Are doctors going to quit treating the people who set Medicare reimbursements, health insurance execs, and the people who manage the reimbursements at those health insurance companies?

After all, those people have far more impact on their earnings.

Its a hostile patient physician relationship. He has no obligation to treat anyone under those conditions.

"Coming soon . . . an Oklahoma statute that yanks physician certification for discriminating against those with different "political views"

I've got news for you pal. If this is not an emergency and I am not on coverage call, then I don't have to treat you. that is the truth. Deal with it.

That is such a good idea. In fact, why don't you and all the people that think like you just stop going to physicians. Nothing is stopping you. You're probably just another one of those whiny people that wants a neurosurgeon when you need brain surgery or an oncologist to manage your cancer or urologist to cut and recontruct your bladder after cancer or internal medicine doc to manage your hypertension, diabetes, depression, and erectile difficulties. Man, how are we ever going to stick it to the rich doctors if we have to rely on them so much!!!

As far as expanding the scope of practice for NP and PAs. I got two words "bring it". I have absolutely no fear that a NP can come close to providing the type of care that I do.

For those of you unfamiliar with the state, Oklahoma is widely known as a medical backwater. This recent action is but the tip of the iceberg.


In regard to "The Okies should consider a substantial expansion in the scope of practice for NPs and PAs..." , Crim should read the following other news out of Oklahoma today:

"Friday, May 11, 2007
BILL targeting Oklahoma optometry procedures clears Legislature
Oklahoma City,OK USA
By The Associated Press

A battle between optometrists and ophthalmologists over the kinds of eye surgery that can be performed in Oklahoma played out in the state Legislature on Wednesday. The House and Senate both approved a bill that would allow optometrists to perform non-laser eye surgeries authorized by the Oklahoma Board of Examiners in Optometry.....

.....Passage came despite opposition from ophthalmologists who say only medical doctors should be allowed to perform such procedures.

Ophthalmologists are physicians who are authorized to perform ocular surgery. Optometrists, who attend optometry school but are NOT medical doctors, are allowed in Oklahoma to perform certain laser eye surgeries.

David Cockrell, president of the Oklahoma State Board of Examiners in Optometry, said the measure was requested because of a recent attorney general's opinion that stated optometrists were not allowed to perform non-laser surgeries. The opinion also said the board didn't have the authority to authorize those procedures.

.... "Because the procedures we already do are termed surgical procedures, we needed put that language in statute so that we can bill for those procedures and receive payment."

Rep. Dale Wells, who supported the bill, said another component of the issue is one of access. He said Oklahoma has 101 licensed ophthalmologists practicing in 18 of the state's 77 counties. By contrast, there are 600 registered optometrists in 72 counties, he said.

Failure to pass the bill "will gut the ability of these people to provide great eye care to the people of Oklahoma."

Ophthalmologists, however, argue that Oklahoma is already the ONLY state in the nation to allow optometrists to perform laser surgery, a policy they oppose.

"It should be of concern to Oklahomans that only in Oklahoma, health care providers who are not trained surgeons are allowed to use lasers to perform delicate eye surgery," said Dr. Cynthia Bradford, secretary for state affairs for the American Academy of Ophthalmologists. "This is an unprecedented policy. It is not in the best interest of patient eye care."

Rep. Odilia Dank, who opposed the bill, agreed.

"Non-laser surgery is surgery with a knife," said Dank, R-Oklahoma City. "The slightest error can do huge damage."

The bill, which passed the House 85-9 and the Senate 40-6, now heads to the governor for consideration."

For those of you who regard Oklahoma as a progressive state, apparently Crim included, why don't you vote with your feet and move there. For anyone else, why don't you vote with your feet and leave. For the innocent or naive who have no choice but to stay in Oklahoma, unfortunately you are getting trampled under the feet of your legislators, the tort bar, and providers who want to be physicians but did not go to medical school.

Crim's last post could be best used as the definition of "Non sequitur" should Kevin start an online dictionary.

As for the non-M.D. providers and innocent sheep in Oklahoma, in time they will learn the hard way that the standard-of-care cannot be legislated. The Oklahoma Governor and legislature has shown its true colors purporting to protect patients by vetoing tort reform while foisting the illtrained on that same populace. The only winner is the tort bar.

"And of course those victims of negligence who won't have the value of their cases decided by the insurance lobby."

God, I hate it when someone repeats that myth about caps - that the whole award, including medical coverage, is limited to whatever the cap is. WRONG, WRONG, WRONG!!! Again, caps have NO EFFECT on medical expenses - just the non-economic damages.

