Family doctors: An endangered breed

[East Detroit]

NEW YORK [[CNNMoney.com) -- Luis Manriquez and Katherine Glass share a common -- and increasingly rare -- ambition: They both want to become family doctors.

"As a primary care doctor, you are a gatekeeper of the medical system," said Manriquez, 26, who with Glass is a first-year student at the University of Washington School of Medicine. "Primary care is where you can have the most immediate impact in affecting patients' lives by managing their health."

Still, Manriquez realizes that he's setting himself for considerable challenges.

For one thing, as a family doctor, Manriquez will probably make one-fourth the salary of a specialist while trying to pay down $140,000 on average in medical school debt.

"That's why only the most committed pursue primary care. Kudos to them," said Jonathan Weiner, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

http://money.cnn.com/2009/07/16/news/economy/healthcare_doctors_shortage/index.htm?cnn=yes

[Sstashmoo]

And ya' get to hang out on internet forums all day. Sweet job.

[ccbatson]

A free market would help the primary care folks most of all.

[sumas]

I did not even know that family doctors still existed. When I was young, we had one. He did house calls and all that. When he retired, that was the end of that.

My husband and I do not have health care insurance. I totally agree that managing health is important but with little access due to finances we have to limp along. Recently, my husband had what appeared to be a serious health issue and we went to emergency which is a poor subsitute for primary care. We did get referred to a low cost clinic for follow up. The doctor we saw there was superb. He recommended follow up tests which we simply cannot afford and he understands that. I totally believe that national health care should be in place and save money in the long run. The ER visit fees were waived due to our situation. The clinic fees were reduced but if this situation persists my husband will qualify for SSI. Isn't access to primary care more cost effective?

[East Detroit]

A free market would help the primary care folks most of all.

I would rather have someone dedicated to people, rather than another money grubbing capitalist as my doctor.

[oladub]

A free market would help the primary care folks most of all.

Why do you say that? I am not agreeing or disagreeing with you but what is your basis for saying that? I realize that the more the government has mettled in health care, the less affordable it has become. However, 'a free market' would take us to a new world without [[government) physician licensing or an FDA. How would that help primary care providers?

[East Detroit]

Why do you say that? I am not agreeing or disagreeing with you but what is your basis for saying that? I realize that the more the government has mettled in health care, the less affordable it has become. However, 'a free market' would take us to a new world without [[government) physician licensing or an FDA. How would that help primary care providers?

No ICD-9 codes, no DRGs; basically they could charge what they felt like and really rake in the cash. I guess thats the bottom line for some people.

[oladub]

ED, Those codes have something to do with classifying diseases according to Wikipedia. How do they relate to Bats' contention that "A free market would help the primary care folks most of all."?

[oldredfordette]

I had a great family doctor until about a month ago, he closed his practice [[bad news). He began teaching young doctors to open their own practices [[good news). He's completely committed to the idea and wants to help.

He's also a supporter of universal health care.

[oladub]

Becoming a doctor is no longer about helping anyone. that breed is long gone.You could be wheeled into an er with all 4 limbs missing and if you are uninsured the best they will do for you is clamp down the veins to stop the bleeding and set you out in front of the hospital to wait for ride home.

There are no more doctors left in this country. They died in the early 70s.

My daughter is a primary care physician. Her boyfriend is an internist. Both grew up in lower middle-class families. They work 60 hour weeks often doing their paperwork after dinner or on Saturday. She has to deliver babies at all hours of the night. Neither cares much about money. Most of their patients are poor. My daughter is recovering from a pulmonary embolism herself which I suspect has to do with years of overwork. When their schedules allow them to get together on weekends, they wind up falling asleep on the couch. Her boyfriend often misses dinner [[an issue) because he does a lot of unrequired work at the hospital, has long conversations explaining things to families, and double checking. They drive a Ford Escort and a Chevy Malibu. Everyone of her young doctor friends I've met are similarly more focused on work they enjoy than whatever they get out of it. Remember that med school now costs about $100,000 at a state school and the nice paychecks do not appear until doctors are about 27 and deeply in debt. So from my perspective, what you wrote is total nonsense.

Doctors deal with whatever work shows up in front of them. Your problems are with health care management and government policies.

Every one of the young doctors I know would like a more Canadian like health care system . They would gladly give up the larger paychecks for more time off. Who would serve the public then is another problem.

