S/o What the f do you all want from doctors?

[Anonymous]

Anonymous wrote:

Anonymous wrote:^^The other way out of it is to drive up income while overhead remains a fairly fixed costs. Procedures can do this, as you can bill a lot for procedures. Adding providers without adding more support staff does it, as well.

Procedure-driven practices (e.g., surgical) can buy some leeway with this. They have their own challenges, but procedures mean income, whereas talking with people tends to be a fixed cost.

On the one hand, it's awful to talk about medical care like this. It feels like it reduces people to numbers, and makes their very real and painful issues into monetary problems. On the other hand:

1. We keep getting told that medicine is just a business, it's not special, and doctors are just employees. And yes, this is what that looks like.

2. If medical practices are owned by private equity, the standard of care of patients is, by definition, not the primary concern. Money is.

3. Physicians could run their own practices when on average, overhead was around 35-45%. This was true up to around the early eighties, but it was going up in the 90s, and that has rapidly accelerated since. It's not feasible at 65-70%, so it consumes itself. Or you go concierge, or you join a large hospital-based HMO-type practice, or you go with private equity. For the most part.

Do you think doctors are special? Isn't this the origin of some doctors' god complex that causes such dissatisfaction for patients.

Okay? This is what then that looks like as time goes on. And, I guess, okay?

I'm not arguing with you, you know.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:21:55, I forgot two more:

I do to want to have pay to park for the privilege of seeing you

I do not want to wait 30 minutes (or more) in your waiting room and another 30 minutes (or more) in the exam room before I am graced with your presence for less than 10 minutes, and then I have to pay even more for parking, for the time I spent waiting for you

You’re going to have to pay for concierge service to get all of this. It’s readily available to you. But…I’m guessing you don’t want to pay.

I'm not paying for concierge services when frankly my PCP is a minor part in my overall health management. The specialists who keep me going don't charge concierge fees.

The same pressures on pcps are hitting specialists. You’ll see a rise in concierge specialists soon enough. Already happening.

[Anonymous]

PS: If it's just a business, then it gets run like just a business. None of this should be surprising for any of us.

[Anonymous]

Maybe medical schools should recommend applicants take some business courses in their undergrad degrees.

I get that many med school applicants have always been at the top of their classes, particularly the sciences, but given the way the health sector works, knowledge of the business world is also important.

[Anonymous]

That would probably make either starting with or transitioning to private equity much simpler.

Concierge practices don't seem to be having business difficulties, but it likely wouldn't hurt. Other than losing out on that time learning about medical things instead.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

It is NOT a stupid system. We have a specifically designed healthcare system that makes a lot of people extremely wealthy. It's called capitalism and the doctor you see is the front line worker.

Two of the features of capitalism are that the front line worker is NEVER the person designing the system and is NEVER the person making the big bucks.
Your best hope is to find the doctor/nurse who internally motivated to provide great care in spite of the system.

[Anonymous]

DP. I'll add to find them before they burn out, because that is also happening at an accelerated rate. The way to stave it off is in part to stop taking new patients, yby the way.

[Anonymous]

Anonymous wrote:DP. I'll add to find them before they burn out, because that is also happening at an accelerated rate. The way to stave it off is in part to stop taking new patients, yby the way.

Or increase the supply of med school spots. If the population is growing and aging and the number of possible medical treatments is growing, we need more med school grads.

[Anonymous]

Anonymous wrote:

Anonymous wrote:DP. I'll add to find them before they burn out, because that is also happening at an accelerated rate. The way to stave it off is in part to stop taking new patients, yby the way.

Or increase the supply of med school spots. If the population is growing and aging and the number of possible medical treatments is growing, we need more med school grads.

This doesn't change the cost of overhead, though. You can deal with that by putting more and more docs into a practice sharing some of the fixed costs of overhead (the building space, EMR access and support, utilities), but it becomes more and more corporate. That becomes more enticing to private equity, because it's ripe to pluck for short term profit.

At this point, those new doctors cannot just put out a shingle for themselves or with a couple of other doctors, unless -- you got it -- it's a concierge practice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

It is NOT a stupid system. We have a specifically designed healthcare system that makes a lot of people extremely wealthy. It's called capitalism and the doctor you see is the front line worker.

