Err, please excuse the ; that went astray up there.
The AMA is a lobbying group for physicians, and fewer than 1/3 of US physicians/medical students belong to it. (I’m not a member either). I’m unaware of any lobbying groups with statutory responsibility to police a profession.
Discipline is left up to state medical examining boards, which are operated by the state government and generally have both physician and non-physician members on it.
And as for producing more docs, we recently had a thread on that topic. Contrary to the assertions of many, it is neither easy nor cheap to create more slots to train competent physicians.
Great minds think alike, DoctorJ!
[sub]of course, fools seldom differ, too[/sub]
You’re about 20 years out of date on this one. We still have dinners, but they have to be accompanied by educational programs (which are highly regulated) and a doc can’t bring his non-doctor family, so they’re a lot less popular than they used to be. Drug reps can’t even bring us pens and note pads anymore.
My institution (a large university) has gone a step further and banned all pharma logos and all drug rep contacts with residents and students. Even faculty are not supposed to go to the dinners, which doesn’t matter because I don’t anymore anyway. The only reason we still see drug reps at all is because they wanted to still have sample medications available, and I pushed against that–I think samples just encourage us to use expensive drugs rather than cheap generics.
So while I’m on board with most of your OP, this is significantly overstating the case.
Doctors have great press, TV. Since its inception TV has had doctors solving complex cases in one hours time. They never worry about money, costs of tests or anything else. They are beautiful. handsome and in great shape. All they care is saving the patient at all costs.
In the beginning it was Marcus Welby then came
Dr. Kildare, Emergency, MASH, House, Northern Exposure, and many many others.
Well they are right, he’s not. Just knowing a subject backward and forward means nothing in terms of being able to teach it, especially to immature teenagers. Since most public schools are tested to see how effective they are at getting students to actually learn, and not how much their teachers know, to a certain degree this makes sense.
The difference between high school teachers, who by and large had to follow certain guidelines and be educated in how to teach, and college professors, who simply had to be educated in their subject matter, was very stark for me as a student moving from HS to college. Put most of those college profs in High School and they would have been lost in about 5 minutes, and fired in a couple of weeks.
I would be inclined to agree with your point if there was some sort of provision for ascertaining whether or not he’s qualified to teach. For example, if he was allowed to demonstrate his considerable experience and proficiency at teaching his subject to immature teenagers. The gist of what he was told is “sure, we’ll observe you teaching and qualify you as a teacher. It takes two years, over the course of which you’ll work as a teacher and pay us $30k for the privilege”. No classes, no education on education, just two years of indentured servitude which costs thirty thousand dollars.
You’d imagine if we really were hurting for qualified teachers, we’d be doing something helpful to fast-track educated and people into the profession. He doesn’t mind working for crap pay because he both enjoys and is good at teaching kids, but just didn’t feel like the system anything to do with proving his qualifications as a teacher so much as joining the club and paying $30k worth of entrance fees.
ETA: for the record, I had the opposite experience from you. The difference in going from people who had been trained to manage behavior and answer questions out of a book to people educated in the topic they were passing on was very stark to me, as a student moving from HS to college. Some of my HS teachers were educated in their topic, but most were just assigned to teach in whatever department they were needed. It’s not that they were bad teachers, just that most of them couldn’t really have a discussion on the topic beyond what was in the textbook or affiliated materials.
[/hijack]
One of the effects of the “public option” that you’ve probably heard mention of would be to reduce costs. Ditto “comparative effectiveness review” which wouldn’t have done so directly, but would have given doctors unbiased info on which treatments were the most effective relative to their cost. I’m not positive, but this may have been the genesis of the BS story that Obama was going to put your granny out on an ice floe. I believe it also got characterized as ‘rationing health care.’ Between the smears, I think this sensible approach to reducing costs has died a quiet death.
This is the problem, of course: any cost-cutting measure can be construed/smeared as ‘rationing’ in some way, shape, or form. Maybe if Republicans could stop using such smears, and engage in some honest debate…?
And maybe there’ll be a breakthrough on cold fusion next week that simultaneously ends any worries about climate change and energy shortages forever.
Mindless expansion and added complexity. (Baucus plan version; House bill has subsidies up to 400% of poverty.)
The main problem is not that there’s a secret group out there that enforces limiting numbers of medical students- it’s the facilities themselves. In fact, there are states out there that are trying to promote the growth of medical schools by providing budget incentives to their state funded medical schools if they can provide more students over the next few years. Who doesn’t want free money from the state if they can get away with it. The problem though?
The schools themselves.
My current medical school has an entering class of about 110 students. They want to update themselves though to try to get to 150 students. The problem? We simply don’t have the facilities and the budget, however the school did manage to set aside it’s budget and now we’re under construction of a new facility to not only update our aging classrooms (we only have 2 “real” lecture halls for the First and Second year Classes right now) and our labs, but also to update our technology, equipment, and hiring the new competent professors and staff for the school as well- the cost though? It’s going to take over 250 million dollars being applied over the next 4 years for the construction to finish, and already they’ve had budget problems with using just that much money and have had to raise tuition for us and will probably continue to do so.
