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‘Out here, it’s just me’: one doctor for 11,000 square miles

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Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#91

Post by beerandt »

perl4ever wrote: post #49
beerandt wrote: post #44

Earlier quoted context omitted.

Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staf…

If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.

Agreed... Yet that's what's happening nationwide.

The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the appropriate checkbox, and then trying to return to your train of thought. The focus ends up being on the data entry instead of the patient.

This is amplified the less specialized the practice is, hence emergency medicine, family practice, and general practice being the most affected. And rural doctors being affected the most since: 1) they generally are expected to handle whatever gets thrown at them since there are no specialists around and 2) they have the smallest practices (can't share costs with other doctors).

Opting out of the system essentially means going cash only, which obviously limits your patients, among other drawbacks. Which leaves burn-out and early retirement or joining a bigger practice in the city. Or concierge medicine, which is one reason why it's becoming more popular.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#92

Post by bradleyjg »

vo2maxer wrote: post #72
chimi wrote: post #59

Earlier quoted context omitted.

I believe the American Medical Association (AMA) lobbying congress to shut down medical schools and artificially limit residencies and thus the supply of doctors is a much bigger factor. A lot of people who are capable and motivated to be doctors for good reasons are shut out because doctors don't want there to be more doctors who will serve to limit their wage growth.

Why go through the costly process of training a physician, when in most healthcare a midlevel practitioner would provide appropriate evaluation and treatment? Also it seems that not all stakeholders in medicine are into restricting physician training[1]. (I come into the discussion with a physician’s perspective.) [1] https://www.modernhealthcare.com/article/20140730/NEWS/30730...

Because Americans all think they deserve attention from someone that fits their personal image of what a doctor should be—-in terms of race, gender, age and personality. Someone who is in the top .001% of intelligence and with twenty years of training. All to spend hours listening to them complain about their cold or achey knees. And they don’t want to have to wait. Also, they don’t think they should have to pay anything for it.

Instead of acknowledging the impossibility of their desires they jump from villain to villain and magical silver bullet to magical silver bullet. The politicians of course don’t tell them they are being childish, but instead indulge their fantasies.

Why do you think the ability to shop around for a physician something so crucial to preserve in any reform? What does that have to do with outcomes?

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#93

Post by yourbandsucks »

refurb wrote: post #89
yourbandsucks wrote: post #75

Earlier quoted context omitted.

Shouldn't Milton Friedman be complimenting them for pursuing their narrow interests and having faith that it will contribute to the optimal free market outcome? When someone doesn't even buy their own brand..

When the system becomes so unworkable that the govt steps in and starts creating unfavorable rules for doctors, they were actually working against their own best interests.

So self interest isn't infallible, is what you're saying? There are coordination problems and externalities?

Next you'll be telling me that money isn't speech and maybe we shouldn't let establishment players capture the government.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#94

Post by perl4ever »

beerandt wrote: post #91
perl4ever wrote: post #49

Earlier quoted context omitted.

If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.

Agreed... Yet that's what's happening nationwide. The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the approp…

I applied for a few jobs at places that did things like practice management software over the years, e.g. athenahealth but never worked in the industry, so I don't have any insight on what it's like on the inside. But I assume there are systemic reasons.

It's easy to say concierge medicine, but I'm not clear on why that should work, if funneling the same amount of money every month through an insurance company doesn't. What is the difference, other than the marketing terminology?

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#95

Post by vo2maxer »

chimi wrote: post #88
vo2maxer wrote: post #72

Earlier quoted context omitted.

Why go through the costly process of training a physician, when in most healthcare a midlevel practitioner would provide appropriate evaluation and treatment? Also it seems that not all stakeholders in medicine are into restricting physician training[1]. (I come into the discussion with a physician’s perspective.) [1] https://www.modernhealthcare.com/article/20140730/NEWS/30730...

We should go through the process of training more physicians, because every day in the USA many people are harmed, up to death, due to there not being enough physicians. We need more midlevels too, I agree, though midlevels are not allowed to do everything doctors can do and are required to have many things approved by a doctor as well. So to increase midlevels would naturally require an increase in physicians. I com…

I don’t mean to underestimate what you’re going through and those in similar situations, but consider the significant harm being done by unnecessary procedures and medications which add no value to a patient’s life. A lot of it is being done by a glut of avaricious physicians in metropolitan areas, particularly those with large elderly populations. Witness end-of-life care with its outrageous in-hospital costs, which again adds little to the quality of someone’s life. This is one of the great scandals in U.S. healthcare.