Two of the features of capitalism are that the front line worker is NEVER the person designing the system and is NEVER the person making the big bucks.
Your best hope is to find the doctor/nurse who internally motivated to provide great care in spite of the system.

More cynically, the system actually wants you to be sick because it pays more. Oncology is a HUGE money maker for the hospitals. Surgeries are also a big $$$$. They'd rather you stay sick and give PCPs no time to actual care for patients. It is gross.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

It is NOT a stupid system. We have a specifically designed healthcare system that makes a lot of people extremely wealthy. It's called capitalism and the doctor you see is the front line worker.

Two of the features of capitalism are that the front line worker is NEVER the person designing the system and is NEVER the person making the big bucks.
Your best hope is to find the doctor/nurse who internally motivated to provide great care in spite of the system.

More cynically, the system actually wants you to be sick because it pays more. Oncology is a HUGE money maker for the hospitals. Surgeries are also a big $$$$. They'd rather you stay sick and give PCPs no time to actual care for patients. It is gross.

Wait what? The healthcare system wanted me to get stage 3 breast cancer? Do tell.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:21:55, I forgot two more:

I do to want to have pay to park for the privilege of seeing you

I do not want to wait 30 minutes (or more) in your waiting room and another 30 minutes (or more) in the exam room before I am graced with your presence for less than 10 minutes, and then I have to pay even more for parking, for the time I spent waiting for you

You’re going to have to pay for concierge service to get all of this. It’s readily available to you. But…I’m guessing you don’t want to pay.

I'm not paying for concierge services when frankly my PCP is a minor part in my overall health management. The specialists who keep me going don't charge concierge fees.

The same pressures on pcps are hitting specialists. You’ll see a rise in concierge specialists soon enough. Already happening.

+1!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

It is NOT a stupid system. We have a specifically designed healthcare system that makes a lot of people extremely wealthy. It's called capitalism and the doctor you see is the front line worker.

Two of the features of capitalism are that the front line worker is NEVER the person designing the system and is NEVER the person making the big bucks.
Your best hope is to find the doctor/nurse who internally motivated to provide great care in spite of the system.

More cynically, the system actually wants you to be sick because it pays more. Oncology is a HUGE money maker for the hospitals. Surgeries are also a big $$$$. They'd rather you stay sick and give PCPs no time to actual care for patients. It is gross.

Just a business. Right?

[Anonymous]

Anonymous wrote:Everyone is mad at doctors. We should be mad at insurance companies and health systems. We should be mad at the broken free market system and republicans in general.

EMRs, while good in theory and intention, were a disaster to roll out. I’m curious how much time and money is spent implementing, maintaining and using these systems instead of focusing on the patient - a recurring complaint on this thread.

Medicine has become like everything else. Ruined by private equity and other bored, rich AHs who are looking for a new “tech disruption”

EMRs were a disaster to roll out because doctors and practices first did a horrible job picking systems, and then did a horrible job training their staff to use them. They made a self-fulfilling prophecy: they decided EMRs were going to be horrible, so they bought the cheapest EMRs they could find, which were obviously going to be horrible.

You really, really don't want to go back to paper charts.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I want my doctor to be a problem-solver and figure out what’s going on instead of writing a script for a medicine that treats the symptoms and doing nothing more.

What if what’s going on is just you’re getting older? I can’t problem solve my way out of you being 75.

Ok, but what about all the times this happens with kids or problems that aren’t related to aging? I can think of numerous examples in my family where it took visiting numerous doctors to find one willing to dig a little deeper to discover the real issue. Most doctors don’t do this because they’re arrogant or lazy. There are some talented doctors who won’t rest until they find an answer. These doctors are worth their weight in gold!

No, most doctors don’t do this because if they spend more than 10 min with you, they get in trouble.

What a stupid system. Everything becomes more expensive because not enough time is spent understanding the problem.

It is NOT a stupid system. We have a specifically designed healthcare system that makes a lot of people extremely wealthy. It's called capitalism and the doctor you see is the front line worker.

Two of the features of capitalism are that the front line worker is NEVER the person designing the system and is NEVER the person making the big bucks.
Your best hope is to find the doctor/nurse who internally motivated to provide great care in spite of the system.

Doctors aren't just front-line workers. Historically they owned the businesses that established the health care industry as it exists today. Even now, many still do.