So that’s 4 years of construction, and 250 million dollars just to try to update the facilities all with the long term goal of basically expanding to accommodate 50 more students.
THAT’S the problem. It’s money, resources, and manpower that has to be put towards the task of trying to train the medical students. That burden tends to fall on the schools that have to often deal with those burdens- there’s nothing from the AMA, the state boards, or some other secret Medical Cabal that’s limiting us from expanding our intake (already the class size has increased from 110 students to 115 students this year from the last- they are trying to expand slowly but surely as there is a state incentive to do this (though these incentives were all before the state had budget problems of its own and decided to cut back on said budgets, and hence my rise in tuition- but that’s neither here nor there) ).
The problem mainly is the fact that TRAINING the doctors cost money.
People expect their health care providers to have a certain standard of competency and knowledge and so there are nationalized exams that every US trained doctor must pass (USMLE I, USMLE II, USMLE III), and the medical schools must train to not only try to train their students to be able to pass those exams, but also to try to instill in their doctors a sense of ethical responsibility, responsibility, and a proper bedside manner and patient interaction skills.
Needless to say, that’s a daunting task, and it’s not as easy as just opening up the floodgates to allow more students to enter a school- you have to have trained people who can effectively teach the students, and you have to have the facilities to even accommodate the students. It’s no easy task and that’s mainly the problem for why more doctors AREN’T just being churned out- it costs money, and 250 million (as we’re finding out) isn’t going to cut it even to raise up 50 more students over 4 years…
How can we afford to increase the amount of students a medical school can train without diminishing too much the quality of training that the patients come to expect of certified doctors? There’s the trade off and the dilemma.
The Association of American Medical Colleges (AAMC) more or less sets the number of physicians by determining how many students a given school can enroll and determining how many schools there are that are accredited to hand out an MD.
I am not aware that the AAMC externally limits a given programs’s enrollment (outside of having an interest that a school not expand beyond its capacity to teach adequately). To the extent that they can, they have recommended increasing the number of physicians to meet projected shortages. They are not involved in promoting a reduced number of physicians for the purpose of maintaining higher compensation.
I will go on record as saying categorically that no healthcare plan in this country is going to effect a net savings. The government may be very sincere about trying but it will not happen. Perhaps a different thread would be suitable to expand that discussion.
While the idea of an unbiased effectiveness review is appealing, carrying it out in practice has proven to be exceedingly complex. 25 years ago there was a nice study suggesting that coronary artery bypass did not result in much prolongation of life. The problem is that as soon as you do the study, the methods which went into that study are already antiquated.
In general, the expensive concept we have is that our healthcare should not be constrained by cost. A study might show your kid has only a 0.1% chance of dying if I don’t CT his busted head, but when you are in my ED both of us want to CT his head. Neither of us wants to be wrong and neither of us are concerned about some cost-effectiveness study. A crude example, but you get the principle, I hope.
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No, doctors are not being “given a pass”. Much of what is included changes how they are paid and what they are paid for. They (we) are probably not going to come out so bad providing we adapt well but then no major player is going to be hurt so bad.
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They are not being attacked much because they have been fairly cooperative (most of us see the need for major changes), because patients like their docs mostly and it is hard to paint them as Stanley Whiplashes (as you can villify a nameless insurance exec), and because many angry docs would be a powerful anti lobbying force. It would be a poor tactic.
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Questions about physician numbers and compensation were addressed in this recent thread. As linked to there physician supply has been steadily increasing. The problem, as documented in that thread (see post # 48 and 49), is that the nature of the beast (what gets incentivized and what not) means that the lion’s share goes into specialty medicine in urban centers, less into primary care, and least into underserved areas’ primary care. And those perhaps less than absolutely required tests get accidentally encouraged. Thus costs increase.
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Further decrease payment for primary care doc visits and you would perversely increase the costs to the system. They would be pressured to see more patients in a shorter period of time which would result in more mindless test ordering rather than more tedious good history taking and detective work. Procedures and in-office testing would become a more important source of income than it is for some of them now and those who currently do not do those things would be pressured to do so. Bad idea.
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CP’s last point is major and we have discussed it before: we (still under any proposal, lies about “death panels” notwithstanding) irration care according to payment source or lack thereof, rather than rationally decide that we have to say no to some absurdly expensive technologies of very limited benefit. This is not going to change.
Doctors and hospitals charge for services performed, not necessarily results. Cranking out tests and procedures will make money for them. The tests do not have to be justified.
The argument of defensive medicine is interesting, but do doctors actually get sued for not doing enough tests?. They escape negligence because you have great difficulty getting expert testimony to counter a doctors defense. Most jurors would not have the expertise to make a proper decision. The medics also have the resources to get top defense lawyers,
I disagree with a cap on medical damages ,caused by doctors errors. How much does it cost to take care of a kid through his lifetime that a doctor’s mistake left him mentally of physically impaired.
