Comments on: "Malpractice fears have thrown the emergency medicine system into crisis"

By: Anonymous

Anonymous — Wed, 16 Jul 2008 21:40:00 +0000

“Physicians should be required to teach and medical schools and application acceptance should be quadrupled.”

The problem with this is that if you accept more than what is accepted now, your standards HAVE to be lowered, and we all know what that means. Not to mention that a glut of physicians in the market makes it more difficult to find a job and will drop reimbursement substantially. A little common sense, please.

By: Anonymous

Anonymous — Thu, 14 Feb 2008 06:05:00 +0000

what does one have to go through to be a neurosurgeon thses days? do you need to go to premed and then med school or a “specific” med school to do that?

By: Anonymous

Anonymous — Wed, 21 Mar 2007 12:24:00 +0000

I have read the previous comments that are primarily focused on ER. I am not a doctor but rather a consumer. I empathize with most of your comments; they are not that different than the way the rest of us would feel. I do find it mystifying that the physicians with their relative wealth can not band together to create a political force that would result in a better system. The current system is a fraud. On my Explanation of Benefits, I typically find that the hospital or doctor has been paid by the insurance carrier only 1/7 to 1/10 of the charge made for a service. This level of disparity for insured versus non-insured is criminal. Doctors, surgeons and specialists deserve to be paid more than other professions because they spend a tremendously greater amount of time in training to be able to practice. On the other hand, medical professionals (nor any of the rest of us) should attempt to gouge people in a time of need to inordinately profit. Medical malpractice insurance and malpratice suits to get money should be illegal. The AMA as it currently acts should be abolished. Unlike the current practice, the physicians who understand the intricacies of medical procedures should properly govern themselves and eliminate the doctors who are “impaired” or generally of poor competence. Sorry, no breaks, not any ever, for the guy on drugs or alcohol in surgery (exception for the guy on the road helping an accident victim before the paramedics arrive). Physicians should be required to teach and medical schools and application acceptance should be quadrupled. I believe that we would all benefit from this and even the physician in the end would get more satisfaction from life. Note that everyone in our society would need to understand that life has risks and your bad luck is usually not somebody else’s fault. You have the resources and the contacts. How about it guys, are you going to get together and create a better system, or be like the guys on my street who wait for somebody else to fight their battle. If your eyes are on the money, don’t bother, whatever you create will be no better than what we already have.

By: Anonymous

Anonymous — Sun, 11 Feb 2007 15:42:00 +0000

“…most surgery centers require operating surgeons to have admitting privileges at a hospital…”

The laws differ state to state. Some states have no such law. Sometimes the surgicenters have empirically adopted such rules but they may in fact not be necessary according to the law. If you owned your own surgicenter with a few surgeon partners you could set your own rules, depending on your state’s laws. As far as I am concerned, the requirement that a surgeon needs to have priveleges at a hospital inorder to gain priveleges at a surgicenter smacks of anticompetition. The hospital lobbyists are powerful and must be held to account here. These sort of laws/rules need to be challenged in court. These are the types of things that the ACS should be working on…

By: Okulus

Okulus — Sun, 11 Feb 2007 01:36:00 +0000

The surgicenter idea is nice, except most surgery centers require operating surgeons to have admitting privileges at a hospital within a set radius of the surgery center. This is so that if a patient becomes unstable while at the surgery center, the operating surgeon can theoretically admit that patient to the hospital. Now in practice, it really makes no sense, since instability usually implies anaesthetic-related problems or cardiopulmonary events, and the most appropriate specialist to be caring for a patient with either of those kinds of problems would not likely be the same one doing surgery at a surgery center. Still the requirements stand, even if they are illusory.
I rarely need my local hospital for anything. Most of my ER consultation is gratis (not my choice) Nearly all my surgery is done at a surgery center and yet, because of their rules, I must still affiliate at the hospital.

By: Anonymous

Anonymous — Sat, 10 Feb 2007 23:46:00 +0000

“Where I am, er call is not a choice. If you have privileges you are on call for the er and consultations. Don’t answer calls or show up and your privileges are cancelled, thus no admitting, no operating.”

You need to build your own ambulatory surgicenter with a few partners and then give the hospital’s ER the middle finger.

By: Anonymous

Anonymous — Sat, 10 Feb 2007 20:48:00 +0000

ER call as a routine part of medical practice for surgeons developed generations ago when surgeons could charge whatever they wanted to whomever they pleased, and scarcely had any malpractice worries. They could make enough from the few prosperous emergency cases to make up for the modest reimbursement from middle class patients and no reimbursement from the poor. They built a reputation and a practice thereby. There were no beepers or cell phones so the stress was mitigated by the fact that he really couldn't be asked to be two places at one time--he dealt with what was in front of him at the moment.

Now, he still has the unreimbursed cases, and reduced reimbursement on all the rest. If Warren Buffet is enrolled in Medicare and comes into the ER, the treating physicians are limited to sub-market reimbursement rates--essentially charity rates--so he now gets the bad without the good.

Little wonder that more and more physicians can no longer justify doing it. For at least a generation now, most have seen it as a drain but did so either for access to the hospital or out of a sense of duty. The odd thing about practicing medicine, is that the "overtime" is reimbursed less than the regular hours.

In our city, the neurosurgeons just built their own specialty hospital, so they don't need the OR's at the general hospital to make top dollar.

While envy of their stunningly high incomes, by my non-proceduralist standards, would tend to make me wish otherwise, I must admit that it is completely fair and rational for them to be paid to provide ER coverage if it is not wothwhile for them to do so otherwise.

I too no longer cover ER's (forswearing general hospital work to accomplish this) because, while I know I will get financially stiffed regularly practicing medicine, I really hate when it happens at 2 am.

By: Anonymous

Anonymous — Sat, 10 Feb 2007 16:38:00 +0000

Where I am, er call is not a choice. If you have privileges you are on call for the er and consultations. Don’t answer calls or show up and your privileges are cancelled, thus no admitting, no operating.

By: Anonymous

Anonymous — Sat, 10 Feb 2007 12:45:00 +0000

“California neurosurgeons have discovered the answer-refuse to cover the ED unless they are paid $1500-$2000 per day for coverage. So worst case $547500-$730000 to be available.”

What a novel idea! Paying the neurosurgeon to provide services…

By: Anonymous

Anonymous — Fri, 09 Feb 2007 20:54:00 +0000

"refuse to cover the ED unless they are paid $1500-$2000 per day for coverage. So worst case $547500-$730000 to be available. Now no need for much of an office, so that expense goes away. Oh and if you can convince a second hospital to pay for coverage it really gets good! "

As long as you don't mind being on call EVERY DAY!!!

A little commmon sense, please....