Comments on: Reader letters: The primary care crisis – don’t take my word for it http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-90884 Anonymous Sat, 18 Apr 2009 18:33:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-90884 "......Health insurance for all will only make access worse - just look at Massachusetts......"<br /><br />I'm no particular fan of schemes like Massachusetts, though I prefer the individual mandate approach of this plan. If it's going to be done at all, at least try it by that approach.<br /><br />Nevertheless, I'll remain an agnostic.<br /><br />Easy for me, as I'm nowhere near Massachusetts......<br /><br />But is the access issue a sign of failure or success? Can't tell from just that statement.<br /><br />Does it mean that patients now have health insurance, want doctors, and supply has not caught up with demand? That would be a sign of success. Evidence would be an increase in people wanting to practice in The Bay State.<br /><br />Or do these people have some sort of government-conceived insurance that no doctor wants? Like if Massachusetts uninsured suddenly got Medicaid, paying Medicaid rates, and doctors don't take Medicaid 'cause a high-Medicaid practice would go bankrupt.<br /><br />I suspect the latter is the case, but not being from there, I don't know. Can someone provide the details? “……Health insurance for all will only make access worse – just look at Massachusetts……”

I’m no particular fan of schemes like Massachusetts, though I prefer the individual mandate approach of this plan. If it’s going to be done at all, at least try it by that approach.

Nevertheless, I’ll remain an agnostic.

Easy for me, as I’m nowhere near Massachusetts……

But is the access issue a sign of failure or success? Can’t tell from just that statement.

Does it mean that patients now have health insurance, want doctors, and supply has not caught up with demand? That would be a sign of success. Evidence would be an increase in people wanting to practice in The Bay State.

Or do these people have some sort of government-conceived insurance that no doctor wants? Like if Massachusetts uninsured suddenly got Medicaid, paying Medicaid rates, and doctors don’t take Medicaid ’cause a high-Medicaid practice would go bankrupt.

I suspect the latter is the case, but not being from there, I don’t know. Can someone provide the details?

]]> By: frankdc http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-83061 frankdc Sat, 26 Jan 2008 00:28:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-83061 b:<br/><br/>You're welcome. All I can say to ya'll is try and fight the good fight. Someone has to do it and your patients' need you. Being a DC I've been abused by insurance carriers for what seems like forever. I've battled them when the situation was right and have enjoyed giving a few of them a blackeye. b:

You’re welcome. All I can say to ya’ll is try and fight the good fight. Someone has to do it and your patients’ need you. Being a DC I’ve been abused by insurance carriers for what seems like forever. I’ve battled them when the situation was right and have enjoyed giving a few of them a blackeye.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-83031 Anonymous Thu, 24 Jan 2008 23:37:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-83031 Thanks Frank!<br/>b Thanks Frank!
b

]]> By: frankdc http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-83013 frankdc Thu, 24 Jan 2008 04:01:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-83013 I've been a practicing chiropractor for 25 years and have greatly valued the relationships I've had with primary care physicians. During my time here I've seen a dramatic decrease in the number of primary care docs a situation that my patients are only recently beginning to notice. Why is this happening, many of them ask. Numerous reasons I tell them including financial strain imposed by insurance. They still don't appear to understand until I put it in other terms. Look, in some instances your doctor may not be making anymore for an office visit than you pay your hair stylist. Now who has more education and a greater impact on your life, I say to them. Now they get the point and just maybe we need to make sure more of them get that point to assure that the time honored family physician is around for all of us to benefit from. My dad's family physician was the beacon of light in the last few months of his life, being taken by prostate cancer. I'll never forget the day he touched my dad on the shoulder and told him, you're one of the lucky ones, your pain in under control. That single statement brought a smile to my dad's face soemthing no other specialist was able to do. I’ve been a practicing chiropractor for 25 years and have greatly valued the relationships I’ve had with primary care physicians. During my time here I’ve seen a dramatic decrease in the number of primary care docs a situation that my patients are only recently beginning to notice. Why is this happening, many of them ask. Numerous reasons I tell them including financial strain imposed by insurance. They still don’t appear to understand until I put it in other terms. Look, in some instances your doctor may not be making anymore for an office visit than you pay your hair stylist. Now who has more education and a greater impact on your life, I say to them. Now they get the point and just maybe we need to make sure more of them get that point to assure that the time honored family physician is around for all of us to benefit from. My dad’s family physician was the beacon of light in the last few months of his life, being taken by prostate cancer. I’ll never forget the day he touched my dad on the shoulder and told him, you’re one of the lucky ones, your pain in under control. That single statement brought a smile to my dad’s face soemthing no other specialist was able to do.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-82957 Anonymous Tue, 22 Jan 2008 13:01:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-82957 Honestly, I know I'm not old yet, but I think the emphasis for the new generation should be self-care - diet, exercise, psychological health and then healthcare providers won't be so overwhelmed. How many people old and young alike are going to the doctor for useless reasons? Why is our society addicted to fear? Fear of having cancer, heart attack, diabetes, etc?? Aging brings with it, unfortunately, a decrease in our body optimization. How can patients tell when it's usually nothing or something to look out for? These days there is a ton of info on the internet, but elderly people often don't know how to use the internet.<br/><br/>I know it's extremely hard to prove, but I am a strong believer in a person's psychological health and its link to physical health. Psychology should be equally considered with "chronic" ailments. Honestly, I know I’m not old yet, but I think the emphasis for the new generation should be self-care – diet, exercise, psychological health and then healthcare providers won’t be so overwhelmed. How many people old and young alike are going to the doctor for useless reasons? Why is our society addicted to fear? Fear of having cancer, heart attack, diabetes, etc?? Aging brings with it, unfortunately, a decrease in our body optimization. How can patients tell when it’s usually nothing or something to look out for? These days there is a ton of info on the internet, but elderly people often don’t know how to use the internet.

