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	<title>Comments on: &quot;What kind of ER is that?&quot;</title>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80210</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Thu, 20 Sep 2007 14:35:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80210</guid>
		<description>Jordan,&lt;br/&gt;&lt;br/&gt;I couldn&#039;t have said it better - thanks!!</description>
		<content:encoded><![CDATA[<p>Jordan,</p>
<p>I couldn&#8217;t have said it better &#8211; thanks!!</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80208</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Thu, 20 Sep 2007 14:26:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80208</guid>
		<description>&quot;What you get is our presence when you need us and our unique training. That&#039;s it. You want more...too bad! No guarentees!&quot;&lt;br/&gt;&lt;br/&gt;No, I don&#039;t get that.  I get that promise from you, but it&#039;s not enforceable in the least.  What you want is something for nothing.  &lt;br/&gt;&lt;br/&gt;&quot;You don&#039;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.&quot;&lt;br/&gt;&lt;br/&gt;An empty threat.  Most of you don&#039;t even have the balls to wean yourself from govt. reimbursements, and you&#039;re going to drop medicine altogether?  Doubtful, since the majority of you likely couldn&#039;t take the cut in pay, even if it was only temporary.&lt;br/&gt;&lt;br/&gt;&quot;Worse out comes. More malpractice, less dedicated physicians. higher mortality.&quot;&lt;br/&gt;&lt;br/&gt;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.</description>
		<content:encoded><![CDATA[<p>&#8220;What you get is our presence when you need us and our unique training. That&#8217;s it. You want more&#8230;too bad! No guarentees!&#8221;</p>
<p>No, I don&#8217;t get that.  I get that promise from you, but it&#8217;s not enforceable in the least.  What you want is something for nothing.  </p>
<p>&#8220;You don&#8217;t like it&#8230;fine, eventually we will move on. Most physicians are smart enough to be highly succesful at many other fields. We will leave.&#8221;</p>
<p>An empty threat.  Most of you don&#8217;t even have the balls to wean yourself from govt. reimbursements, and you&#8217;re going to drop medicine altogether?  Doubtful, since the majority of you likely couldn&#8217;t take the cut in pay, even if it was only temporary.</p>
<p>&#8220;Worse out comes. More malpractice, less dedicated physicians. higher mortality.&#8221;</p>
<p>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.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80207</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Thu, 20 Sep 2007 13:49:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80207</guid>
		<description>To anonymous 2:42&lt;br/&gt;&lt;br/&gt;If this is the same anon each time here is what I think.  Many times in this discussion you have argued something like this:&lt;br/&gt;&lt;br/&gt;&quot;if I guarantee you immunity from the harm you cause, what are you going to guarantee me?&quot;&lt;br/&gt;&lt;br/&gt;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.  &lt;br/&gt;&lt;br/&gt;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....&lt;br/&gt;&lt;br/&gt;What you get is our presence when you need us and our unique training.  That&#039;s it.  You want more...too bad! No guarentees!&lt;br/&gt;&lt;br/&gt;You don&#039;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.&lt;br/&gt;&lt;br/&gt;Go ahead....use nurse practitioners and PA&#039;s instead.  Train more physicians in less costly ways or physician providers for cheaper.  You know what you&#039;ll get....&lt;br/&gt;&lt;br/&gt;Worse out comes.  More malpractice, less dedicated physicians.  higher mortality.&lt;br/&gt;&lt;br/&gt;You get what you pay for.  you want to pay us less or make us work more...fine.  We&#039;ll leave.  It&#039;s your health.  you figure it out!&lt;br/&gt;&lt;br/&gt;Supply and demand.&lt;br/&gt;&lt;br/&gt;period.&lt;br/&gt;&lt;br/&gt;Jordan</description>
		<content:encoded><![CDATA[<p>To anonymous 2:42</p>
<p>If this is the same anon each time here is what I think.  Many times in this discussion you have argued something like this:</p>
<p>&#8220;if I guarantee you immunity from the harm you cause, what are you going to guarantee me?&#8221;</p>
<p>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.  </p>
<p>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&#8230;.</p>
<p>What you get is our presence when you need us and our unique training.  That&#8217;s it.  You want more&#8230;too bad! No guarentees!</p>
<p>You don&#8217;t like it&#8230;fine, eventually we will move on.  Most physicians are smart enough to be highly succesful at many other fields.  We will leave.</p>
<p>Go ahead&#8230;.use nurse practitioners and PA&#8217;s instead.  Train more physicians in less costly ways or physician providers for cheaper.  You know what you&#8217;ll get&#8230;.</p>
