Obamacare Physician Crunch Has California Politicians Scrambling

Back in October, the the American Journal of Medical Quality published a warning that, even as Medicaid is expected to vastly expand the patients it serves across the country under the requirements of the Affordable Care Act, the doctors willing and able to serve those patients are already at capacity. Now, California officials are getting hip to the fact that the state doesn't have enough physicians to go around, and they're scrambling to find pretty much anybody capable of bandaging a boo boo to fill the gap.

From the Los Angeles Times:

As the state moves to expand healthcare coverage to millions of Californians under President Obama's healthcare law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients. ...

Currently, just 16 of California's 58 counties have the federal government's recommended supply of primary care physicians, with the Inland Empire and the San Joaquin Valley facing the worst shortages. In addition, nearly 30% of the state's doctors are nearing retirement age, the highest percentage in the nation, according to the Assn. of American Medical Colleges.

State officials' first instinct isn't unreasonable: To ease occupational licensing barriers so that other health-care providers can do more to deal with the shortage.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

Arizona already lets nurse practioners hang their own shingles, and the sky has yet to fall. These practioners are usually perfectly able to deal with the usual issues seen at the primary care level, and then to pass concerns beyond their abilities higher up the food chain — which is what primary care physicians do, anyway.

But the LA Times article also cautions that letting alternative practioners fill the gap "could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics." I'll add that alternative practitioners also tend to see fewer patients than physicians. Pediatric nurse practioners see, on average, 11-20 patients per day, which is about half what physicians see.

Which is no reason not to free these providers to see patients. That should be done to provide choice and competition, independent of the demands of Obamacare.

But, are those nurse practitioners and pharmacists going to be any happier than physicians with expanded Medicaid?

Last year, a Physicians Foundation survey found that 26 percent of physicians had closed their practices to Medicaid patients because of concerns over compensation and red tape. Kaiser says the number of doctors turning away Medicaid patients is closer to a third.  Pharmacists haven't been much happier. Walgreens pharmacies in Washington turned away Medicaid prescriptions because they were losing money filling them (the state relented) and pharmacies did the same in Delaware.

Expanding the pool of potential health care providers is a great idea. But, believe it or not, physician assistants, nurse practitioners, optometrists and pharmacists expect to be paid, too. If they get frustrated and lose money the same way physicians have, there will just be a larger pool of people refusing Medicaid patients.

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  • Professional Target||

    Can you say scarce resources?

    Heheheh.

  • BuSab Agent||

    But, but, there's still checks in the checkbook!

  • Sevo||

    I have a feeling that the docs who backed Obama(non)care expected to continue to practice at the same pay rates they had been getting.
    Surprise, surprise!

  • Fluffy||

    The endgame will be:

    1. Physicians not allowed to decline Medicaid or Medicare patients.

    2. Physicians not allowed to retire. (Either by outright militarization of the field, or by newly devised draconian financial penalties like "occupational exit taxes" or something else made up on the spot.)

  • ||

    1. Physicians not allowed to decline Medicaid or Medicare patients.

    This will happen. Guaranteed. Physicians are already being herded into hospital group practices, AKA "They work for the hospital and not for themselves".

    2. Physicians not allowed to retire. (Either by outright militarization of the field, or by newly devised draconian financial penalties like "occupational exit taxes" or something else made up on the spot.)

    This, however, will not. There will be even more strings placed on both practitioners and patients. Shit rolls downhill, Fluffy.

    The only wicked "exit taxes" will be on docs like me who fled and still hold an American medical license.

    The "militarization" will happen when HillaryCare gets passed (and it will).

  • Jerry on the boat||

    What ever happened to states outlawing the corporate practice of medicine?

  • Jordan||

    Yeah this really fucking sucks, now that my wife has just started residency. I hope she gets at least a couple of paychecks before it's not worth it anymore.

  • ||

    Expanding the pool of potential health care providers is a great idea. But, believe it or not, physician assistants, nurse practitioners, optometrists and pharmacists expect to be paid, too.

    YOU ARE SOD-DAMNED RIGHT WE DO!

    Also, don't forget dentists, DNP's, CRNA's, and other Allied Health Occupations.

