Not a Liberal/Conservative Problem, but a Government/Bureaucracy Problem

I don't disagree that bureaucracy is part of the problem, but the AMA lobbies against many of the most obvious solutions. I agree they don't have unilateral power, but they are very influential and have succeeded in doing many things that are good for their members but bad for the system as a whole. Limiting med schools, limiting residency positions, limiting ability of PAs and other practitioners to help provide basic care, etc - these are all things that make doctors more valuable but don't improve the system.

You mention that doctors work 80 hours - the solution to that is more doctors. Yes, you'll get some crappy ones, but there will also be incentive to provide better service. Right now, any specialist, great or crappy, has a waiting list several weeks long because there aren't enough of them. It doesn't benefit the system at all.

I don't have a particular issue with the wage thing - doctors earn it. But if you had more doctors, they might get less in wages but also not need to work 80 hours. And if we loosened practice requirements (like making PAs or nurses more valuable), then people could get into the medical industry more cheaply and not need to make as much to pay back as much debt.

There are lots of solutions out there. And there are lots of reasons why they don't get implemented. The AMA is one of those reasons. That's why I say they are part of the problem as opposed to the solution. They do what they are designed to - protect and support doctors - really, really well. But that doesn't necessarily lead to the best overall outcome for everyone else.

 

In fact it is precisely what has been called for by both parties for years (and by Obama) and fits the plain meaning of the term, so you are not even remotely close to not being b****slapped by hardens giant sack oh my god **** yeah.

 

I don't have a great answer to the increasing role of PA's and NP's. They're both a blessing and a curse to doctors. And correlatively to the implementation of healthcare.

Blessing because in the outpatient setting, they do increase available providers. Curse because they are not doctors and really can only consistently handle basic preventative care/low acuity problems. Which sounds great until they get a complex patient with a problem and have to refer to a doctor, continuity of care suffers (which is a big deal). PA's aren't trained or certified to admit patients to a hospital from the outpatient setting.

Plus from the doctor perspective, this disrupts his patient complexity/acuity mix. So he gets left with all the complex patients (whose office visits take longer) while the PA/NP can crank through all the bread/butter cases. So the doc gets paid less for handling more difficult patients. Doesn't make sense there. Plus the doctor has to supervise PA's in the cases; so all in all the doctor becomes the supervisory/administrative/complex case provider who gets paid less. That sounds awful and isn't really medicine.

On the inpatient side, mid-level providers function as a mid-level resident who gets paid a lot more. When I rotated as a general surgery intern for a private practice group, they required 24hour pager call. My residency program split the pager call into two 12-hour shifts for 365 coverage so we worked ~80hr per week. Most PA/NP's don't work weekends/nights/holidays like doctors do, and typically average a normal 40-45hr workweek. So replacing two residents would 3, maybe 4 mid-level providers making 80k-100k each plus benefits. So the total cost in salary would be ~$240-$300k that would otherwise cost $100k in resident salaries. (Although the current supposition is that the resident will later make $300k in future salary).

In-patient mid-level providers can provide a critical service though; although they may not have the education a doctor has, doing the same job every day does provide very good on-the-job training and continuity of quality day-to-day.

One thing I have yet to mention which will hugely impact the direction of mid-level providers in healthcare is malpractice insurance. Currently mid-level providers pay minimal to none, as they are currently covered under the auspices of the supervising physician. The more independence/autonomy they're given means they will have to bear the burden of malpractice individually, which will drastically change the economics of getting a lesser-trained provider.

In sum, we really don't know what the end result will be with mid-level providers. Access to care will go up, but outcomes and costs may not trend in the positive direction. I'm sure many people could care less about the plight of the doctor ("because they're paid so much"), but the fact remains we are the integral part of healthcare so we cannot be ignored.

 

That took long enough, no thanks.

 

Once again, the AMA is a lobby group not a governing body.

You want to pay more for a 'good' surgeon? So poor people only deserve treatment from young, unexperienced surgeons? Talk about your have's and have not's.... Sheesh.

 

Actually by your standards its free market. Rural areas pay more for doctors to go practice there. It's common knowledge the lowest salaries are found in NYC/LA/SF.

At the cost of quality assurance? I'm sure you buy all your meat and dairy from China, where they are far cheaper.

You haven't convinced me why doctors' salaries are the reason healthcare is expensive.

 

Yea, no.

 

I can't argue that supply hasn't kept up with demand. Particularly adding tens of millions of new patients to the healthcare system. But I haven't been. That's something that everyone recognizes.

That's just in no way an excuse to open the floodgates on standards for medical training. I'm stunned I even need to argue this point. At no point has this even ever been in the conversation anywhere.

 

I'm stunned you consistently can't get basic facts right. The Texas Medical Association, as with the American Medical Association, is a physician's group. The Texas Medical Board is a state government regulatory agency that licenses physicians.

 

Bless your heart for not blaming me.

The only solution to the national healthcare crisis I've seen you propose is to abolish national and state accreditation bodies and requirements.

Pardon me if I think addressing the physician shortage with unaccredited physicians is a bad idea. Would you go to an Uzbekistani physician who only speaks Farsi (English competency is a requirement to practice in the US). Would you want your loved one's cancer operation performed by an unlicensed doctor schooled and trained in Barbados?

Meanwhile, I've detailed a laundry list of things that have negatively impacted healthcare and the way doctors practice medicine. Yet, all you want to do is cut physician pay and cut any barriers to PERFORMING MEDICINE ON REAL PEOPLE.

 

Ever heard of D.O.s? No? Look it up. Seems like somebody has already solved your alleged problems.

As for me? I'll stick with M.D.s when I choose my doctors, thanks very much.

 

You keep beating the same drum.

As I've said, the bottleneck is the ability to create a new medical school with sufficient educational and training abilities. You're implying its some conspiracy to suppress healthcare when its not.

There's no evidence to support skyrocketing salaries. You show me a single piece of evidence that shows physician compensation is going up or even staying level. Meanwhile, I've quoted the exact percentage physician salaries contribute to national healthcare expenditures.