<p>Worse out comes.  More malpractice, less dedicated physicians.  higher mortality.</p>
<p>You get what you pay for.  you want to pay us less or make us work more&#8230;fine.  We&#8217;ll leave.  It&#8217;s your health.  you figure it out!</p>
<p>Supply and demand.</p>
<p>period.</p>
<p>Jordan</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80203</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Thu, 20 Sep 2007 12:38:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80203</guid>
		<description>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 &quot;but I also think that when people make the decision to live in smaller areas....&quot;, then when pointed out how wrong you are with respect to Tucson, you change the subject. In reply to your statement, YES, I don&#039;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&#039;t think it is a big issue makes me realize you understand nothing about medicine and the importance of time in treatment. This isn&#039;t some law brief you can put into drawer until tomorrow. You love academic arguments but you have very little understanding of reality.</description>
		<content:encoded><![CDATA[<p>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 &#8220;but I also think that when people make the decision to live in smaller areas&#8230;.&#8221;, then when pointed out how wrong you are with respect to Tucson, you change the subject. In reply to your statement, YES, I don&#8217;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&#8217;t think it is a big issue makes me realize you understand nothing about medicine and the importance of time in treatment. This isn&#8217;t some law brief you can put into drawer until tomorrow. You love academic arguments but you have very little understanding of reality.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80200</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Thu, 20 Sep 2007 04:09:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80200</guid>
		<description>Funny, my state went up while Texas went down. Must be a different stock market.</description>
		<content:encoded><![CDATA[<p>Funny, my state went up while Texas went down. Must be a different stock market.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80186</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Wed, 19 Sep 2007 19:42:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80186</guid>
		<description>&quot;Guess the state medical association, the people processing the applications, and the returning doctors themselves don&#039;t count.&quot;&lt;br/&gt;&lt;br/&gt;Again, point me to where any of those people say that physicians are &quot;returning&quot;.  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 &quot;crisis&quot;, and they&#039;ve now come online as well.  Thus, more jobs for physicians, again, unrelated to &quot;reform&quot;, but due to population growth.  A growth that actually outstrips the growth in physicians.  &lt;br/&gt;&lt;br/&gt;But if all the tort reform lobbyists say it was due to that, it must be true.&lt;br/&gt;&lt;br/&gt;You&#039;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 &quot;reform&quot;.  Why didn&#039;t you go to Tennessee, a place that had the very same thing happen, and a lot nicer people than Texas?  &lt;br/&gt;&lt;br/&gt;Oh, and interestingly enough, this very same thing happened after the last &quot;crisis&quot; 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.</description>
		<content:encoded><![CDATA[<p>&#8220;Guess the state medical association, the people processing the applications, and the returning doctors themselves don&#8217;t count.&#8221;</p>
<p>Again, point me to where any of those people say that physicians are &#8220;returning&#8221;.  Are there more applications?  Of course &#8211; 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 &#8220;crisis&#8221;, and they&#8217;ve now come online as well.  Thus, more jobs for physicians, again, unrelated to &#8220;reform&#8221;, but due to population growth.  A growth that actually outstrips the growth in physicians.  </p>
<p>But if all the tort reform lobbyists say it was due to that, it must be true.</p>
<p>You&#8217;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 &#8220;reform&#8221;.  Why didn&#8217;t you go to Tennessee, a place that had the very same thing happen, and a lot nicer people than Texas?  </p>
<p>Oh, and interestingly enough, this very same thing happened after the last &#8220;crisis&#8221; 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.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80183</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Wed, 19 Sep 2007 19:18:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80183</guid>
