"What kind of ER is that?"

The lack of specialty care is becoming a growing problem. Blame malpractice and declining reimbursement:

At any given time in a Tucson ER, there will be no neurosurgeon to stop your bleeding brain, no plastic surgeon to fix your flailed flesh, no orthopedic surgeon to handle your complex fracture, no gastroenterologist to stem your internal hemorrhage, no hand surgeon to save your mangled fingers . . .

. . . It took a perfect storm of complex factors “” falling insurance reimbursement, rising malpractice rates, too many uninsured patients, fear of lawsuits, changing lifestyle choices “” to create this crisis, to destroy what was once seen as a civic duty to treat emergency patients. These factors have led to the overall doctor shortage plaguing Arizona “” a shortage especially acute among specialty surgeons.

(via a reader tip)

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  • Anonymous

    I thought you guys said primary care physicians were disappearing because there was more money in the specialties. Now it’s the specialties that are disappearing?

    So what are we to do with all these horror stories? I guess pay more in taxes so the govt. can pay you more and give you immunity from your mistakes? What are you promising us in return?

  • Anonymous

    A neurosurgeon on call to save you when you are in a car accident that is not your fault.

    I wouldn’t be too sarcastic if I were you. You never know when it will be you that REALLY needs a neurosurgeon, general surgeon, hand surgeon, ENT, Urologist, etc. on to be on call.

  • Anonymous

    The specialties are disappearing to non-emergent work. The neurosurgeons limit their work to spine. The GI’s work out of surgicenters.

    What you get with tort reform is availability of a doctor to help you when you need one. That does not require more taxes. It does keep the lawyer from getting his jackpot.

  • Anonymous

    “What you get with tort reform is availability of a doctor to help you when you need one.”

    Promise? How many doctors and what type do you GUARANTEE me in exchange for me limiting your liability? And what do you guarantee is the furthest I will have to travel for these services?

    You’re asking for a guarantee from me, so what do I get from you other than nonbinding promises?

  • Happyman

    anon 2:51 says “what do I get from you other than nonbinding promises?”

    I say, you get neither a guarantee nor a promise of ANYTHING (in fact, i didn’t see any of the posters offering such).

    Again, good luck when you need a doctor. I hope you live in a major metro area.

  • Anonymous

    How about a guarantee to indemnify me for any judgement over the limit of insurance?

  • Anonymous

    You just have to shake your head at a daft general public that continue to support the provider first system. There is no need to provide special privileges to the providers and protect their after-expense income from competition if they don’t hold up their end of the bargain.

  • Anonymous

    since when have the after expense income of providers been protected recently.

    Heard of huge medicare cuts which are followed by private insurance cuts… ever heard of minute clinics?

    What about the thousands of foreign doctors that flood the US each year?

    What protections are you talking about? Being trained in order to practice legally. I say abolish it… if you want someone who hasn’t been properly trained treating you go ahead. In fact, you can do this fairly easily right now. Just go to a foreign country and let them butcher you. Just don’t come back when you need the iatrogenic effects corrected.

  • Anonymous

    Happy
    Tucson is a major metro area.

  • Anonymous

    “What are you going to give me in return?”

    Maybe the availability of a neurosurgeon after you smash that thick head of yours up against a windshield in a collision. You throw words like “negligence” like you have some clue about what you are talking about. Do you honestly think it is a good idea to ship people to phoenix, Albequrque, San Diego, or LA (look up the distance on a map)? Ever heard of the “golden hour”? Know what it means?

  • Anonymous

    “Do you honestly think it is a good idea to ship people to phoenix, Albequrque, San Diego, or LA (look up the distance on a map)? Ever heard of the “golden hour”? Know what it means?”

    I don’t think it’s a good idea, but I also think that when people make the decision to live in smaller areas, they know that they will do without certain things. I don’t expect to get top notch Indian food or shop at Neiman Marcus if I choose to live in rural Idaho, so why should I expect to have medical specialists of every stripe within an hour? Particularly when you continually tell me healthcare is not a “right”?

    So again, if I guarantee you immunity from the harm you cause, what are you going to guarantee me? Not “maybe”, but guarantee like I just guaranteed your liability limits?

  • Anonymous

    Well, along the lines of knowing what you get into with moving into a rural area, maybe you should stay away from states that have passed tort reform.

    Some states have decided they would rather have doctors than sue doctors. Or more to the point, limit the jackpot that goes to the lawyer.

    Please feel free to avoid those states. There are still plenty of states you can parasitize.

  • Anonymous

    “Some states have decided they would rather have doctors than sue doctors. Or more to the point, limit the jackpot that goes to the lawyer.”

    Ahh, the great “disappearing doctor” myth. Another nice article of faith physicians rely upon. For scientists, you guys sure swallow a lot of insurance bs whole.

  • Anonymous

    And you’re real good at generating it.

  • Anonymous

    re: ” I also think that when people make the decision to live in smaller areas, they know that they will do without certain things”

    Anon 11:29 (ie CJD) you really need to think before you type. Tucson is NOT a “samller area”. The metro area includes over 1 million people and is in the top 50 for metro areas in the USA.

  • Anonymous

    “Ahh, the great “disappearing doctor” myth. Another nice article of faith physicians rely upon. For scientists, you guys sure swallow a lot of insurance bs whole.”

    So let’s see – the increasing number of doctors returning to Texas after tort reform went into effect MUST be a myth. The lack of specialist physicians in Arizona, a judicial hellhole, MUST be a myth. The lack of pediatric neurosurgeons in NJ, my home state, due to a hostile legal environment, MUST be a myth. I guess it doesn’t fit your worldview…

  • Anonymous

    “Anon 11:29 (ie CJD) you really need to think before you type. Tucson is NOT a “samller area”.”

