz WouLd StOP eATin AvoCado ToAsTS! Y u sO IrReSPoNSiBle!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

This. Also it’s a terrible ROI. I’m HYP and only the idiots went to med school. Like the ones who clearly got in as recruits and/or legacies for fake sports like fencing and crew.

I work a few hours a day and don’t make significantly less than a specialized physician from the best schools. And I never had to work a 30 hour shift.

You make mid six figures working a few hours per day? What do you do?

That poster probably runs a PE firm.

What I think the poster doesn't get is that PE firm managers benefit from being in a temporary, regulatory-powered bubble. Once stupid hogs make enough trouble, the regulations will change, and the bubble will pop.

Some really clever people who made a fortune might do OK, but a lot of other people will be in prison, or broke and mostly unemployable.

That poster is pathetic and clearly makes every life decision based on ROI. If they’re right though, it’s scary that society’s idiots are becoming doctors. We need well trained and high quality people in medicine, so we need to make med school far more selective and much cheaper. All physicians should follow the concierge model ie abandon insurance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It seems that if you want what used to be normal healthcare, you have to concierge.

This isn’t quite true. I have no problems getting fairly immediate call backs, telehealth appointments and sick visits for my kid at the pediatrician.

Same, for both pediatrician and my own PCP. OP, you just need to find another practice.

[Anonymous]

American doctors have become aggressive representatives of the pharmaceutical industry. Think about that.

When was the last time a doctor spent a minute or two explaining how you can help stop the root cause of your problem?

[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.

+1

I don't understand how doctors are no longer trained to listen through a stethoscope. Before COVID my son had a bad cough that wasn't going away. I took him to the on call doctor at his pediatrician's office who is in his 30's. He quickly listened to his chest and took an x-ray and said it just takes a while to get over a cold. After a week my son was getting worse and had a fever. I took him back to his pediatrician's office and his pediatrician who is in his late 60's or early 70's listened to his chest sitting up and thumped, then face up, then face down and said "right here, it's pneumonia and pointed to a spot on his chest. He then took out the x-ray and showed me something that didn't look like much. He said it was hard to see on an x-ray without narrowing in by listening. Prescribed antibiotics and he got better.

Is it that med schools no longer have students practice with stethescopes?

[Anonymous]

Are you kidding??

[Anonymous]

Anonymous wrote:Are you kidding??

Kidding about not being able to effectively use a stethoscope? Once blood pressure monitors became automatic instead of having to actually listen to get blood pressure I think a lot of medical providers are losing or never acquired the art of listening to help inform treatment.,

[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.

You think that was unintended? How optimistic of you 🧐

[Anonymous]

Anonymous wrote:

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.

+1

I don't understand how doctors are no longer trained to listen through a stethoscope. Before COVID my son had a bad cough that wasn't going away. I took him to the on call doctor at his pediatrician's office who is in his 30's. He quickly listened to his chest and took an x-ray and said it just takes a while to get over a cold. After a week my son was getting worse and had a fever. I took him back to his pediatrician's office and his pediatrician who is in his late 60's or early 70's listened to his chest sitting up and thumped, then face up, then face down and said "right here, it's pneumonia and pointed to a spot on his chest. He then took out the x-ray and showed me something that didn't look like much. He said it was hard to see on an x-ray without narrowing in by listening. Prescribed antibiotics and he got better.

Is it that med schools no longer have students practice with stethescopes?

Hands on anything is being taught less and less. Younger doctors know a lot about running multiple tests, however.

People here often have a low opinion of foreign medical graduates, but many of them were taught hands on medicine to a far greater extent than US graduates.

[Anonymous]

You guys dont understand how docs should be trained because you guy are not docs. Does anyone come to your field from a completely different field and tell you were trained incorrectly? Jeez, people whats up?