		<description>Guess the state medical association, the people processing the applications, and the returning doctors themselves don&#039;t count.&lt;br/&gt;&lt;br/&gt;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&#039;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&#039;m one of those doctors you say doesn&#039;t exist.&lt;br/&gt;&lt;br/&gt;I see it with my own eyes. You have talking points from the trial bar.</description>
		<content:encoded><![CDATA[<p>Guess the state medical association, the people processing the applications, and the returning doctors themselves don&#8217;t count.</p>
<p>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&#8217;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&#8217;m one of those doctors you say doesn&#8217;t exist.</p>
<p>I see it with my own eyes. You have talking points from the trial bar.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80177</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Wed, 19 Sep 2007 16:04:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80177</guid>
		<description>&quot;So let&#039;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.&quot;&lt;br/&gt;&lt;br/&gt;There is no evidence that a bunch of doctors are &quot;returning&quot; to Texas.  The number of doctors hasn&#039;t even kept up with the population growth of Texas.  So why is it surprising when the population grows that there are more doctors?&lt;br/&gt;&lt;br/&gt;What about Arizona makes it a &lt;br/&gt;&quot;judicial hellhole&quot; that you know of?  How many incorrect verdicts come out of there?  What&#039;s that, you have no clue?  How surprising.&lt;br/&gt;&lt;br/&gt;&quot;The lack of pediatric neurosurgeons in NJ, my home state, due to a hostile legal environment, MUST be a myth.&quot;&lt;br/&gt;&lt;br/&gt;So if we give you an &quot;unhostile legal environment&quot;, how many will you guarantee us?</description>
		<content:encoded><![CDATA[<p>&#8220;So let&#8217;s see &#8211; 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.&#8221;</p>
<p>There is no evidence that a bunch of doctors are &#8220;returning&#8221; to Texas.  The number of doctors hasn&#8217;t even kept up with the population growth of Texas.  So why is it surprising when the population grows that there are more doctors?</p>
<p>What about Arizona makes it a <br />&#8220;judicial hellhole&#8221; that you know of?  How many incorrect verdicts come out of there?  What&#8217;s that, you have no clue?  How surprising.</p>
<p>&#8220;The lack of pediatric neurosurgeons in NJ, my home state, due to a hostile legal environment, MUST be a myth.&#8221;</p>
<p>So if we give you an &#8220;unhostile legal environment&#8221;, how many will you guarantee us?</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80176</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Wed, 19 Sep 2007 16:02:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80176</guid>
		<description>&quot;Anon 11:29 (ie CJD) you really need to think before you type. Tucson is NOT a &quot;samller area&quot;.&quot;&lt;br/&gt;&lt;br/&gt;No kidding.  But this article doesn&#039;t really tell you that much about why this ER doesn&#039;t have these people.  But even given Tuscon&#039;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&#039;re not, why should you get guaranteed liability protection?&lt;br/&gt;&lt;br/&gt;You keep skipping around that fundamental question.  Don&#039;t want to admit you want something for nothing?</description>
		<content:encoded><![CDATA[<p>&#8220;Anon 11:29 (ie CJD) you really need to think before you type. Tucson is NOT a &#8220;samller area&#8221;.&#8221;</p>
<p>No kidding.  But this article doesn&#8217;t really tell you that much about why this ER doesn&#8217;t have these people.  But even given Tuscon&#8217;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&#8217;re not, why should you get guaranteed liability protection?</p>
<p>You keep skipping around that fundamental question.  Don&#8217;t want to admit you want something for nothing?</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2007/09/what-kind-of-er-is-that.html/comment-page-1#comment-80165</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Wed, 19 Sep 2007 12:56:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2007/09/what-kind-of-er-is-that.html#comment-80165</guid>
		<description>&quot;Ahh, the great &quot;disappearing doctor&quot; myth. Another nice article of faith physicians rely upon. For scientists, you guys sure swallow a lot of insurance bs whole.&quot;&lt;br/&gt;&lt;br/&gt;So let&#039;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&#039;t fit your worldview...</description>
		<content:encoded><![CDATA[<p>&#8220;Ahh, the great &#8220;disappearing doctor&#8221; myth. Another nice article of faith physicians rely upon. For scientists, you guys sure swallow a lot of insurance bs whole.&#8221;</p>
<p>So let&#8217;s see &#8211; 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&#8217;t fit your worldview&#8230;</p>
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