Docs - care to link to (current this week*) Diagnostic Codes?
Might give the folks an overview of the mess that is Insurance Company requirements.
And: for all those codes which have given birth to sub-codes (old: 10; new 10.1.21), how specific do you have to be? Can you just code “10” or do you need to add all the dots and numbers after it?
Does this vary with payer? Does Blue Shield allow “10” but United Health require the maximum established sub-codes?
If this were true then we should see a much greater rate of dissatisfaction among doctors in countries that have a single payer system. This doesn’t seem to be the case.
In fairness, a greater number of doctors are indeed moving to the United States (as opposed to moving away from the United States), in large part because they can make more money and probably pay lower taxes there. I wouldn’t automatically assume they were dissatisfied with their jobs in their home countries; they just decided to seek better opportunity, as they defined it.
As I pointed out above, 19% of Canadian specialist physicians practice in the US.
In many cases they also benefited from subsidized medical school tuition and don’t have the same level of debt that newly minted US medical practitioners have. I believe Canadian practitioners don’t even need to repeat their residency to qualify in the US.
What would that prove to you? Are you aware that Americans tend not to migate anywhere, in general?
I love it when replies demonstrate that the poster has no clue about the issue.
Private insurance and fee for service physicisans exist side-by-side in many (probably all) single payer countries. If ten Monopoly dude with the monocle and the rich car happens to live in London, for example, he is perfectly free to buy private insurance and visit physicians who cater to the wealthy that want white-glove service.
First another “me too” to “docs who would be fine with single payor done right.”
But more a call of bullshit to the premise of the op and its linked article. The newspaper article reads the actual survey very selectively.
So yeah, single payor would help with that.
In 2012 a total of 31.8% of physicians were very or somewhat optimistic/positive about the current state of the medical profession. In 2016 that number was 46.1%.
In 2012 a total of 22.6% of physicians were very or somewhat optimistic/positive about the future of the medical profession. In 2016 that number was 37.2%.
In 2012 66.5% said that if they had their careers to do over, they would choose to be a physician, that yes, medicine is still rewarding. That number increased to 71.7% in 2016.
From 2008 to 2016 the number saying that they’d recommend medicine as a career to their children or other young people went up from 40.2% to 50.8%.
So let’s be very clear: doctors whine, we always have, but as a group we are whining less as the ACA became implemented than we were before.
Also clear in the data: change is hard, stressful. Those with the best morale seem to be the newer guard, those not married to the way things were, who have grown up expecting medicine to be a team sport. Older docs and specialists are more often complaining that things are not as they used to be.
Meanwhile despite the numbers of whining old fart physicians medical school applications and enrollments both continue to increase.
The implementation of Obama’s healthcare reform has been associated with more physicians being optimistic about the current state of and the future of healthcare in America, more who say they’d pick the career again if they had to do it all over again, more who’d recommend the career to their kids or other young people, and more applying to become doctors.
And count me with the majority who would say that I would certainly choose the same path if given the chance. Would I recommend it? That question requires a more nuanced response. It is a very big investment of debt and/or family funds and time. If my opinion was asked for I’d want to have a discussion about why they are thinking about the career. If it is to make money there are ways for a smart young person to make more with less time/dollar investment. If it is to provide healthcare there are path to consider (like nurse practitioner and physician assistant) that can allow one to provide care with less investment as well. There are good reasons to make the investments in my book but I’d want to know what they thought they were.
ETA - my eldest is in medical school. He really did not ask my opinion though …
Which is a pointless comparison. It’s always easy to say “I’d support X if it was done right;” it’s the “real communism, which has never been tried, is preferable to capitalism” line of argument.
The relevant question is whether you’d prefer UHC given the way you expect it would actually be implemented compared to what we have now.
As for myself, yes I would.
OTOH it is a bit of a trick question as I do not realistically see it as having any chance of being actually implemented in any form in any moderate term future.
I have more hopes for an expanded public option however.
Sure I would. A lot of countries tried to make communism work and none of them succeeded. So it’s fair to say, based on empirical evidence, that communism doesn’t work in the real world.
But that’s not true about public health care systems. A lot of countries have tried to make those work and they’ve generally succeeded. Based on empirical evidence, public health care systems work in the real world. And there’s no reason to think one wouldn’t work in America.
This is called concierge medicine. I don’t know much more about it than that.
Around here, most insurance-free practices are psychiatrists, plastic surgeons who do cosmetic work only, and a few family practitioners, mostly the ones who have independent walk-in practices. There was one in my city for a while whose sign had his name on it, and underneath it, it said “Adults $50, Children $25”.
These doctors will usually be happy to give patients needed paperwork for insurance reimbursement.
This doesn’t seem particularly surprising, given that the U.S. has a much larger population than Canada, and thus a much greater total demand for doctors. It doesn’t necessarily say anything about how happy they were with single payer, other than that giving it up to go where the patients are wasn’t a deal breaker for them. (And for all we know, maybe it was a deal breaker for some of the remaining 81%.)
Personally I think that the U.S. can make a pretty compelling pitch to Canadian doctors even if they do prefer single payer, namely “We have a similar culture to the one you’re used to, your skills are in high demand here, you’ll still be close enough to home that you can visit frequently, and you don’t have to spend the winter months defending the Wall against a horde of ice zombies.”