  • pmains||

    As a professional, how do you expect the trend toward increasing credential requirements for NPs, Physical Therapy Assistants, etc. to be affected by this shortage?

  • ||

    db had asked me a while back if increasing med school class sizes overnight in the USA would drop the price of medical care appreciably quickly, and I really thought about it, and being in a country with centrally planned, state directed care, the answer to that question is "no".

    Reason: We're expensive to train, about 20% of any class of any discipline aforementioned doesn't make it through, and the biggie is underwriting their risk and find enough people to train them. Nursing in particular is really having this problem with enough seasoned nurses willing to teach them.

    About the talent pool, sure, there's enough to fill it, but with double the class size, goes at least double the liability risk (actually, much higher). Think about it: You have 200 medical students unleashed (with adult supervision) and each of them can make scores of mistakes in a day. Now double that. Now make them residents. Risk is lessened but mistakes still happen. Nurses have a restricted scope of practice, and in theory should make less mistakes, but this is not so, including ARNP's and PA's (who have RX authority).

    Last is liability (just because you have a shitload of doctors does not mean liability will be lessened and is an independent variable) and the American public's desire for a guaranteed perfect DX and 100% resolution of a given malady and this is impossible. All we can strive for is a very high confidence interval of care.

  • Juice||

    American public's desire for a guaranteed perfect DX and 100% resolution of a given malady and this is impossible.

    Really? I thought Americans had pretty low expectations when they go to the doctor. I know I do.

    I always feel like nothing will really be done and it will cost a lot, maybe get a prescription.

  • ||

    I thought Americans had pretty low expectations when they go to the doctor.

    My patients want the problem fixed and for me not to kill them in the process, and I so far have delivered.

    I know I do.

    Maybe you should have that checked out.

    I always feel like nothing will really be done and it will cost a lot, maybe get a prescription.

    Then don't go.

  • Ted S.||

    American public's desire for a guaranteed perfect DX and 100% resolution of a given malady and this is impossible.

    The government takeover will simply end liability. Because fuck you, that's why. Government-sector doctors will be just as liable as government-sector police officers.

  • ||

    As to the others, if you made PA's, ARNP's, and even Pharmacists the equivalent of doctors overnight, they also get the physicians' level of malpractice insurance liability overnight, and their professional liability rates are based almost primarily on scope of practice.

    Basically, all these groups want doctor power without paying doctor level liability, which is why pharmacists, as a group, don't want RX authority.

    For nurses, it's basically a power trip, as the ARNP and (to a lesser degree the PA) went nuts with wanting to RX every little thing, and the reason her liability was cheaper was restricted scope of practice and the supervising doctor assuming the overall liability.

  • Heroic Mulatto||

    BABY BOOMERS MUST LIVE FOREVER!!!!

    ENSLAVE ALL PRIESTS OF THE MEDICINE GOD!!!!

  • JeremyR||

    There really isn't a "crunch" though. There are basically the same number of doctors (for now), it's just shuffling around who will have access to them.

    Before, if you didn't have money or health insurance, it mean you had no access to a doctor. You either just didn't go or wait futility in an emergency room (where they apply triage, so you probably won't get to see a doctor unless they hit a lull) or free clinic.

    So it's not really a new problem. It's just now that people with health insurance won't have as easy access to doctors as they once did. For people who didn't have it, anything is an improvement.

    But it's a problems doctors have manufactured themselves, by having just strict licensing and regulations. Nurses and such can do most of their job. But like any other business, by keeping the number of doctors down, they boost their salaries.

  • ||

    But it's a problems doctors have manufactured themselves, by having just strict licensing and regulations. Nurses and such can do most of their job. But like any other business, by keeping the number of doctors down, they boost their salaries.

    Bullshit to all of this. See my above post to pmains @ 17.09

    The reason we have such strict licensing, quite frankly, Jeremy, is patients

    When Pro Libertate quotes Animal House, "Pre-Med, Pre-Law, what's the difference?" He's right in a way.

    Patients, like legal clients for lawyers, have the potential to be either the doc's best friend (rare) or worst enemy (often).

    If you can do my job better than I can, Jeremy, have fucking at it.

    Also, "free" == "provided at no cost". No such thing as "free".

