Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

I think it may be bias on a patient’s end to think this is all a pcp does. In my practice, I see really sick patients with many comorbities. For example, a cancer survivor with diabetes and hypertension. I need to know what kinds of chemo my patient has been on since there will be life long risks associated. I also need to know all the diabetes drugs and their interactions with her other meds. I need to know that she is more likely to have recurrence of cancer and also potential blood clots, PE etc. I need to understand that if she walks into my office with low blood pressure and tachycardia that it may be sepsis. All of these things I learned with brute repetition in residency - caring for patients who are super sick day in and day out. Before you say anything most specialist will not handle a cancer patients diabetes and hypertension - esp if they are a survivor and in remission. That’s in primary care land. Just an example.

Those patients probably nee you. There is no reason that a healthy family needs your level of expertise.

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

I think it may be bias on a patient’s end to think this is all a pcp does. In my practice, I see really sick patients with many comorbities. For example, a cancer survivor with diabetes and hypertension. I need to know what kinds of chemo my patient has been on since there will be life long risks associated. I also need to know all the diabetes drugs and their interactions with her other meds. I need to know that she is more likely to have recurrence of cancer and also potential blood clots, PE etc. I need to understand that if she walks into my office with low blood pressure and tachycardia that it may be sepsis. All of these things I learned with brute repetition in residency - caring for patients who are super sick day in and day out. Before you say anything most specialist will not handle a cancer patients diabetes and hypertension - esp if they are a survivor and in remission. That’s in primary care land. Just an example.

Anonymous wrote:

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Is all that training really necessary to order a strep test, see the results and prescribe an antibiotic? How about to see a mole and refer a patient to a dermatologist? So much of what a PCP does, especially for healthy patients, is routine care that does not need perfect undergraduate grades, three years of medical school, three years of residency, and a fellowship

Anonymous wrote:

Anonymous wrote: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.

I liked how you tried to spin it as a defense of Obamacare. Heathcare pretty much went *south* for most people after Obamacare without necessarily adding that many more people to the system. Prior to Obamacare it was around 15% uninsured but even much of that was younger people who rarely saw doctors. We now have far higher deductibles, most of the best doctors are now in concierge practices, the administrative bloat is staggering. And yes, everything is much more expensive.

I don't have a solution but I can clearly point to Obamacare as when the quality and accessibility took a noticeable dive.

Anonymous wrote:I agree that NPs are the future. It won’t be worth it for doctors do to so much training. The problem is lack of standardization of NP training but it seems that most patients don’t care - they just want someone to “listen” vs actual experience rotating through various divisions. For example, to become a primary care doctor, I still have to do three years post medical school rotating through the icus, ED, hepatology, oncology, primary care, women’s health, cardiology, etc. the idea is that I should have seen all these things and proved competence. There are no strict guidelines for NPs/PAs. They finish in 2 years and could get a job in outpatient obesity medicine then switch to the icu with little training and no one cares.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.

As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.

Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.

I’m definitely in and out as fast as possible with patients like you that’s for sure

Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.

and this is why doctors are retiring like crazy and you all will be taken care of by nurse practioners who are very nice and ok at going through algorithms they are taught in their online NP school, but don't really understand pathophysiology enough to actually problem solve. Good luck in 15-20 years if you think medicine is bad now.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

They are well compensated. They want to be put on a pedestal for being a doctor and those days are long gone.

Sure, but some doctors, like radiologists and dermatologists, get paid too much, while others- namely, PCPs- get paid too little.

PCPs choose their job. If they want more pay they should do more specialties.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.

As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.

Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.

I’m definitely in and out as fast as possible with patients like you that’s for sure

Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.

and this is why doctors are retiring like crazy and you all will be taken care of by nurse practioners who are very nice and ok at going through algorithms they are taught in their online NP school, but don't really understand pathophysiology enough to actually problem solve. Good luck in 15-20 years if you think medicine is bad now.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Every time I read this threads I feel discouraged about becoming a doctor and feel like despite whatever I do it’s not worth it to anyone. That’s def making me consider retiring/ cutting back early. Also more women are entering medicine and they tend to have a higher attrition. I get it- I’m a mom and having to have emotional labor placed on me by patients and my family is tough. At the end of the day, I’ll pick my family over mg patients.

What was your vision when you started your studies? I imagine doctors see a lot of people at their unhappiest.