Doctors cover up mistakes. bad doctors are defended by the AMA. It is difficult to find information about a bad doctor. Like the police who cover up bad apples, the associations don’t realize that the whole profession is harmed by covering up for the incompetent.
The successful lawsuits against doctors generally have a non disclosure agreement of guilt or amount of damages the case resulted in. People can not readily find out how good or bad a doctor is. You can not find out how often or how successfully he was sued. It should be public knowledge.
Fair enough. I don’t think most would assume I was talking about ALL doctors though.
Fair point, but I the golf/dinner things were mostly random, common (albeit incorrect) examples. But, it must be noted the outright bribes some doctors receive could be used for anything. Plus, that those taking bribes are unlikely to follow rules restricting golf outings or dinners.
If doctors need information on new drugs, why don’t they set up an industry website outlining the drugs, etc. They could have doctor patient feedback in several fora, and an informal feedback source.
I don’t mean so much fixing prices, but freezing out insurance companies that consistently jerk them or their patients around. I don’t think they would violate anti-trust laws that way. Or they could just be more open about what they pay to other doctors so insurance companies can’t take advantage of the information asymmetry.
But there doesn’t seem to be any evidence that this defensive medicine is saving them any money in the long run. It certainly costs us collectively, but it may not even be an effective strategy on an individual level.
Can you elaborate on this?
In light of what you said above, it what ways should doctors have more control of how healthcare is delivered? In what ways is the current amount of control lacking?
For all that people insist they don’t want a bureaucrat ‘coming between’ them and their doctor, it is in fact already happening. Insurance companies have far more say over whether or not a patient gets a specific treatment than the patient and doctor do.
If a patient requires a specific treatment, many insurance companies will insist that all ‘less invasive’ (read: less expensive) treatments be used first. Then and only then if those treatments are not effective will they consider the original course of treatment. Of course by that time the problem has advanced well beyond the simple fix that was needed and additional treatment is required and the cycle starts all over.
Of course, patients are welcome to go ahead and have whatever procedure they need performed, they’ll just have to pay for it themselves. At which point the insurance company will promptly disallow any and all issues pertaining to that problem saying it was not medically necessary. All of which rather invalidates the reason for having insurance in the first place.
This is the attitude that truly needs to be changed. Doctors no longer make the huge salaries they did in the past. Physician reimbursement has gone down each year since 1999 and continues to do so. The average primary care doctor makes considerably less than 200K which is far less than the CEOs of the insurance companies that are the ones dictating your care expenses so they can get their big bonuses.
Since primary care doctors make so little money and have to put in so many hours, there is a shortage of those types of physicians. Do you think having them paid less is going to solve the problem? I don’t think so. You may look around and there will be months to wait to get a simple blood pressure medication because no one wants the job anymore.
http://www.azcentral.com/news/articles/2009/02/05/20090205mr-medstudents0206.html
Some doctors don’t make as much as they did in the past. Some are cleaning up. But ,if you become a doctor ,you are assured of making a very,very good living.
We can make medical school a lot cheaper. We can make all colleges cheaper and we should. We have less respect for education than we do for making money off it. Education is like health care. It goes up every year far above inflation. It does not reflect the economy, just that they are taking advantage of a power position.
We insist on limiting med schools suggesting that controls the quality of doctors. Then we have to import doctors who graduate from med schools that we have no input in at all.
[quote=“TheMightyAtlas, post:6, topic:510248”]
I am looking at a bill from my last doctors visit and the follow-ups.
$315 for an annual physical (less than 15 minutes with doctor)
$95 for EKG (done by Nurse)
$85 for EKG interpretation (I wasn’t there, nothing was communicated back to me except the bill)
$1102 for nine tests. One ($700) done by a doctor, who spend about 30 minutes with me. It took about 5 weeks to get this test scheduled. The guy is booked solid, eight hours a day, five days a week.
$180 for interpreting various tests done by the doctor (I had to call three times for the doctor to speak to me about the test results)
Total $1177, reduced to $547 by my insurance, out of which I paid $477, $400 for annual deductible, $77 for co-pays.
QUOTE]
Can I ask where you live and what your insurance is? Because i want to move there!
Here are comparable payments for my area (major metropolitan area)
payment for physical: $120
EKG with interpretation $40
Lab drawing fee: $4
Total $164 for about 1.25 hours of work (45 minutes spent with patient, additional 10 minutes writing up report, 5 minutes to read and write up EKG, 5 minutes to review lab tests (that the lab gets paid for-we only get the drawing fee), 10 minutes to review results on the telephone with the patient. All this is exclusive of nursing salaries, expenses, etc.
A friend of mine has lymphoma. His doctor ordered a scan. The insurance company rejected it. They said it was not the right test. The doc said the test was meant to pinpoint radiation treatment and he wanted to run it. Now the patient has to come up with about 1200 bucks. The insurance company most assuredly comes between the doctor and patient.