Edit: For whatever reason, I was downvoted on this comment. I’m truly curious to know why. Is it too alarmist? Is it betrayal of my colleagues from someone in the trenches of our inefficient healthcare? Am I just restating the well known? Is it believable? Here is an article which should stimulate continuing discussion[1]. As far as I know, this hasn’t changed. I’m not sure how increasing the amount of medical school graduates and residency spots will deal with the issue described.

[1] https://www.propublica.org/article/unnecessary-medical-care-...

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#96

Post by trungdq88 »

evan_ wrote: post #84
lazyasciiart wrote: post #58

It should be illegal for the government to detain people in areas with inadequate access to medical care. If they want to put immigration detention centers (or any prison) in the middle of nowhere, they should be required to pay for a doctor to be there too. And it isn't a case of 'well migrants cross the border in the middle of nowhere so it's their fault' - almost all immigrants held in this place are transferred f…

At least in Alabama, they've been releasing prisoners with medical conditions, so they don't have to treat them. When/if they get better they re-arrest them. https://www.al.com/news/2019/09/alabama-sheriffs-release-sic...

This is depressing.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#97

Post by aantix »

chimi wrote: post #59
belltaco wrote: post #3

The decades long wait times for green cards for immigrant doctors is also hurting health care in rural America. https://money.cnn.com/2018/06/08/news/economy/immigrant-doct... https://www.wusa9.com/article/news/local/maryland/communitie... https://time.com/5299488/international-medical-graduates/

I believe the American Medical Association (AMA) lobbying congress to shut down medical schools and artificially limit residencies and thus the supply of doctors is a much bigger factor. A lot of people who are capable and motivated to be doctors for good reasons are shut out because doctors don't want there to be more doctors who will serve to limit their wage growth.

You need wage growth. It’s half million dollars in schooling and deferred wages.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#98

Post by beerandt »

perl4ever wrote: post #94
beerandt wrote: post #91

Earlier quoted context omitted.

Agreed... Yet that's what's happening nationwide. The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the approp…

I applied for a few jobs at places that did things like practice management software over the years, e.g. athenahealth but never worked in the industry, so I don't have any insight on what it's like on the inside. But I assume there are systemic reasons. It's easy to say concierge medicine, but I'm not clear on why that should work, if funneling the same amount of money every month through an insurance company doesn'…

Edited:

Easy... They don't take insurance. They're typically cash only, which allows them freedom to do things like charge for house calls.

Or they have contracts directly with employers to do checkups and on-demand visits onsite. Employers that are either big enough -or financially successful enough- to be self insured are essentially paying cash for office visits and most covered services anyway. (Many companies that are ~200+ employees self insure, but still pay an insurance company just to manage it all. An in house or concierge doctor on contract might cut out enough paperwork to get rid of the middleman.)

I've also seen some setup as prepaid membership operations. But the common denominator is they cut out insurance and medicare/medicaid, which cuts out 90% of the regulations... Including electronic medical records.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#99

Post by beerandt »

lazyasciiart wrote: post #58

It should be illegal for the government to detain people in areas with inadequate access to medical care. If they want to put immigration detention centers (or any prison) in the middle of nowhere, they should be required to pay for a doctor to be there too. And it isn't a case of 'well migrants cross the border in the middle of nowhere so it's their fault' - almost all immigrants held in this place are transferred f…

It might not be their fault for breaking the law in the middle of nowhere, but they did still break the law.

Not saying it justifies lack of medical care, I just think you're making an excuse for the wrong "element" of their behavior.

Re: ‘Out here, it’s just me’: one doctor for 11,000 square miles

#100

Post by novok »

driverdan wrote: post #50
novok wrote: post #27

Earlier quoted context omitted.

And pay two thirds less. The qualifier is equal pay.

I've never seen a remote job that paid two thirds less. Some do pay less based on location but many don't.

I can choose 400k-500k compensation working at fang or I can choose 100-200k compensation working remotely.
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