To be clear, that was a Game of Thrones reference, not a Trump reference. Trump of course has no interest in building walls that keep out white walkers. And anyway, he doesn’t believe in climate change.
So, another article pointing out an area where the US system performs badly compared to single payer systems. And its not like the fact that the US system imposes a massive extra bureaucracy hasn’t been pointed out here before. Frequently.
Okrahoma, why do you think US physicians are so much more stressed than physicians in single payer countries? Why do you think it is the US, with its high remuneration for physicians, that has a looming shortage ?
Oh, on the subject of physicians expatriating and practicing in other countries:
The Anglosphere, and the US in particular, has a huge advantage. English is the world language, and the US/Hollywood cultural exports mean a lot of people outside the US soak up a basic familiarity with US culture. If I say drive-in, prom, high-school football teams, cheerleading etc, most people in the developed world have some idea what that means from US High School comedies, even if their own nations don’t have anything like it.
If you work in IT, or the oil industry, or maybe mining, you may well have English as your working language even in non-English speaking countries.
But dealing with patients is not one of those areas. If you are a GP in a non-English speaking country, a large fraction of your patients may be old, some may be confused and few will be fluent in English.
Basically, a physician leaving the US faces much higher barriers in terms of language
and culture than someone coming the other way. And that is besides the pay issue.
So which countries are most popular for expat doctors? Well according to the OECD it is in order: Israel, New Zealand, Ireland, Australia, the UK, Switzerland, the USA, Sweden, Canada and Spain. Cite. (Originally from the OECD, but the article has a better table)
As we can see, English-language countries dominate. And despite massively higher pay and easier integration, the US does not compare well to other English-language countries in the popularity stakes.
I suppose it is possible that doctors are discouraged by the amount of bureaucracy, a known feature of the US system. Cite.
There was this guy Ludwig Von Mises who explained how government intervention into the market causes problems, which in turn are used to justify further interventions. Maybe you’ve heard of him.
Being a doctors isn’t a profitable as it used to be but I think doctors still have the highest average lifetime earnings of any profession. By a LOT.
So what are your doctor friends recommending to their kids? I know a shitload of Asian doctors, and many of them want their kids to take risks they couldn’t take because their parents were relatively poor. Many of them want their kids to be doctors. If none of your doctor friends want their kids to enter the highest paid profession in the country, what do they want their kids to do?
You mean like medicare? I know several doctors that call themselves geriatric specialists so that they can deal with only medicare patients. Something close to 10% of a private practitioner’s fees go to dealing with insurance companies.
Single payer doesn’t necessarily man what you think it mean. Single payer is like public education. Just like you can start a private school, you can start a practice outside the single payer system and have people pay you in cash or you can only accept private insurance. single payer can mean that everyone has coverage through the national plan (and for most people, that is all the coverage they have and need)
The number of physicians is determined by the number of medical school graduates, which is determined by the Association of American Medical Colleges, and the closely related AMA, granting accreditation to programs. Medical school is notoriously difficult to get into, and no doubt every year there are highly qualified applicants who would make fine physicians who do not make the cut. If doctors are so miserable, then they could work within their own guild to increase the number of doctors. Of course, increasing the supply might have the additional result of decreasing the demand and by extension the salary.
I’ve been hearing about the looming doctor shortage for years now, and never understand how nobody seems to bring up the fact the shortage is entirely manufactured.
**Damuri Ajashi **, what you highlighted in the article is what bothers me the most - the completely made up statement that there is “an alarming growth in burnout and dissatisfaction among practicing physicians” when the survey actually shows decreasing rates of each.
I have not specifically recommended a career in medicine to my kids. They should do that which interests them and that allows them to feel like they are making a positive contribution to our world, so long as they make enough at it that they are not having to live in my house. The oldest several years out of college decided that would be medicine, went back and took the science classes he needed and is now in med school. Fine. The next is trying to build a career in urban agriculture. So far he makes very little at it but he has few needs. Fine. The next is graduating with a degree in geology … who knew that in college he’d discover a love for the subject? He’ll be employed. Fine. And my High Schooler? She has time yet. I am not advising for a career in medicine or against it. She knows I love what I do and that her mother loves her job as a therapist as well. She should find what she loves and make enough at it to support herself.
If however she tells me she is thinking about premed primarily because it assures her a comfortable income I would strongly advise her to reconsider the choice.
Fiveyearlurker, medical school enrollments and numbers graduating are consistently increasing year on year as are residency spots (which is felt to be the bottleneck more than medial schools).
Is the pipeline increasing fast enough? Maybe not. But whatever your opinion of it it must also be noted that physicians are increasingly no longer alone in providing healthcare, we work with teams now, and many, including quite a few who are academically capable enough that they would have been very competitive medical school applicants, are choosing the N.P. or P.A. pathways. They will help fill the gap between supply and demand.
Back to the OP regarding electronic records, I am not at all surprised that most doctors hate it. Everyone hates it when they have to stop doing things the way that had been doing them and learn a whole new system. That doesn’t mean that changing the system is a bad thing, or that once they learn to use it they won’t change their mind.
In the end Uniform electronic records are in the end going to be much better for everyone than the current system of massive rooms of paper files and whining faxs and misplaced catscans that we have lived with in the past.