"Witness the collapse of cognitive medicine before our eyes"

With my training, expertise and education, I should be able to collect at least $250/hour. I’m pretty sure medicare will pay me less than $75. After overhead I make less than a massage therapist for an hour teaching. Family’s happy but I can guarantee you that if I sent them a bill for the other $175, they would be furious. My time should be free, right? It’s your right, right? Is your time free?

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Anonymous
Sooner rather than later, Medicare Part B will fail the failure it deserves, which is the only fate it should have as long as it pretends to offer access while only controlling payout. Inadequate pay inevitably begets inadequate access. Basic market behavior will not change, even for the government.
Soon “opting out” will be a painless option.
The only real alternative that has a hope of working in the future is to fix payment and permit balance billing without limits.
Anonymous
I’m starting to agree as well. It’s going to be a bottom-up thing. Primary care will lead the way…..they’ll be forced into it.
Anonymous
Corrected for accuracy.
“To the extent that my profession has oligopolized the healthcare market, I should be able to collect at least $250/hour. I’m pretty sure medicare will pay me less than $75. After overhead I make less than a massage therapist for an hour teaching. Family’s happy but I can guarantee you that if I sent them a bill for the other $175, they would be furious. I should be judged in terms of having responsibility commensurate with my economic privilege, right? I should be held to the standard of first, do no harm? You think that the patient population should actually expect something along the lines of altruism for giving providers the competition-free and perpetual employment system that have now? Silly rabbit, do no harm refers to the providers’ pocketbook and social status.”
Anonymous
So don’t take Medicare. Market your services at your hourly rate, and get paid based on what you believe your skill is worth.
Anonymous
“”You think that the patient population should actually expect something along the lines of altruism for giving providers the competition-free and perpetual employment system that have now? Silly rabbit, do no harm refers to the providers’ pocketbook and social status.”
Good to see that there is still work for psychiatrists.
“Perpetual employment”? You mean that there are always sick people somewhere? Or do you mean that every single governmental authority and private company personnel office seems to need a doctor’s signature on something?
“Competition free?” You mean that all the other specialists in my town aren’t in fact my competitors? Do you mean that doctors in other specialties that “intersect” with mine aren’t “competitors”? Or do you mean that the university medical center down the road, with its tax-advantaged status and huge advertising and marketing budget, they aren”t competing? Or do you mean that any huckster with no credible training can’t just break the laws passed by the representatives of the voting citizens of my state and offer “services” that he can claim, with no verification, are the same quality as mine? I must be a chump for having gone to school and worked as a resident and having paid thousands of dollars in certification and re-certification examination fees if that is the case; I could have just got me a wagon and a signboard like Mr. Haney from “Green Acres”.
Anonymous
When you can come back and tell me that you are hurting for patients because of the purported “competition” that you think that you are seeing, then you might have a point.
Are you advertising the buy three procedures get one free?
Are you advertising that if a patient can find a lower price than your advertised price then you will perform said procedure for free?
As far as the hucksters go, feel free to call your local PD. “Practicing medicine” without a license is a felony. Unfortunately, the malpractice of medicine with a license is virtually impossible to eradicate.
If only the auto mechanics had jumped on “practicing automotive diagnosis and repair requiring a license” in the 1900s. They would have a playing field similar to allopathic medicine.
Anonymous
“If only the auto mechanics had jumped on “practicing automotive diagnosis and repair requiring a license” in the 1900s. They would have a playing field similar to allopathic medicine.”
Your car may not be recent vintage, but if it were, you would find just how well auto mechanics have done with their business. Just about everything now that is more complicated than an oil change needs dealer service (and sometimes that too.) And to think, I don’t even own a Porsche.
Maybe I’m not hurting because my patients think I am doing a good job and that I am worth their trouble? Is there room somewhere in your collection of theories for that idea?
Do I have to advertise? Do I need to have someone outside my office with a signboard and a big rubber hand waving at drivers as they go by?
Doing lots of things without a license is a crime. Driving a car, for one. Operating a funeral home requires one too. In my state, doing electrical work if you are not a licensed master electrician is against the law. Since when has medicine ever been exclusive that way? And in any case, any doctor can get a license to practice as long as he fulfills the requirements. Are you suggesting that those not qualified be allowed to practice as medical doctors too? If you have your pants in a bunch about malpractice issues as things are now, I can only imagine what the situation would be if they actually did let people with no qualifications get licenses to practice. But you can dream, can’t you.