Sorry to diverge from Bats comment but yours was so absurd it needed addressing. I'm still trying to find out why Bats thinks that, "A free market would help the primary care folks most of all."

[ccbatson]

A free and just market and selfishness results in the highest quality of service at the lowest cost...always. What better place to have these characteristics than health care?

[turkeycall]

A free and just market and selfishness results in the highest quality of service at the lowest cost...always. What better place to have these characteristics than health care?

Selfishness will result in low cost? "Selfishness" and "low cost" are mutually exclusive terms. One is the antithesis of the other.

[grumpyoldlady]

We live in Minnesota, and had never heard of the "PA" [[physician's assistant), or the "NP" [[nurse practitioner). We started going to a clinic in the small town nearby [[760 people). The doctor there always seemed more interested in rushing us out the door than listening to what we had to say. Once he was gone when we needed an appointment, and the PA saw us. She listened carefully, asked lots of questions, made good notes, and made sure we were satisfied with answers and had no more questions before she let us leave. She moved to another clinic about 35 miles away, and we followed her there. For personal family reasons she is no longer practicing. My husband now is being treated through the VA system, and the local outreach VA clinic has a PA and a doctor. The PA spends loads of time with us...the doctor seems to busy to pay attention to what we are saying to him. I actually think sometimes the PA's and NP's are more up to date on meds and new discoveries than the doctors are. There are still many, many family practice doctors here in rural Minnesota.

[ccbatson]

Not under a free market Turkeycall...here's how:

Dr. Smith competes with all of the other Dr. Smiths out there for patients. Patients bid with their patronage looking for the best quality and the lowest price. Dr. Smith produces at an optimal quality and price in order to gain the business and to get paid. Purely selfish interests can be in place and the consumer gets the best quality and lowest costs.

[ccbatson]

PAs and NPs are extenders of Physicians [[ideally) they can't practice independently, and both you, and they, would not want them to.

Your anecdotal story and experience is not sufficient to draw a conclusion regarding types of health care systems [[private versus government). In favor of a private system and against the public is the presence of incentive in the former and absence in the latter.

[ccbatson]

PAs and NPs are extenders of Physicians [[ideally) they can't practice independently, and both you, and they, would not want them to.

Your anecdotal story and experience is not sufficient to draw a conclusion regarding types of health care systems [[private versus government). In favor of a private system and against the public is the presence of incentive in the former and absence in the latter.

[rb336]

I realize that the more the government has mettled in health care, the less affordable it has become.

That is a totally unsupportable comment

[rb336]

In favor of a private system and against the public is the presence of incentive in the former and absence in the latter.

i would rather have the clear increase in positive outcomes, lower infant mortality, and higher life expectancy of the latter. the "incentive" you talk about? that is to cram as many "pieces of work" [[as you once crassly refered to your patients) into the shortest period of time, to get as much referal money for pointless tests as you possibly can, and to get kickbacks for the latest poorly-vetted toxic chemicals Big Pharma tries to push down our throats

[oladub]

Originally Posted by oladub
I realize that the more the government has mettled in health care, the less affordable it has become.

rb replied, "That is a totally unsupportable comment"

rb, Regulations cost money. If prescriptions were not required and all drugs were over the counter, they would be much cheaper. Hillary and McCain were even trying to make vitamins into prescription products. The cost of providing Medicare services are sometimes more than the cost of delivering the service so hospitals routinely transfer some of that cost to patients with insurance. Hospitals require expensive construction although some patients could make do with an attached Days Inn. The government drives some qualified medical people out of health care because they don't have the proper government credentials. It should be up to the patient to decide if they want to go to a cheaper immigrant Russian doctor, chiropractor, nurse, or whatever for treatment in a free society.

Even HMO's were foisted on us by a Democrat Congress. Richard Nixon signed their legislation in 1973. "In the Senate, Kennedy, author of the HMO Act, also encouraged its passage: ``I have strongly advocated passage of legislation to assist the development of health maintenance organizations as a viable and competitive alternative to fee-for-service practice. ..... This bill represents the first initiative by the Federal Government which attempts to come to grips directly with the problems of fragmentation and disorganization in the health care industry. ..... I believe that the HMO is the best idea put forth so far for containing costs and improving the organization and the delivery of health-care services.'' In a roll call vote, only Senator Herman Talmadge voted against the bill. -ronpaullibrary

Put it like this. Is it cheaper for a doctor to deliver a service by him/herself or a doctor with a paid government employee looking over the doctor's shoulder and some paper shufflers to keep track of everything the doctor does for the government employee?