  • Night Elf Mohawk||

    I don't buy it. Someone capable of taking vitals and with access to a half-decent computer program could do 90%+ of what a GP does. Doctors could do the other 10%. My doctor agrees, though it took a couple of visits to work him up from 50% to 90%.

  • Heroic Mulatto||

    The problem is knowing when it's the 10% as opposed to the 90%. That's what the letters M and D are for.

    Jus' sayin'

  • ||

    Then don't go to your doctor and do it yourself. And assume 100% of your own liability.

    And I certainly don't buy your claim of, "All I need is a sphyg, steth, WebMD, SpO2, and thermometer." This is also assuming the patient is not lying to the computer program to influence a DX. Please, by all means, DX a tetrology of Fallot for me, or tell me the hallmarks of cursory mental illness, or DJD. Even artifacts and cardiac gallop. Asthma and COPD. Knock yourself out.

  • Brandon||

    I would happily assume 100% of my own liability, but Walgreen's doesn't acknowledge my self-written prescriptions, doc.

  • ||

    but Walgreen's doesn't acknowledge my self-written prescriptions, doc.

    Which is their right, Brandon. One thing GF Brandon is going to learn VERY QUICKLY is her spectacular liability she is going to incur (residents can be sued for malpractice). And her malpractice insurance ain't gonna be cheap.

    When you and the rest of the USA are ready to release 100% liability of:

    1) Licensed Medpros (including dentists and allied health).

    2) Pharma manufacturers (do you sue your recreational drug dealer?).

    THEN you will see prices go down and licensing restrictions, and RX PERMISSION SLIPS! go bye bye.

  • Adam330||

    I'm pretty sure Walgreen's refuses to acknowledge his self-written prescriptions out of fear of the DEA, not any fear of tort liability (which could be remedied with some waivers).

  • ||

    I'm pretty sure Walgreen's refuses to acknowledge his self-written prescriptions out of fear of the DEA, not any fear of tort liability (which could be remedied with some waivers).

    Ask Walgreen's what they think. Or are you not familiar with the armies of trial lawyers and med-mal attys. out there?

    I'm pretty sure you are suffering from confirmation and representational bias.

    (Spoiler Alert: DEA ain't going anywhere, and neither is Scheduling, Adam.)

  • Brandon||

    Hey, I'm happy to release pharmaceutical companies from liability if it kept me from having to deal with the current incarnation of the medical establishment. But clearly I don't have much influence with the rest of the USA.

  • ||

    I'm happy to release pharmaceutical companies from liability if it kept me from having to deal with the current incarnation of the medical establishment.

    Ok, now:

    You need either your gall bladder or appendix removed, or perhaps a lap band or gastric bypass. Do you also release me from any and all liability to keep prices low?

    Also, wonderful Googling on Tetralogy of Fallot. Can you now find me a neonate with this affliction? Correctly? The first time? And you don't know beforehand what the kid has, by the by.

  • ||

    And homeopathic medicine can replace surgery.

  • ||

    Very funny, heller.-D

  • Brandon||

    Tetrology of Fallot tests:
    Chest x-ray

    Complete blood count (CBC)

    Echocardiogram

    Electrocardiogram (EKG)

    MRI of the heart (generally after surgery)

    Symptoms:

    Blue color to the skin (cyanosis), which gets worse when the baby is upset

    Clubbing of fingers (skin or bone enlargement around the fingernails)

    Difficulty feeding (poor feeding habits)

    Failure to gain weight

    Passing out

    Poor development

    Squatting during episodes of cyanosis

    Google has made even the mighty Groovus obsolete. According to this, all I need are technicians and surgeons.

  • Brandon||

    And yes, I misspelled tetralogy, but so did you.

  • ||

    According to this, all I need are technicians and surgeons.

    Now you are going to need me, Brandon. Surgeon. Or are you going to do it? GF Brandon sure as hell isn't qualified yet to do it.

    Big deal, I misspell lots things. It didn't kill anyone here.-)

  • ||

    Also, Brandon, with mighty, mighty Google, find a random patient, ask all the questions I know off the top of my head (it will take you a bit to find them) and go DX to your heart's content, and be prepared to guarantee your work.

