The dark secret of specialists is that they are trained to see the bizarre. In order to adequately train a specialist in diseases and illnesses that rarely occur, they must train at large, academic medical centers. In such places, where doctors throughout the region send their difficult cases, they do end up seeing quite a few bizarre cases. To deal with the bizarre, they do lots of tests and perform lots of procedures. Because they are trained this way, they carry these habits out into the real world. Thus, when they see rather simple cases they are more likely to overtreat them or try to make the bizarre out of the ordinary.
This especially frightening when you consider how specialist-based our health care system is, with the average Medicare patient seeing five or more specialists annually.
That’s a lot of testing and explains the excessive practice variation that drives up health care spending.
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{ 6 comments }
oh give me a break. I am a specialist and let me let you in on a little secret… What is common is common. I don’t spend all day just dealing eith zebras, rather I deal with bread and butter.
My experience with zebras and specialists has been that the very difficult cases move from the community to the academic centers. I’ve had specialists tell me flat out that they don’t see enough of types of zebras to manage them. My experience is that they know just as little about the zebras as I do. If you aren’t managing zebras every day, you lose the ability to manage, without a refresher course. That runs across all specialties, including comprehensive care doctors. For some instances I know that managing zebras can be very time consuming and difficult. And that takes away time from the volume mentality paid by Medicare. In fact, just the other day, I had a patient that a specialist said was “out of their scope.” In other words, it required too much effort for payment. It was not out of their scope. It was a difficult case of a common problem. A type of punting the zebra to someone else who has the time to spend on it.
If you are a specialist, and you get paid so much more to manage special cases, you should manage them. Unfortunately, that’s not reality. They often get transferred to the academic centers that receive federal and state funding. And have the time to manage really difficult cases.
Then perhaps you should be reimbursed like a generalist.
anon 1:02:
What is bread and butter to a specialist is usually not not bread and butter to a generalist. Just like a generalist usually has a wider overall medicine knowledge base, the specialist knows more about a given area. This should be clear to anyone with experience in the field (ie. a statement of the obvious).
Just because it is my bread and butter does not mean that is a generalists bread and butter. I only do what the generalist can’t or won’t do, so maybe I shouldn’t be paid like a generalist since I am their crutch.
Well, as a zebra, I can tell you my PCP did much more for me than any specialist until I found the right one. And my PCP still coordinated my care on this end because my specialist was/is all the way across the country.
And to “anonymous” who said,
“oh give me a break. I am a specialist and let me let you in on a little secret… What is common is common. I don’t spend all day just dealing eith zebras, rather I deal with bread and butter.
I just think very few specialists or PCP’s take the time to see the stripes. (And for me, that was literal.)
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