    No kidding. But this article doesn’t really tell you that much about why this ER doesn’t have these people. But even given Tuscon’s size, are you arguing that there automatically is a right to have all those people on call? If the patients give you tort reform, are you going to guarantee 24 hour access to all? If you’re not, why should you get guaranteed liability protection?

    You keep skipping around that fundamental question. Don’t want to admit you want something for nothing?

  • Anonymous

    “So let’s see – the increasing number of doctors returning to Texas after tort reform went into effect MUST be a myth. The lack of specialist physicians in Arizona, a judicial hellhole, MUST be a myth.”

    There is no evidence that a bunch of doctors are “returning” to Texas. The number of doctors hasn’t even kept up with the population growth of Texas. So why is it surprising when the population grows that there are more doctors?

    What about Arizona makes it a
    “judicial hellhole” that you know of? How many incorrect verdicts come out of there? What’s that, you have no clue? How surprising.

    “The lack of pediatric neurosurgeons in NJ, my home state, due to a hostile legal environment, MUST be a myth.”

    So if we give you an “unhostile legal environment”, how many will you guarantee us?

  • Anonymous

    Guess the state medical association, the people processing the applications, and the returning doctors themselves don’t count.

    My state had access problems, insurance not available, and prices going through the roof. Tort reform passed, insurers came back to the state, insurance became available, occurrence policies written again. Tort reform overturned in the courts, multimillion noneconomic damage awards back within a month, insurers left the state, price goes up, we’re back to claims made and I had to pay a tail when I left to a state with a more favorable tort climate. I’m one of those doctors you say doesn’t exist.

    I see it with my own eyes. You have talking points from the trial bar.

  • Anonymous

    “Guess the state medical association, the people processing the applications, and the returning doctors themselves don’t count.”

    Again, point me to where any of those people say that physicians are “returning”. Are there more applications? Of course – with population growth there are more patients. There were more hospitals being built, and thus more jobs for physicians. A number of new Texas hospitals were being built at the height of the “crisis”, and they’ve now come online as well. Thus, more jobs for physicians, again, unrelated to “reform”, but due to population growth. A growth that actually outstrips the growth in physicians.

    But if all the tort reform lobbyists say it was due to that, it must be true.

    You’re right, insurance companies are coming back to Texas, and are reducing their prices. Of course, they are doing that all over, in states with and without “reform”. Why didn’t you go to Tennessee, a place that had the very same thing happen, and a lot nicer people than Texas?

    Oh, and interestingly enough, this very same thing happened after the last “crisis” in the 80s. Economy improved, rates went down, more insurers came in the market. Then, economy crashed, injured patients get blamed, and away we go again.

  • Anonymous

    Funny, my state went up while Texas went down. Must be a different stock market.

  • Anonymous

    Well CJD, one thing you have shown is that you are too arrogant to admit when you are wrong. Initially you justify your statement with “but I also think that when people make the decision to live in smaller areas….”, then when pointed out how wrong you are with respect to Tucson, you change the subject. In reply to your statement, YES, I don’t think it is unreasonable for a metropolitan area of GREATER THAN 1 MILLION PEOPLE to have all specialties on call and available (and most docs on this website would agree with me on this). That you don’t think it is a big issue makes me realize you understand nothing about medicine and the importance of time in treatment. This isn’t some law brief you can put into drawer until tomorrow. You love academic arguments but you have very little understanding of reality.

  • Anonymous

    To anonymous 2:42

    If this is the same anon each time here is what I think. Many times in this discussion you have argued something like this:

    “if I guarantee you immunity from the harm you cause, what are you going to guarantee me?”

    Well I look at it as this. As physicians we took the time and money it cost to learn how to provide a service. A service that takes a reasonabley high level of intelligence, dedication, and hard work.

    When we finish training we offer this service to the community. This is a service that the community desperately needs. If malpractice and reimbursement issues make it too difficult to provide this service then we will stop. period. You ask what you get if you limit our liability….

    What you get is our presence when you need us and our unique training. That’s it. You want more…too bad! No guarentees!

    You don’t like it…fine, eventually we will move on. Most physicians are smart enough to be highly succesful at many other fields. We will leave.

    Go ahead….use nurse practitioners and PA’s instead. Train more physicians in less costly ways or physician providers for cheaper. You know what you’ll get….

    Worse out comes. More malpractice, less dedicated physicians. higher mortality.

    You get what you pay for. you want to pay us less or make us work more…fine. We’ll leave. It’s your health. you figure it out!

    Supply and demand.

    period.

    Jordan

  • Anonymous

    “What you get is our presence when you need us and our unique training. That’s it. You want more…too bad! No guarentees!”

    No, I don’t get that. I get that promise from you, but it’s not enforceable in the least. What you want is something for nothing.

    “You don’t like it…fine, eventually we will move on. Most physicians are smart enough to be highly succesful at many other fields. We will leave.”

    An empty threat. Most of you don’t even have the balls to wean yourself from govt. reimbursements, and you’re going to drop medicine altogether? Doubtful, since the majority of you likely couldn’t take the cut in pay, even if it was only temporary.

    “Worse out comes. More malpractice, less dedicated physicians. higher mortality.”

    I would think committing more malpractice would make you more dedicated to improve. I fail to see how NOT having to pay for the harm your negligence causes makes you less dedicated.

  • Anonymous

    Jordan,

    I couldn’t have said it better – thanks!!

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