    And find someone to underwrite you.

  • Night Elf Mohawk||

    And I certainly don't buy your claim of, "All I need is a sphyg, steth, WebMD, SpO2, and thermometer."

    Who said WebMD? Imagine a Watson-type system, chock full of medical knowledge. Is there any realistic reason to believe that such a system couldn't perform extremely well? Or even better than the overwhelming majority of actual doctors? Do you think it could do better than the random doctor at CareNow who's supposed to see at least four patients an hour for an entire shift?

  • ||

    I do imagine, and the Watson-type system would make a wonderful adjunct, but would be piss poor as a primary diagnostician.

    Does Watson feel empathy?

    And no, I don't believe it could do better than random doctor in the US, CAN, UKR, or even FRN.

  • Brandon||

    Does Watson feel empathy?

    Do doctors?

  • ||

    Do doctors?

    Yes. I do; if anything, I care too much. Dr. PG does. Almost all of my graduating med school class did (there were a few exceptions). And generally, we all do, until asshole, lying, non-compliant patients and general "I KNOW MORE THAN THE DOCTOR!" makes us seem a bit calloused at times.

    What you want us to do is turn on and turn off clinical detachment and dispassion like a light switch and it is just not that simple 100% of the time, Brandon. Ask GF Brandon about this. Does she have empathy?

  • Brandon||

    We get it, Groovus. Doctors are wonderful, and if they have any flaws it's that they care too much and don't charge enough. You're the Dunphy of physicians. :)

  • ||

    Wrong Brandon. We have a shitload of flaws, including yours truly. I am not the dunphy of doctors, nor have I ever claimed to be, but I am damn good at what I do.

    I do want just a smidgeon of respect of my POV, however, and most libertarians and anarchists seem genetically incapable of at least trying.

    THAT'S what pisses me off more than anything.

  • Night Elf Mohawk||

    Does Watson feel empathy?

    Again, where did I say that patients would be interacting directly with Watson? The nurse, or whoever, can have the emotions while Watson does the deductions.

    Watson can outperform someone in the 99.99999 percentile at something as freeform a Jeopardy and Deep Blue can beat a Grand Master at something as specific as chess. Why do you believe a similar system couldn't do at least as well as an average doctor at assessing symptoms, especially since elite doctors would have input in the process?

    Also, the empathy of 5000 doctors and a couple of indomethacin will make my pseudogout flareup go away.

  • ||

    Again, where did I say that patients would be interacting directly with Watson? The nurse, or whoever, can have the emotions while Watson does the deductions.

    You didn't; however, whatever Watson spits out (and Watson is being used with oncology, which can be a notoriously subjective discipline), the nurse can override. Otherwise, can you sue Watson?

    Why do you believe a similar system couldn't do at least as well as an average doctor at assessing symptoms, especially since elite doctors would have input in the process?

    Medicine is also political, both internally and externally, and Watson does not have the capacity for ethics, and will reduce the patient to nothing more than a toaster. And programmers may do the same thing. What if Watson says, "Cut off the leg!" and the Dr. and patient disagree? As Ice Nine pointed out below, the ARNP and PA have a different view (and a massive tendency to over-TX and -DX) and may disagree with Watson's DX and TX.

    Watson may be freeform and specific, but does Watson have the capacity for intuition and creativity?

    Also, the empathy of 5000 doctors and a couple of indomethacin will make my pseudogout flareup go away.

    Does indomethacin work every time? And is it palliative or curative?

  • Night Elf Mohawk||

    Watson may be freeform and specific, but does Watson have the capacity for intuition and creativity?

    Kasparov said that some of Deep Blue's moves demonstrated what he would call intuition and creativity in a human opponent.

    What if Watson says, "Cut off the leg!" and the Dr. and patient disagree?

    C'mon, man, you've got to do better than that. I never said that Watson would be appropriate for all decisions, only that it could very well be appropriate for the majority of what most doctors see on a day-to-day basis. You're suffering from tunnel vision or being purposefully obtuse if you think it takes a doctor to do most of what a GP, at least, does. Watson could free up doctors to deal with something worthy of their training and not be bogged down in the mundane issues.

    Does indomethacin work every time? And is it palliative or curative?

