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A fourth of U.S. health visits now delivered by non-physicians

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Re: A fourth of U.S. health visits now delivered by non-physicians

#81

Post by lolinder »

lionsdan wrote: post #80
konschubert wrote: post #75

Earlier quoted context omitted.

Is there such a cap?

"In 1997, Congress passed the Balanced Budget Act, a bipartisan effort to cut back on spending. The act put a cap on the number of annual residencies CMS would support, and froze the funding at 1996 levels. . . . Since 2007, a bill to increase the number of residencies has been introduced in every Congress . . . but never passed." https://www.washingtonian.com/2020/04/13/were-short-on-healt...

But why aren't more residencies paid for through other channels?

I wasn't under the impression that medical residents were solely a drain on hospital resources—my sense was they did a lot of the smaller tasks to free up licensed physicians to do more. At some point, if there aren't enough CMS-funded residencies and there aren't enough licensed doctors, wouldn't hospitals just start hiring more residents?

The article you linked to has a heading that touches on this ("how did we end up with Medicare basically determining the number of new doctors per year?"), but doesn't actually answer the question it poses. It explains why the government started funding residencies, but not why the industry is now completely dependent on that funding.

Re: A fourth of U.S. health visits now delivered by non-physicians

#83

Post by drpgq »

rchaud wrote: post #13
penjelly wrote: post #7

canadian anecdote: i havent seen my GP ever . He just oversees resident (student doctors). Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. Most of the time they deflect me from specialist care.

I'm Canadian too, and the only time I didn't see my family doctor (phone appointment) was at the height of the COVID lockdown. Are you located in a remote area?

I'm in Hamilton and I mostly see residents.

Re: A fourth of U.S. health visits now delivered by non-physicians

#84

Post by ejb999 »

hx8 wrote: post #44
ejb999 wrote: post #36

Earlier quoted context omitted.

They don't want to solve your problem over a messaging system - and prefer you to come in - the MD can't bill anyone for answering you questions over the phone or even via messaging - which is why they push for an appointment. Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free? I know I am not - and while you personally may only ask one…

> Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free? It's common practice to answer emails and take calls from customers and not charge them for it in many industries. If you have 3000 patients, and you spend 3 minutes/patient/year on these interactions, then you spend ~30 minutes a day answering emails or leaving voice mails which is p…

No way a typical question takes 3 minutes to answer; just by time you read the message, pull up the chart, read the chart, make the call, talk with the patient and then document the outcome of the call back into the chart, you are in it for 15 minutes at least … not to mention the context-switching time you need as you move from one task to the next.

And I disagree that it is ‘common’ in other industries - ever try to get on the phone with an Amazon or Google or Facebook senior level developer to solve a technical problem -without being on a paid support plan? Sure, you might get some low level clerical person or entry level tech support, but you aren’t getting to those senior folks for free.

Re: A fourth of U.S. health visits now delivered by non-physicians

#85

Post by ejb999 »

gnicholas wrote: post #56
ejb999 wrote: post #36

Earlier quoted context omitted.

They don't want to solve your problem over a messaging system - and prefer you to come in - the MD can't bill anyone for answering you questions over the phone or even via messaging - which is why they push for an appointment. Not sure what line of work you are in, but are you willing to answer endless emails and or voice mails from customers, all for free? I know I am not - and while you personally may only ask one…

If they don't want to have a way to ask a question, they shouldn't have one. The assistant who answers questions has literally never provided value. She is just wasting her time, and mine. I would actually prefer if they didn't pretend you could get useful info through the "ask a non-emergency medical question" option. And as tssva said, these questions are often follow-ups on topics discussed at an appointment, so i…

They are willing to answer some questions, I.e. the ones a nurse or medical assistant can answer; it’s the medical questions that only a provider can answer that they need to be able to bill for.

Re: A fourth of U.S. health visits now delivered by non-physicians

#86

Post by userinanother »

rcpt wrote: post #27
vsskanth wrote: post #12

The number of new physicians in the US are restricted because you need to go through residency and the number of residency slots are limited because they have to be funded by Medicare (why ?). There's a huge lobby (AMA) to keep it that way, to ensure their members salaries remain high. PAs and NPs don't have the same restriction so hospital systems are pushing to have them handle office visits as much as possible. Th…

AMA stopped lobbying for that around ten years ago

Did congress fix the pipeline problem? Seems like no

Re: A fourth of U.S. health visits now delivered by non-physicians

#87

Post by userinanother »

penjelly wrote: post #15
rchaud wrote: post #13

Earlier quoted context omitted.

I'm Canadian too, and the only time I didn't see my family doctor (phone appointment) was at the height of the COVID lockdown. Are you located in a remote area?

no i am in ottawa, and i go to a major hospital, their family health division.

Don’t go to a teaching hospital that’s always a mistake unless you have some really abnormal problem

Re: A fourth of U.S. health visits now delivered by non-physicians

#88

Post by oramit »

robomartin wrote: post #16
penjelly wrote: post #7

canadian anecdote: i havent seen my GP ever . He just oversees resident (student doctors). Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. Most of the time they deflect me from specialist care.

> Ive had chronic health issues for 3 years now without much relief, despite having been to the doctors office 20+ in that time. This is the problem with all of these systems that try to violate the laws of physics (aka: free market economics). They invariably results in substandard care, if you receive care at all. Keeping people alive isn't the same thing as actually solving problems with quality care. This is my b…

"They provide high quality care at a reasonable price."

What's the cost to the patient for this boutique care?

Re: A fourth of U.S. health visits now delivered by non-physicians

#89

Post by rcpt »

userinanother wrote: post #86
rcpt wrote: post #27

Earlier quoted context omitted.

AMA stopped lobbying for that around ten years ago

Did congress fix the pipeline problem? Seems like no

Because the funding comes from Medicare and when you talk about that in Congress everyone loses their minds.

Past lobbying by the AMA gets some blame. Current government inability to fund public healthcare gets some to.

Re: A fourth of U.S. health visits now delivered by non-physicians

#90

Post by derbOac »

j-bos wrote: post #14

It wouldn't be so bad, except so many MDs, PAs, and NPs are just bad. This is coming from someone who has been traveling with a sick family member for a few years. There are great (read: skilled, thoughful, patient, investigative, this.patient data driven) professionals out there, but they are badly outnumbered and booked for months near a year into the future. A huge bunch display the interest, skill, or attention o…

I've had two experiences in the last 10 years or so involving two "significant" conditions — not necessarily in the standard sense of threat to life, but in the sense of nonroutine and potentially becoming something more problematic, involving multiple significant testing procedures and several different teams of providers. The two things were totally unrelated issues.

Both of them just reinforced my sense that the degree pretty much doesn't matter anymore. In one case I saw several physicians of different specialties, and none of them had any idea what was going on. My own initial hunch ended up being correct, and I kind of ended up fixing it myself (complicated to explain, nothing illegal or inappropriate; ironically the first physican I saw was also correct, the only one who got it right, but he dismissed it and convinced himself it was wrong). In the other case, the best care we got was from a PA. The physicians were all specialists who were financially motivated to give care that was totally useless but very expensive (we figured this out by looking in the primary scientific literature and realizing that all the procedures they were heavily pushing were no better than waitlist controls). The PA was the only one recommending things that were actually useful.

I've seen useful MDs as well, especially with pediatricians and radiologists. I'm not saying MDs are bad or useless. But I'm increasingly convinced that different educational and training paths do not necessarily mean inferior or superior care; that a lot of services could be provided through different providers or mechanisms; and a lot of what people see providers for could be obtained without any provider as a middleman.

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