Comments on: Things are looking grim in Hawaii

By: Anonymous

Anonymous — Tue, 20 Mar 2007 05:18:00 +0000

As a physician who grew up in Hawaii and went to UH as an undergrad but now on the mainland, it makes no sense to come back to Hawaii except for family.
I know what my friends in Hawaii make – I can make much more in San Francisco or New York City, places where reinbursements are considered low and the cost of living is the same or higher. The people of Hawaii will suffer. I’m sorry. I think most people have left and will not return.
In regards to training PA/nurses to do my job – sure, whatever, if you want them to treat you because you have no money then be it. Wait till they get some lawsuit then who pays for that? If you really need something does that mean you will pay my out of pocket physician fees of say an extraordinary amount? Let’s see – get appendicitis, stay in the hospital 2 days, anesthesia and surgery cost – probably $20,000. Few days in the ICU – $25,000+. I may see $300 total the entire time or of the total bill. This is not something I can trade bread for – it’s just got too expensive.
Here’s a hint – if we are salaried and don’t get sued, most doctors will be happier than anything.
For those doctors who stayed – the courage – thank you for taking care of the rest of my family there.

By: Anonymous

Anonymous — Wed, 31 Jan 2007 08:40:00 +0000

I don't usually post, but Criminaliopath has watched to many Geico commercials with the cave man.

He sounds a little bitter; like a pseudo-intellectual that couldn't get into a medical school.

They do have tough standards.

By: Anonymous

Anonymous — Tue, 30 Jan 2007 03:11:00 +0000

“It makes more sense to train NPs and PAs and staff local clinics in rural and urban areas such that those who are currently not worthy of access to physicians do not go without access to health care”

I like that. Kind of a Chinese/Darwinistic model.

By: Anonymous

Anonymous — Tue, 30 Jan 2007 03:03:00 +0000

I would suggest you leave for Samoa. I think you will get paid better and you WILL be doing community service. I have never why anyone wants to live and work in Hawaii. Hawaii is a place to go live AFTER you have made your money ELSEWHERE.

By: Criminallopath

Criminallopath — Tue, 30 Jan 2007 02:15:00 +0000

Anon 7:18

Argumentum ad absurdum my friend. It makes more sense to train NPs and PAs and staff local clinics in rural and urban areas such that those who are currently not worthy of access to physicians do not go without access to health care. It makes sense for individual states to not offer comity agreements in regards to providers trained in their state in order to avoid extortion and loss of health care services. A system without excessive government intervention or involvement is nothing but a pipe dream. Those that pushed for the implementation of the findings of the Flexner Report in 1910 should have given some thought to the unintended consequences of bedding with the government. We are now seeing the fruition of these consequences. The whole funding system needs to be evaluated. Others have done well enough in looking at the 79% but very few are looking at the other 21%.

By: Anonymous

Anonymous — Tue, 30 Jan 2007 01:55:00 +0000

Quit whining and just leave HI. Enough already.

By: Anonymous

Anonymous — Tue, 30 Jan 2007 00:18:00 +0000

Since it makes sense to you to totally flood the situation with more physicians. Will you not suggests that also we dramatically increase the number of hospitals. Should we triple or quadruple the number of hospitals? That will surely be cheap to do and has similar logic to dramatically increasing the number of physicians. If my town of 25,000 now has 2 hospitals. Doesn’t spending millions and millions to build 6 more make sense. I mean that should drive prices to more reasonable levels. I mean why not a hospital on every street corner. Like the previous poster stated 21 cents of every healthcare dollar are spent on physician payments. It seems like your rants would be better served solving the problem of the other 79 cents.

By: Criminallopath

Criminallopath — Mon, 29 Jan 2007 22:07:00 +0000

By the way Criminal who is going to provide the "extra training" for the NP and PAs, as well all of the new med students and residents that you propose. Since there is such a critical shortage as it is I'm sure they would be more than happy to train their competition. Will these trainers appear out of thin air.

Those who currently train are already training their competition. There is no shortage of those who are qualified to handle the bulk of the basic science training for the first two years of medical school. Given the purported "crisis" in Hawaii, one would think that clinicians would be more than happy to receive a fat paycheck from the State with no liability in order to simply train others.

The only problem is they will be spending a ton more because all of the practitioners using the system and ordering tests.

As will be the case for any system in which coverage and access is offered to a greater number of people regardless of the provider organization or delivery scheme. The key is to try to judiciously utilize every additional bit of funding spent on the system to ensure that the most patients (not existing providers) first and foremost are deriving the benefits.

By: Anonymous

Anonymous — Mon, 29 Jan 2007 21:59:00 +0000

Let the social experiments begin. Before we drive the whole country down an untried path let individual states determine what will and will not work. Sounds like Hawaii will provide some interesting data.

By: Anonymous

Anonymous — Mon, 29 Jan 2007 21:20:00 +0000

Either move or put it on the hospital. Make them pay you a salary well above MGMA guideline. You don’t hear of about any hospitals in Hawaii going out of business. By the way Criminal who is going to provide the “extra training” for the NP and PAs, as well all of the new med students and residents that you propose. Since there is such a critical shortage as it is I’m sure they would be more than happy to train their competition. Will these trainers appear out of thin air. This problem will be fixed in about 7 years in Criminals world. The only problem is they will be spending a ton more because all of the practitioners using the system and ordering tests. The dirty little secret is all of the money is going to the hospitals from insurers not in the physicians pocket. The money you save in provider payments will bite you on the rear because of increased usage of the system. For every healthcare dollar only 21 cents goes to physicians 79 cents goes to other enterprises such as testing and HOSPITALS. I think their only option is to hold the hospitals feet to the fire and make them pay a high MGMA salary and be an employee otherwise leave.