    It works every single solitary time. It is palliative. I've never heard or read anyone say that there is a cure for pseudogout. Is there a cure?

  • ||

    Kasparov said that some of Deep Blue's moves demonstrated what he would call intuition and creativity in a human opponent.

    Ah! Dr. PG's fave player! I still have yet to beat her at chess (dammit!) However, assessing a patient head to toe and covering all your bases is more than 32 chess pieces.

    You're suffering from tunnel vision or being purposefully obtuse if you think it takes a doctor to do most of what a GP, at least, does.

    And you arguably suffer from rep. and confirm. bias if you think I don't endorse the use of ARNP's and PA's (had both in my last practice in The States)
    They need supervision, but extremely handy.

    Watson could free up doctors to deal with something worthy of their training and not be bogged down in the mundane issues.

    The basics don't change, and the mundane provides the foundation for a comprehensive practitioner.

  • ||

    It works every single solitary time. It is palliative.

    I'm glad!!!!-D

    I've never heard or read anyone say that there is a cure for pseudogout. Is there a cure?

    To my knowledge, there is no cure and must be managed with pharma, elevation, keeping the extremities warm, diet that doesn't mimic a lot of uric acid in the blood, and my patients have found allopurinol works very well.

    A cure? Amputation to prevent tophi from forming. I'm pretty sure you don't want that.

    Oh, will Watson be RX'ing off-label?-)

  • Night Elf Mohawk||

    I've also used allopurinol but it didn't seem to work as well, for me, as indomethacin. I absolutely cannot tie the occurrences to anything in my diet. Right now, the only thing that works is to pop some indomethacin as soon as I feel the first twinges. About four hours later, I take some hydrocodone because it takes a while for the real pain to set in and because the indomethacin takes a while to do its thing. Twelve hours or so later, everything is peachy.

    As a general rule, I prefer to avoid amputation. However, around Christmas I failed to go to the doctor and pay $75 for an office visit so he would prescribe what he and I both know we need. Then I got a flare up. By the time I could get an appointment I was in mortal agony and wouldn't have been too averse to amputation. He drained 120cc of gunk, threw in some lidocaine, and gave me the prescription that could have avoided all of that.

  • ||

    I absolutely cannot tie the occurrences to anything in my diet.

    Are you sure? Are there any specific preludes to an onset? You mentioned Xmas, were you exposed to a lot of cold?

    Right now, the only thing that works is to pop some indomethacin as soon as I feel the first twinges.

    Ok, this and the rest is fine.

    As for the rest, why do you not have refills and a standing order to prevent this inconvenience? (The vicodin I can see as a an RX problem, and should be dispensed by a pharmacist or OTC, IMO)

    Have you thought to ask for this?

  • Night Elf Mohawk||

    Normally I have some in reserve but he will not issue anything other than a single "do not refill" prescription at a time. I ran out mostly because he was out of the office a lot during the holidays.

    Are you sure? Are there any specific preludes to an onset? You mentioned Xmas, were you exposed to a lot of cold?

    I'm as sure as I can be. I can get an episode on July 4th as easily as Christmas. I tracked the hell out of my diet when this first started happening. The doctor eventually drew fluid and looked at the crystals and decided pseudogout rather than gout gout.

  • ||

    Normally I have some in reserve but he will not issue anything other than a single "do not refill" prescription at a time.

    Now I want to jump out of my chair and punch him in the face. This doesn't meet your needs. I am visibly angry.

    I ran out mostly because he was out of the office a lot during the holidays.

    Unfortunately, we have lives too.-( It sounds like the TX regimen is fine, but I would recommend finding either another doc or an ARNP (you have the established HX to use one).

    Idiopathic (psuedo)gout is basically managed how I initially said, and determining exactly the type of crystals that form may be unnecessary expense (since the TX either way is pretty much the same). What also concerns me is your height and how this also affects your stride and later foot problems. Believe it or not, TED hose (compression socks) may also be able to help with comfort, but the problem is one of strict blood chem.

    I have to leave now,-( If you need further help, don't hesitate to ask.

  • ||

    Why do you believe a similar system couldn't do at least as well as an average doctor at assessing symptoms, especially since elite doctors would have input in the process?

