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.

What does this mean? What kind of people?

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.

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.

Anonymous wrote:I feel sorry for the sick and poor in rural areas. We have it pretty good in the DMV compared to most areas.

My parents are in rural PA and they actually have an easy time finding doctors--both primary care and specialists. The DMV is hard because the cost of running a practice is so much higher (rent, salaries, even utilities).
Physicians are reimbursed the same in both places but their overhead is twice as high here.

Anonymous wrote:I feel we am no longer getting good care. My daughter’s pediatric GI for example only sees patients in person once a week. All her other appointments are virtual. I understand seeing patients once or twice a week virtually, but four times a week? Isn’t this a lot? I feel with pediatrics especially a physical exam is impossible. My PCP still doesn’t see patients with respiratory symptoms in person. I’ve been coughing for more than a month now and they refuse to see me in person. Our kids pediatrician only has two hours dedicated for sick visits and they are from 3-5 pm. The rest are for well visit. The two hour time limit makes it virtually impossible to get an appointment. If a child has respiratory symptoms they push you to go to urgent care. In the grand scheme of things I know this isn’t a big deal but I feel like seeing a doctor in person for certain complaints is getting to be harder and harder.

Lol, this reminds me of trying to get a doctors appointment for my son with a serious sinus infection. He had already done a virtual appointment with another doctor and round of antibiotics, but was still sick. His doctor would NOT see him if he was sick. I had the most ludicrous conversation with the nurse/receptionist about why a doctor wouldn't see a SICK patient (What the hell???), and why would I come to see the doctor if he wasn't sick!!! I felt like I was in the twilight zone.

Anonymous wrote:

Anonymous wrote:

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

It was. But at that time only doctors could own medical practices. Then the rules changed and PE and other investors got into the business. Your money is now supporting an additional layer of people getting rich.

Which additional layer are you talking about?
Admin bloat?

Private Equity ie Wall street has entered the room and has bought up a lot of practices. Say what you want but the policy makers are to blame. Obamacare accelerated the problem. Ask any doc and they will all say the same.

Medicare has provided the docs about a 10% cut over the last five years. Combine that with increase staff costs and overhead, the money has to come from somewhere. It means shorter visits and more time with PAs.

Anonymous wrote:

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

It was. But at that time only doctors could own medical practices. Then the rules changed and PE and other investors got into the business. Your money is now supporting an additional layer of people getting rich.

Which additional layer are you talking about?
Admin bloat?

Its become a factory line since obama care kicked in. welcome to a somewhat world of socialized healthcare that docs need to process as many as possible to turn a profit.

also dont forget, inflation has gone nuts but the insurance reimbursement to doctors has stayed constant so they cant afford to hire staff. Its really a sh*t show.

Its about to hit dentistry next.

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

It was. But at that time only doctors could own medical practices. Then the rules changed and PE and other investors got into the business. Your money is now supporting an additional layer of people getting rich.

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.

You sound crazy.

Anonymous wrote:I feel we am no longer getting good care. My daughter’s pediatric GI for example only sees patients in person once a week. All her other appointments are virtual. I understand seeing patients once or twice a week virtually, but four times a week? Isn’t this a lot? I feel with pediatrics especially a physical exam is impossible. My PCP still doesn’t see patients with respiratory symptoms in person. I’ve been coughing for more than a month now and they refuse to see me in person. Our kids pediatrician only has two hours dedicated for sick visits and they are from 3-5 pm. The rest are for well visit. The two hour time limit makes it virtually impossible to get an appointment. If a child has respiratory symptoms they push you to go to urgent care. In the grand scheme of things I know this isn’t a big deal but I feel like seeing a doctor in person for certain complaints is getting to be harder and harder.

It sounds like you need to find better doctors’ offices. I have no problem getting next-day appointments with the pediatrician. Finding an office with mid-levels helps. I'm perfectly fine seeing an NP 90% of the time, and even for the remaining 10%, the mid-levels help spread the work around.

They never refused to see respiratory symptoms. That's insane. During some of covid's peaks, they tested the child in the car before having them come in the office.

Your pediatric GI doctor seeing patients virtually 4 days a week is... wild. Most doctors have drastically cut back on virtual appointments because they can't bill as much for them. Are you sure they aren't just booked solid for the in-person visit slots? I can't imagine any explanation for this. I suppose a physician that is doing procedures all-day might struggle to find time to leave the hospital or endo center, but even then I wouldn't expect more than a couple days like that per week. Plus I highly doubt pediatric GIs do nearly the volume of procedures that adult GIs do.

I’m grateful that my experience of doctors in recent years has been very different from what’s being relayed. I’ve been on state medical insurance for the last several years, I have been working only 3/4 time because of significant health issues and needed to go on Medicaid equivalent in order to have really good insurance. My state was first in the nation to require universal health coverage and we are very close to that objective so I’m lucky in that regard. My Medicaid has covered everything and in the last few years, during pandemic, I have been to many doctors visits with my GP and numerous specialists and none of them were telehealth - just masks required in office and covid screening. I had several in hospital covid tests prior to procedures in hospital, but now it’s just masks. The only telehealth experiences I’ve had are in the mental health arena where much of the business is going forward with that model, I think because it allows much lower overhead I’m fairly sure the two therapists I’ve been working with the last two years are both working from home and I’ve never met either of them in person but the therapy has been terrific just the same.

Still, I am very concerned about what’s happening in healthcare, it is definitely a crisis. I work in healthcare myself the last seven years as a hospice caregiver, and I’ve talked a lot with my own providers and with clients providers about the stress on nursing and physician care, the shortages and pressures intensified by the pandemic - but the problems were there long before and no, it’s not because of the ACA. I’ve yet to meet one healthcare provider who isn’t glad to see more people getting access to medical care. The issues in healthcare are about corporate profits taking priority over patient care and provider wellbeing. It has all the same pains of every other capitalist industry, it is just that the cost to human welfare is that much higher. We set this system up all wrong and we are paying a very dear price.

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.

Anonymous wrote:I don’t trust any Doctor Who is younger than 50

I can’t figure out if this was an intentional “typo” just to make a joke, or if the PP really only trusts doctors who are old.

Unless you’re going to a tertiary center, younger doctors that have more recently completed their fellowships are far, far more likely to be up-to-date with their medical training and expertise. Again, tertiary centers are different, but I'd definitely avoid any community physician over the age of 60.