please again read my post of 1:44pm – I refer to ortho all the time, and I never said I can treat someone’s fracture with my mind.

you sound like a friggin’ dumbass inexperienced med student doing an ortho rotation or something. clearly not treating patients at an attending level by the way you spout bs. i guess we’ll never find out “anon”

Ah, but they don’t. why is that, do you think? In fact, last time I referred to a cardiologist he called me back and said “you want me to see this guy or you just want an echo?”

I don’t mean to start a war between PCP’s & procedural specialists – all I am saying is that ANY honest physician will acknowledge that the likelihood of having a procedure done on you depends, at least in part, on the financial rewards related to doing so.

Perhaps specialists should be capitated (before you get in a huff, yes, at a higher rate than PCPs to account for the add’l training & expertise).

Just so we are clear.

Secondly
re:”but to disrespect entire groups of individual practitioners is silly”

Let’s look at your other previous post.

“I sure wish I could keep “my” patients from running through the primary care eval and treatment mill they have to navigate before their PCP magnanimously gives up, admits defeat and sends the patient to someone who can figure out the problem.”

“… rest assured” that we lowly “proceduralists” have seen our share of “Pen Jockeys” in primary care.”

If those lines are dripping with sarcasm and disdain towards our PCP associates than I don’t know what is. You see anon, the difference between you and me is that I used to be a internist before I subspecialized. I’ve walked in happy’s shoes. I (unlike you) know exactly what he is talking about. I am personally very understanding of PCP’s plight and always keep them in the loop with THEIR patients (and since they are the PCP then THEY (not me or YOU) are the primary doctor). Also, when I was a PCP, I tried to keep MY patient’s away from the “cath jockey’s” and “scope jockey’s” rather referring to those subspecialists who thought through the need for procedures. If you don’t think “cath/scope jockeys” don’t exist than you don;t practice medicne in the USA.

Lastly; this thread was about the lack of pediatric rheumatolgist’s at all in a major city, yet several (maybe not you) have minimized their input. When it comes to putting the complexities of some rheumatologic diagnosis and treatment together I will always tip my hat to them an their COGNATIVE skills.

Like they say in the computer world: RTFM

PS: Back when I was a hospitalist I never had a problem getting a ortho or cards c/s. However, getting a rheum c/s was like fishing in the desert. I think anybody who minimizes rheum docs doesn’t have a good handle on how difficult some of the diseases that fall in their realm can be to diagnose and manage.

And I can assure you Happyman, in MOST instances that does NOT entail those dreaded (brrrrr) PROCEDURES. It entails application of those congitive principles which Kevin seems to feel is the exclusive purview of non-surgical, non-procedural doctors.

If you’ve seen your share of “Cath Jockeys,” rest assured” that we lowly “proceduralists” have seen our share of “Pen Jockeys” in primary care.

I refer even very elderly patients for cataract surgery all the time, as this adds to quality-of-life at almost any age.

I also don’t hesitate to refer patients who have a sudden unexplainable change in ambulation to an orthopod.

Practicing medicine (esp. primary care) is about applying judgment for the best treatment of the patient. For some, however, this his devolved into running patients through an UNNECESSARY mill of procedures. That is the point.

I’m not saying that nobody should ever be seen by a cardiologist, I’m sorry you misunderstood that. I am saying, however, that there is a TREMENDOUS financial incentive to do procedures, and you must be blind or stupid to not acknowledge that that influences behavior.

And I am somewhat judicious in my referral to specialists, especially to ones I know will run my patients through their in-house procedure mill, then give me no answer in how to manage them.