    Does Watson have the capacity to ferret out patient dishonesty? Many times, this takes nothing more than intuition and a solid Dr./Patient relationship. If you are your own Dr., NEM and I'm sure you are keeping the most accurate medical HX, and you refuse to let me see it (your right), then I should be able to kick you to the curb. Under current USA law via EMTALA, I could not.

    In UKR, I can.-) (I am eating lunch now.)

    I am not convinced Watson can ferret out fraud and a deceitful patient, and is basically a medical Congressional Budget Office.

  • Night Elf Mohawk||

    I am not convinced Watson can ferret out fraud and a deceitful patient, and is basically a medical Congressional Budget Office.

    Part of that responsibility would fall on the medical personnel interacting with the patient. I think Watson could ferret out fraud and deceit pretty easily where the supposed symptoms don't match how the body actually works.

    That said, I doubt most doctors could ferret out a sufficiently motivated deceitful patient.

  • ||

    I think Watson could ferret out fraud and deceit pretty easily where the supposed symptoms don't match how the body actually works.

    Doesn't always work that way, my friend.

    Hit your thumb with a hammer and try to get Watson to tell you how much your thumb should hurt...

    That said, I doubt most doctors could ferret out a sufficiently motivated deceitful patient.

    They can if they really want to and have the time and inclination. Watson doesn't have the capacity for deceit or self-interest. There is a saying, "To catch a thief..."

  • Night Elf Mohawk||

    Hit your thumb with a hammer and try to get Watson to tell you how much your thumb should hurt...

    You keep forgetting that I'm talking about an actual human being between the patient and Watson. Are you saying it takes a doctor to evaluate the answer to that question? Because it sure as hell ain't the doctors who ask me how much my knee hurts when I go in.

  • ||

    You keep forgetting that I'm talking about an actual human being between the patient and Watson.

    No, I don't. The ARNP (as well as the doc) may be a political axe-grinder and may supercede the patient (both pros and cons here).

    Are you saying it takes a doctor to evaluate the answer to that question?

    Depends on the patient. Ever had fibromyalgia? Diabetic neuropathy? Is there a HX of drug use? Is the patient a "drug seeker"? Will Watson order every expensive test to make sure the diabetic isn't lying on a FBS or morning BS (and I pull out an A1C because I suspect a Twinkie binge)?

    Because it sure as hell ain't the doctors who ask me how much my knee hurts when I go in.

    Then either get a different doctor (your right, for now) or start opening up collaborative dialogue without a chip on your (tall & most likely broad) shoulder. I would ask PX scale and ask you to use descriptors to qualify your PX to establish a baseline (I do this all the time). What if there is "referred" or "Phantom Limb PX"?

  • ||

    Oh, one other thing, NEM: DX'ing healthy people is a piece of cake. When the S/S are congruent with 25 other possible maladies, conditions, and diseases, then. it. gets. hard. Quickly.

    I give you a patented RC'z Iron Law:

    "The less you know about something, the easier it looks"

  • Brandon||

    When the S/S are congruent with 25 other possible maladies, conditions, and diseases, then. it. gets. hard. Quickly. is lupus. Duh.

  • Night Elf Mohawk||

    I figure if computers can fly planes and win on Jeopardy, they can weed out a crapton of patients who don't actually require a doctor's knowledge. Now, of course, I don't expect a doctor to agree.

    "The less you know about something, the easier it looks"

    Lawyers used to say that a lot. There are a lot of cases that require actual "human" lawyers. And there are a lot that require printing out a standard document with the blanks filled in correctly that can be done by a paralegel or a guy with access to the internet.

  • Heroic Mulatto||

    And there are a lot that require printing out a standard document with the blanks filled in correctly that can be done by a paralegel or a guy with access to the internet.

    And when something goes wrong? You want to deal with that when the stakes are high? Sure, I could have bought a NOLO book on Immigration Law and attempted to get my wife's visa and then adjustment of status by myself. But what if something happened that I could not foresee because I wasn't trained to do so? I wasn't prepared to risk splitting up my family. I went with my ex-Ambassador turned Immigration attorney and things went swimmingly, even by INS standards.