I know it’s extremely hard to prove, but I am a strong believer in a person’s psychological health and its link to physical health. Psychology should be equally considered with “chronic” ailments.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-82954 Anonymous Tue, 22 Jan 2008 03:34:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-82954 b:<br/>fellwship is going well. No regrets at all. Government, insurance company's, and society all treat primary care like dirt. Well guys you get what you pay for. Garbage in....garbage out. I just feel bad for my friends who haven't left it yet. Somehow I think I will end up being the PCP by default on a subset of my patient's down the road as there will be not be enough PCP's left to see them b:
fellwship is going well. No regrets at all. Government, insurance company’s, and society all treat primary care like dirt. Well guys you get what you pay for. Garbage in….garbage out. I just feel bad for my friends who haven’t left it yet. Somehow I think I will end up being the PCP by default on a subset of my patient’s down the road as there will be not be enough PCP’s left to see them

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-82947 Anonymous Tue, 22 Jan 2008 02:00:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-82947 "Why do we pay the primary care guy the least amount of money, but expect them to know everything, talk to the family, organize referrals, screen for a gagillion things, all in a 15 minute visit. "<br/><br/>Because it is "we" who pay, not the person who needs the service, and "we" use RVS to fight over the payment levels and decide how much it is worth. "We" naturally think "we" are worth more than "you".<br/><br/>You have let someone who doesn't need you decide how much you are worth. It is like letting vegetarians decide what hamburgers are worth. “Why do we pay the primary care guy the least amount of money, but expect them to know everything, talk to the family, organize referrals, screen for a gagillion things, all in a 15 minute visit. “

Because it is “we” who pay, not the person who needs the service, and “we” use RVS to fight over the payment levels and decide how much it is worth. “We” naturally think “we” are worth more than “you”.

You have let someone who doesn’t need you decide how much you are worth. It is like letting vegetarians decide what hamburgers are worth.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-82936 Anonymous Tue, 22 Jan 2008 01:10:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-82936 Wow! We should start a support group for former PCPs now doing fellowships. It's tough to go back, but it is proving to be worth it!<br/><br/>I bailed on primary care in upstate NY after a few years of severe beatings. Now I am half way through fellowship and the job offers (outside upstate) flooded in. It was a joy to behold. More money, less work, more respect and a better place to live.<br/><br/>Let me start the refrain of the future: "Primary care who?" Never heard of it. <br/><br/>It's nice to no longer have to worry about it. Wow! We should start a support group for former PCPs now doing fellowships. It’s tough to go back, but it is proving to be worth it!

I bailed on primary care in upstate NY after a few years of severe beatings. Now I am half way through fellowship and the job offers (outside upstate) flooded in. It was a joy to behold. More money, less work, more respect and a better place to live.

Let me start the refrain of the future: “Primary care who?” Never heard of it.

It’s nice to no longer have to worry about it.

]]> By: DCS http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-82935 DCS Tue, 22 Jan 2008 00:35:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-82935 For many of the reasons listed by the other commenters I resigned from ownership of a family practice group and now work seeing urgent care patients 40 hours a week. I get paid a salary and get home on time. I do not have to spend several hours per week filling out forms for which I receive no reimbursement; I do not have to argue with faceless utilization nazis about prescriptions I have written or imaging studies I want to order. Do I miss the continuity of family medicine? You bet I do! But after 25 years in the trenches with no sign of relief, only "improvement" schemes proposed by private and government policy wonks, I felt it was time to take care of me for a change. For many of the reasons listed by the other commenters I resigned from ownership of a family practice group and now work seeing urgent care patients 40 hours a week. I get paid a salary and get home on time. I do not have to spend several hours per week filling out forms for which I receive no reimbursement; I do not have to argue with faceless utilization nazis about prescriptions I have written or imaging studies I want to order. Do I miss the continuity of family medicine? You bet I do! But after 25 years in the trenches with no sign of relief, only “improvement” schemes proposed by private and government policy wonks, I felt it was time to take care of me for a change.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/01/reader-letters-primary-care-crisis-dont.html/comment-page-1#comment-82929 Anonymous Mon, 21 Jan 2008 17:49:00 +0000 http://clients.emmense.com/kevinmd/2008/01/reader-letters-the-primary-care-crisis-dont-take-my-word-for-it.html#comment-82929 I am sorry I left attorneys off my list. However, this is the one area of the current healthcare situation that has affected specialty care more than primary care. My current malpactrice is 15,000 per year, a lot of money to be sure, but nowhere near the amounts other specialties pay, ie ob-gyn.<br/><br/>Another point: any statements that healthcare obeys market forces are incorrect and convey a lack of understanding of the issue. Healthcare is not like choosing what restaurant to go to. People utilize healthcare when they are sick, making it something they need, not something they choose to utilize. Preventive care is different, requiring a very motivated patient; like a tax rebate, people will spend their money elsewhere if given the chance, totally defeating efforts to pick up/treat illnesses early.<br/><br/>underpaid family practitioner in upstate New York I am sorry I left attorneys off my list. However, this is the one area of the current healthcare situation that has affected specialty care more than primary care. My current malpactrice is 15,000 per year, a lot of money to be sure, but nowhere near the amounts other specialties pay, ie ob-gyn.

Another point: any statements that healthcare obeys market forces are incorrect and convey a lack of understanding of the issue. Healthcare is not like choosing what restaurant to go to. People utilize healthcare when they are sick, making it something they need, not something they choose to utilize. Preventive care is different, requiring a very motivated patient; like a tax rebate, people will spend their money elsewhere if given the chance, totally defeating efforts to pick up/treat illnesses early.

underpaid family practitioner in upstate New York

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