"Why is that a bad proposal to veto?
# posted by Anonymous : 1:49 PM"

Have you ever been sued? Have you ever purchased malpractice insurance? Have you ever seen the noneconomic damages requested in lawsuits? Do you own stock in a company that has been sued affecting the value of your investment? How much of the cost for the products you buy reflects legal and insurance costs? Do you think a company would rather relocate to or from Oklahoma? Do you think a medical doctor would rather relocate to or from Oklahoma? Would you rather relocate to or from Oklahoma?

"Have you ever been sued? Have you ever purchased malpractice insurance? Have you ever seen the noneconomic damages requested in lawsuits? Do you own stock in a company that has been sued affecting the value of your investment? How much of the cost for the products you buy reflects legal and insurance costs? Do you think a company would rather relocate to or from Oklahoma? Do you think a medical doctor would rather relocate to or from Oklahoma? Would you rather relocate to or from Oklahoma?"

1. Yes
2. Yes
3. Probably
4. I have no idea, and neither do you.
5. I have no idea, and neither do you - depends on the company.
6. I'm not a doc, so I don't know. There are so many factors that go into where one takes any jobs it's impossible to make a blanket statement.
7. I like where I live, but Tulsa is a great town and I would happily live there.

None of your questions validate your position that people shouldn't be held responsible for the harm their negligence causes and the cost of that responsibility should be set by insurance industry lobbyists.

It is totally amazing that every single time there is discussion about mal-practice drs. absolutely belive they are the only person involved. Do they teach this sever self-importance attitude to you in med school or was it there from your families?

When there is a mal-practice case then there is also a patient some where. Maybe even a child. Why do NONE of you care about the patients? There is something wrong with you guys. some of you have no morals whatsoever. Yes, you think and believe you do, but that is just your feelings of granduer kicking in. Do you all all need some lithium?

I will repeat my contention that many of the subjects of Kevin's blog are not able to be understood by those not involved in delivering health care. Several of the above posts are evidence of this fact.

As a medical practitioner from an underprivileged nonmedical family background who has lost at least two family members to alleged medical negligence, I have well founded opinions. The sweeping generalizations two posts up aside, there are two sides to every coin. Doctors are patients too.

There is no doubt in my mind that general liabiliy reform is needed, that caps on noneconomic damages have been proven to be effective in California and Texas, and that this is not strictly a matter affecting physicians. In fact, the legislation promulgated involves noneconomic damages on all sorts of nonmedical cases. There is no doubt in my mind that there is significant abuse and manipulation of our legal system in general.

The amount of space devoted on this blog to legal matters is out of proportion to the relative impact of such matters on medical practice and economics. It is the emotional impact and the fact that doctors take it personally that makes legal matters loom so large. One person I know has perhaps a most practical perspective, regarding such matters merely as a cost of doing business. This may be the only rational way to view such matters with our present adversarial system, and we must work to be fair while reducing costs of doing business with limited economic resources. A good start is to reduce the take of the middle-man and transactional costs, whether by insurance company, attorney, high cost triage provider, or unscrupulous physician.

I disagree with the above post, and that is a fact you cannot change.

" I can prove that premiums were immediately and significantly reduced after caps passed."

Where? That does not even make sense, because of the typical 4 year tail on claims. And, before caps become effective, a number of cases are filed that would normally be strung out over a longer period of time so the insurer is going to need a larger reserve for the next 2-3 years. So unless your insurer was overestimating its losses in the first place, it makes no sense for them to immediately decline following passage. Plus, many insurers will tell you they're waiting to see if the caps survive legal challenges.

Rates go up and down with the economy. Recently, as interest rates and the stock market have gone up, rates have gone down in both capped and non-capped states.

Defensive medicine = quality services? In that case, what's the complaint about? Isn't that what we're paying for - quality services?

That's some awesome analysis. I hope you're not diagnosing patients that way. I can just hear you: Hmm, it was sunny when you came in, and you weren't in that much pain, but it's dark now and you hurt worse. . . quick, turn on the lights and you'll be cured!

Its moments like this that remind me why I quit clinical practice. From neurosurgery, at age 37. Went into full time research, and my life is infinitely better. No predatory lawyers, no litigious patients, no begging for reimbursement- and I'm still using my education.

The battle is lost. The lawyers, politicians and insurance companies have won. You just might not realize it- yet. My solemn advice for any physician under the age of 45: get out while you can still build a new career.