  • Night Elf Mohawk||

    And when something goes wrong? You want to deal with that when the stakes are high?

    "A lot" != "everything."

    I don't want to use Nolo to defend myself in a murder trial, but there are plenty of things you can handle quite competently with it.

    I'll be getting my investor's visa in Ecuador via a non-lawyer.

  • Juice||

  • Fluffy||

    DX'ing healthy people is a piece of cake.

    Right, and 90% of the people a GP or a pediatrician or a gynecologist sees every day are healthy.

    I take my kid to the pediatrician, and they have a nurse take his height and weight and check his vision, and then the doctor comes in and gives him some immunizations.

    Are you seriously telling me the entire sequence of visits where this takes place couldn't have been done by people with less scarce skills?

    And I bet one family after another comes in and gets the same drill all day.

    When she's not pregnant, my wife goes to the gynocologist once a year and (or so I gather) they poke around in her box, find nothing, and send her home.

    And I bet one chick after another gets the same drill all day.

    I'm paying $2 grand a month for this shit?

    Every time I'm sat in a doctor's office it's been full of healthy people getting checkups and hysterical housewives who are there to demand antibiotics for the common cold.

    Why can't those people be screened out so that doctors can focus on people who actually require medical treatment?

  • ||

    Whose going to accept the liability Fluffy? You?

    Why can't those people be screened out so that doctors can focus on people who actually require medical treatment?

    Ever read the fable, "The Boy That Cried Wolf?" There is always the chance that the next visit may reveal something. Or can you DX via psychic discernment?

    Or in case you haven't noticed, "MEDICAL CARE IS A RIGHT!!!!"

    As per: CMS, Roe v. Wade and COBRA/EMTALA, and now ObamneyCare.

  • ||

    Right, and 90% of the people a GP or a pediatrician or a gynecologist sees every day are healthy.

    Do you have proof for this claim?

  • ||

    The last thing that ALL the drs above are doing is establishing a health HX, so IF and WHEN something deviates from the norm, THEY KNOW IT and have a solid HX to gauge against.

  • Ice Nine||

    That's what I say, Groove. I've known good PAs and good NPs but my family and I will for damn sure be going to seeing a RD (real doctor) for all but the very simplest things. As you know, RNs have a separate mentality toward medicine by virtue of their particular training which prepares them well for what they do. But, again as I know that you know, that does not translate to thinking like a physician, god bless them, and this is a significant shortcoming IMO. And ten years of practicing nursing only reinforces this and a couple years of NP training does not affect that a whole lot.

    PAs are OK but they are no substitute for a physician. So, I think they will both be fine for simple stuff but I won't be relying on either of them for anything important. And I can guarantee you one thing, they will over-test and over-treat. I worked with paramedics for decades and I could never break them of over-treating in the field. Anything they could do to a patient, in terms of meds and sticking things in patients, they would by god do it. Every time. And these people will be no different.

    So there is a big difference, as you and I know as physicians, Groovus, in approach to the patient and the problem, which is very important. Sure there is a manpower crisis coming and we need to utilize these people for sure but frankly I think it would be better for medical care if we imported thousands of Indian and other reasonably well-trained foreign MDs for the reason I stated above.

  • Heroic Mulatto||

    I think it would be better for medical care if we imported thousands of Indian and other reasonably well-trained foreign MDs for the reason I stated above.

    The reason you stated above wasn't hot South and East Asians to marry, so you're argument is invalid.

  • Heroic Mulatto||

    *your

    Goddammit.

  • Ice Nine||

    Hey, a lot of them would be female and not a few of those would be hot so I think the argument holds. OTOH, they'll be making piss-poor money so maybe you want to forget about it anyway.

  • Restoras||

    Wait...you mean the government needs doctors to practice medicine? What about all the bureaucrats in charge of healthcare?

  • Ted S.||

    What we need is central planning of the legal system, with government bureaucrats determining who can practice what type of law and where they may practice it.

    If it's good enough for the field of medicine, it's good enough for the field of law.

  • Jack Strange||

    Uhhh....there is central planning of the legal system, with government bureaucrats determining who can practice what type of law, the bar exam, and where they may practice is, the bar association. Both are mandatory for lawyers.

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