Comments on: Specialists and zebras http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html medical blog Mon, 22 Mar 2010 02:53:32 -0400 http://wordpress.org/?v=2.8.4 hourly 1 By: Robin http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html/comment-page-1#comment-87595 Robin Sat, 11 Oct 2008 00:39:00 +0000 http://clients.emmense.com/kevinmd/2008/10/specialists-and-zebras.html#comment-87595 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. <br/><br/>And to "anonymous" who said, <br/><br/><i>"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><br/><br/>I just think very few specialists or PCP's take the time to see the stripes. (And for me, that was literal.) 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.)

]]> By: Anonymous http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html/comment-page-1#comment-87593 Anonymous Fri, 10 Oct 2008 22:10:00 +0000 http://clients.emmense.com/kevinmd/2008/10/specialists-and-zebras.html#comment-87593 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html/comment-page-1#comment-87592 Anonymous Fri, 10 Oct 2008 21:59:00 +0000 http://clients.emmense.com/kevinmd/2008/10/specialists-and-zebras.html#comment-87592 anon 1:02:<br/>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). 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).

]]> By: Anonymous http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html/comment-page-1#comment-87588 Anonymous Fri, 10 Oct 2008 18:02:00 +0000 http://clients.emmense.com/kevinmd/2008/10/specialists-and-zebras.html#comment-87588 Then perhaps you should be reimbursed like a generalist. Then perhaps you should be reimbursed like a generalist.

]]> By: The Happy Hospitalist http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html/comment-page-1#comment-87587 The Happy Hospitalist Fri, 10 Oct 2008 17:18:00 +0000 http://clients.emmense.com/kevinmd/2008/10/specialists-and-zebras.html#comment-87587 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.<br/><br/>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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/10/specialists-and-zebras.html/comment-page-1#comment-87586 Anonymous Fri, 10 Oct 2008 14:17:00 +0000 http://clients.emmense.com/kevinmd/2008/10/specialists-and-zebras.html#comment-87586 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. 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.

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