I can't imagine being a psychiatrist listening to people complaining all day.

I was a nontraditional medical school applicant. I worked for several years in public policy and thought I could make a bigger difference in medicine. I think the hardest part is the amount of administrative burden. The way things work now, we spend less time with our patients (one study found that we spend more time waiting for the elevators with with patients while working inpatient). We have to write tons of notes for even a brief patient interaction, coordinate care which requires a lot of back and forth and messages, and it bleeds into our life outside of the hospital. Not to mention we have the administration double booking patients and adding more and more workload which equals more and more paperwork( and less and less time with patients). Maybe AI can help but otherwise - it’s feels like I make very little difference.

My doctors do notes during the visits.

Trust me there is a lot more paperwork and cleaning things up after visits. Every hour of patient care face to face comes with another hour of paperwork. Many doctors in my group have to go down to 24 hours of patient care a week in order to keep their hours closer to 40 hours and actually have balance but of course, that leads to a shortage. There is a lot of background work you don’t see which is a huge issue with patient perception of doctor’s work.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Every time I read this threads I feel discouraged about becoming a doctor and feel like despite whatever I do it’s not worth it to anyone. That’s def making me consider retiring/ cutting back early. Also more women are entering medicine and they tend to have a higher attrition. I get it- I’m a mom and having to have emotional labor placed on me by patients and my family is tough. At the end of the day, I’ll pick my family over mg patients.

What was your vision when you started your studies? I imagine doctors see a lot of people at their unhappiest.

I can't imagine being a psychiatrist listening to people complaining all day.

I was a nontraditional medical school applicant. I worked for several years in public policy and thought I could make a bigger difference in medicine. I think the hardest part is the amount of administrative burden. The way things work now, we spend less time with our patients (one study found that we spend more time waiting for the elevators with with patients while working inpatient). We have to write tons of notes for even a brief patient interaction, coordinate care which requires a lot of back and forth and messages, and it bleeds into our life outside of the hospital. Not to mention we have the administration double booking patients and adding more and more workload which equals more and more paperwork( and less and less time with patients). Maybe AI can help but otherwise - it’s feels like I make very little difference.

My doctors do notes during the visits.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

I've had multiple CT's lately trying to figure out what's going on. The newer machines don't have that much radiation and it's better to know and get treated than suffer. Be thankful you don't need it or have serious struggles with your health.

Maybe if doctors put more effort into helping than blowing me off, I wouldn't need them.

As a doctor I would caution you that doctors are human beings too and when faced with a person who is figuratively (or literally) attacking them, they will do always what they can and should, but you certainly won't get anyone to go the EXTRA mile for you. Unfortunately, you might need someone to go the extra mile and you won't get it this way with this attitude. When patients are nice and we have a good trusting rapport, we will go above and beyond to try and help them when something isn't clear cut (eg talk with specialists again, do more in depth research, ponder the problem...). You are a phenotype that is driving physicians to hate medicine some days.

Except most doctors will not even go an inch and try. They do a five minute appointment to get you out with no help.

I’m definitely in and out as fast as possible with patients like you that’s for sure

Fund a new profession and stop wasting peoples time with your incompetence. Ironic you can post here during the work day but cannot take the time to help someone.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Pay has no increased in decades, docs are leaving networks or choosing to not work for Pennies on the dollar. Thank you Obama care.

All those poor, struggling doctors?

Who have a 100k in student loan debt. Doctors should be paid well to compensate for 8 years of education plus 4-6 years in residency and training working 60-70 hours a week for a lot less pay.

They are well compensated. They want to be put on a pedestal for being a doctor and those days are long gone.

Sure, but some doctors, like radiologists and dermatologists, get paid too much, while others- namely, PCPs- get paid too little.

PCPs choose their job. If they want more pay they should do more specialties.

Anonymous wrote:

Anonymous wrote: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.

I liked how you tried to spin it as a defense of Obamacare. Heathcare pretty much went *south* for most people after Obamacare without necessarily adding that many more people to the system. Prior to Obamacare it was around 15% uninsured but even much of that was younger people who rarely saw doctors. We now have far higher deductibles, most of the best doctors are now in concierge practices, the administrative bloat is staggering. And yes, everything is much more expensive.

I don't have a solution but I can clearly point to Obamacare as when the quality and accessibility took a noticeable dive.