Anon. 3:22, if you ever did have your loony way, I nominate you to be the first patient for one of those unqualified people you think we all need so much.
Anonymous
Here. Let me help you out. One only hopes that your knowledge of clinical medicine exceeds your lack of knowledge of motor vehicles (yet another example of why clinicians have no business in talking about “motor vehicle caused” XYZ). All modern day motor vehicles utilize computer systems that can be accessed directly through the OBD2 port (usually inferolaterally located with respect to the steering column). You, yourself, can purchase hardware to connect to the OBD2 port of your car from a place such as http://www.vetronix.com and in a matter of minutes figure out why the “check engine” light came on. It is about as easy as diagnosing 99% of mundane human conditions such that a NP could do it without having to pay a cut to some provider.
You may have patients because you are skilled. On the other hand you could be a bottom of the barrel “pass” student from medical school with a helping hand through residency to cover the type of care exemplified by iatrogenic pneumothorax during intercostal drain insertion for a pleural effusion. The problem with the current system is that there is no effective competition to weed out the latter while rewarding the former. And let us at least be honest by not bringing up the crony packed medical “disciplinary” board(s). By the way, you have made my point when it comes to a lack of competition given the lack of necessity for advertising your services.
If one is going to discuss licensing, let us at least include the Flexnerian limitations that precede such. Such restrictions exist for no other field of endeavor. In regards to clinical medicine, if providers were objectively judged (instead of the usual “bad outcome” excuse) using standards commensurate with their privilege, quite a few would be unlicensed rather quickly.
Anonymous
OBD and OBD II? Been there, done that. Getting a handheld to plug in under your dash isn’t the same as fixing the problem, though. Sure, anyone with a $200 Wal-mart reader can do that. But suppose the part is “dealer-only”, or suppose no independent mechanics outside the dealership want to touch a car for fear of being unable to secure parts needed. It happens. So the dealership mechanics get a good deal of secure business. The age of the shade-tree mechanic is gone.
But OBD is besides the point.
Doctors mainly get business by referrals. You know, that old-timey thing called “word of mouth”. If you can handle things other doctors find difficult and distasteful, you are even more appreciated. Sure, I could be a bottom-of-the barrel doc, or I could be a doc that has a particularly sought-after and difficult to attain specialty (some things in life do actually take hard work to get and keep, in case that circumstance isn’t familiar to you). When you have demonstrated that attainment, on the record, people will seek you out for your opinions and work. It is called expertise. You seem to be under the illusion that expertise is only some devilish fraud controlled by malevolent forces and that freeing up all the requirements for “qualifying”–which seems to mean that no one could reasonably tell the qualified from those not but saying they were–will make medical care both better and more plentiful. (If so where is the groundswell of support for this idea, . . . anyone . . . anyone . . . . Bueller?)
And what is a day without Flexner, the bugbear of your particular paranoia? He had to rear his ugly head to torment you.
Rest well. Take the blue pill first.
Anonymous
>>If one is going to discuss licensing, let us at least include the Flexnerian limitations that precede such. Such restrictions exist for no other field of endeavor.
Bullshit.
You want to become an electrician in my state, you have a choice of two training programs.
Both are run by the electrician’s union. Only reason I know that is I asked an electrician. I should check the plumbers someday.
Anonymous
Actually we have quite a few “shade tree mechanics” locally that compete with the various “repair departments” at the dealerships. The ease of diagnosing problems with a modern motor vehicle are akin to the ease of diagnosing the vast majority of common conditions. Yet, there is no requirement for auto mechanics to have a PhD in automotive engineering nor were over half of all automotive technician schools closed down by existing mechanics in order to reduce the supply of those that could legally perform the work at hand.
In as far as referrals go… word of mouth? Are you serious. More like sending patients to the golfing buddy or to the fellow provider that shares a fiscal interest in the surgery center or imaging center that both providers own. If clinical medicine was a field governed as a meritocracy there are quite a few that would go without any patients that under the current system enjoy free access to predate on the patient populace. Regardless, the patient class itself is not blameless having made true the desire of the Massachusetts Medical Society to turn allopaths into those that should be “looked upon by the mass of mankind with a veneration almost superstitious.”
A day without the anti-competitive components of Flexner would equate to a day in which the populace would enjoy better access to better quality healthcare. Bottom of the barrel providers would be out of business.
I took the red pill a long time ago, hence my disregard for the sacred cow allopathic system that has been put into place using nefarious methods that put organized crime to shame.
Anonymous
I take it that includes your psychiatrist.
Anonymous
What a witty retort! Given the junk science that goes on in clinical medicine, however, such is par for the course.

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