As you know, the President is trying to make health care, he says, $1T more expensive. Others are saying $2-3T. Since someone will have to bare those costs, it is another example of government causing health care to become less affordable. If it doesn't show up on someone's doctor bill, it will show up as some new tax.

It doesn't have to be this way. If Michigan simply adopted Ontario's system health care costs would decline. However our topic is about what our government has done and now plans to do.

Hitsville, Kid, singular, and other of her med school friends I know. Granted, there are no doubt some there for the money. Would you rather they went to law school or were bankers getting bonuses from Bush and Obama? One of the obvious things that Med schools could do to lower what doctors charge is to train twice as many doctors. Its not like there is a shortage of med school applicants. Double the number of doctors and they wouldn't be able to sell their services for as much as much because of increased competition. It wouldn't necessarily even cost the taxpayers anything.

[ccbatson]

Rb...too myopic. The incentive is not as shallow as simply getting the cash as fast as possible. It is about creating a practice that thrives over years or decades by having the best services at the lowest prices.

[rb336]

BS bats. just look at all the stats about time spent per patient -- it has declined as fast as the rate of out-of-pocket expenses and premium costs has increased, all so they can cram more patients into a day.

heaven forbid that you want to ask a doctor why one medicine was chosen over another, or ask any other questions for that matter. they just don't have the time.

typical visit to the GP:

you wait
you wait some more, usually 45 min-1 hr after apt. time [[hey, your time is no where NEAR as valuable as the mighty medicine man!)
you fill out a form which may or may not ask if there is anything you are particularly interested in having checked out
you wait
you wait some more
a nurse or technician takes vitals,
you wait
you wait some more
finally, Dr. comes in, looks at your chart, does an uh huh, uh huh sort of deal, may listen to your heart and lungs, may not, tells you to make an apointment to get blood drawn, get xrays, etc. try to ask a question, the response is "wait until you get x, y or z test results.
typical time with the doc, 5-10 minutes

[mjs]

Typical visit to the GP:

you wait
you wait some more, usually 45 min-1 hr after apt. time [[hey, your time is no where NEAR as valuable as the mighty medicine man!)
you fill out a form which may or may not ask if there is anything you are particularly interested in having checked out
you wait
you wait some more
a nurse or technician takes vitals,
you wait
you wait some more
finally, Dr. comes in, looks at your chart, does an uh huh, uh huh sort of deal, may listen to your heart and lungs, may not, tells you to make an apointment to get blood drawn, get xrays, etc. try to ask a question, the response is "wait until you get x, y or z test results.
typical time with the doc, 5-10 minutes

Thats never been my experience. Maybe its because I take morning appointments and come five to ten minutes early, but at the appointment time, I'm always in the exam room with a staff member taking vitals. Doctor comes in five to ten minutes later, we chat as he looks things over and we ask each other a few questions. He tells me when to expect the results or tells me what I need to do next. I even ask confirmation questions about vitamins, other health issues, how equipment works, whether I can drink with the prescription, etc. Maybe its because I prefer DOs. I don't know.

BS bats. just look at all the stats about time spent per patient -- it has declined as fast as the rate of out-of-pocket expenses and premium costs has increased, all so they can cram more patients into a day.

I'd like to see these stats. I know that its possible I may not be the norm so I trust wide objective studies over individual examples even my own. Seriously, I'd like to see these stats.

Heaven forbid that you want to ask a doctor why one medicine was chosen over another, or ask any other questions for that matter. they just don't have the time.

Assuming you have any data, what do you propose to fix it? Is this the 10,000 thing that you answer with they need to quit being so greedy? Should they work even more hours? Should we cap their pay as well? If you think there's a shortage of Doctors now, just wait until everyone has coverage and we're still not dealing with why Americans are so unhealthy.

[Detroitej72]

Maybe its because I prefer DOs. I don't know.

Agreed. I've had a D.O. pretty much since my teens and prefer them way over M.D.s.

[ccbatson]

Rb...the dynamic I described refers to how things would work in a market driven system. You can see some examples in elective fields today...examples? Take a gander at the cost for corrective eye surgery today compared to 15 years ago...guess what the direction of cost has been...try "not up"

[Detroitej72]

Correct, technological advances are always costly at first, then the prices drop to a more reasonable rate.