Doctors' - WHO NEEDS THEM !!!

[bustedglass 1]

Hi all,

Just did something today - AGAIN - that really "chaps my hide", and I was just looking for a place to vent .

I have numerous health issues that cause me to visit the various doctors on a more than regular basis. And I have found that over the last several years, when I make these visits, I am being seen by a Nurse Practicetioner, or a Physians Assistant - AND NOT BY A DOCTOR .

Now dont get me wrong, I am probably better off seeing these people, for they seem to know as much as, or MORE than the doctor. And, they always take more time with you. I think that I am getting real good care from these people.

But, here comes the part that I have a hard time with. When the bill comes, I have been charged a FULL doctors' visit rate . If I have been seen by a person that does NOT have a real Medical Doctor degree, should'nt I be charged a lower amount ???

I am on Medicare, and a portion of the charge is covered by Medicare, but I have to pay the balance. My wife does NOT have any type of health / medical insurance ( we just can't afford it ), and I have to pay the full amount. I just get madder than hell when she has not seen a real Medical Doctor, but I have to pay his / her rate. I don't get a "break" for him / her using an assistant while he / she is out on the golf course .

I am not trying to upset these assistants with this thread, I want to thank them for the great work that they are doing. I just think that their services should be charged at a lesser rate than that of the "BOSS".

For those of you that are with me on this, let me hear from you. If there is anyone out there that i have offended, I am truely sorry .

[Teddy da Bear 11]

I know what you are saying. The people to write/talk to are the insurance companies. They are forever trying to get Dr's. to lower their charges.

I am angry with my doctor for a different reason. I would like to lose weight.

I go into see him and he says it's all up to me! Well....obviously it has been "up to me" for a while now......that's why I need to lose weight. Now I think it's time for "Dr." to take over on this problem as it is obvious that I am not solving it. He told me to go home and decide what "I" want to do... He is an idiot... That is why I came to see him!....but that is most doctors for ya...

They process patients like cattle and care less than they should. B)

[DOC in Kentucky 178]

Guys,

I have worked in healthcare for over 35 years and trust me, it isn't what it used to be. The best advice I can give you is, that if you aren't happy with your present doctor, find another! I know thats easier said then done but there are still some compasionate doctors and healthcare providers out there, and they are getting harder and harder to find.

You are paying for their service so go to someone you are happy with and about. It seems that the best Doc's are the older ones that really know and care about patient care. I have also found that female's are more compassionate and willing to listen. The new young ones are in it for the $$$$$ and insurance companies are trying to squeeze them, so they try to see more and spend less time with each.

Healthcare is no different then any other business and it seems that everybody is trying to get off cheap. I guess its no different than the tractor manufacturing business now a days. Unfortunately we live in a throw away, easy come, easy go society.

Sorry for the rant and its just my 2 cents worth !!!!

[wh500special 2,053]

First of all, you're not offending me since I'm not a doctor...but I think your posts demand a brief "counterresponse". I'm not writing this to inflame you, just to provide a view from the other side of the fence.

There are many reasons healthcare costs are so high, and most of them do not relate to subsidizing a Wednesday golf outing for your physician. You can also thank such things as malpractice liability, defensive medicine, the under/uninsured losses, overhead costs, and - of course - salaries.

Medicine is an expensive business and most systems run on relatively slim profit margins (if at all). Most religiously affiliated systems are non-profits too so most of what you pay is passing right through a lot more hands than just those of your physician. And, not all physicians make the kind of money society seems to assume they do. Your family practice doc/general practice doc probably makes much less than you'd think.

You're being billed by the clinic you go to not by the individual doctor, nurse practicioner, or physcian's assistant. just like in most businesses there are standard rates for the services rendered regardless of who does the work. Insureance companies and Medicare then negotiate those rates down (since they are "buying in bulk") which pushes costs up for others - especially cash customers like your wife.

The physician in that office is responsible and liable for all the work performed by those working with him. In the case of the NP and PA your "real degreed doctor" (your words) also has to review the charts and your case after you've left.

it is not a hands-off deal for them since they share in the responsibility for your welfare.

Clinics and hospitals are relying more on NP's and PA's because it allows the "real" doctors to focus on patients that require more specialized care and spend more time with them. Generally NP's and PA's are scheduled to see fewer patients in a day which is why they can spend more time with you. Be thankful that you have them at your disposal since many places don't.

Your doctor may have to see 30+ scheduled patients a day. and work in the "emergency" patients (flu, acute illness, etc.). And round at the hospital. And visit nursing home patients. And take call all day and night. And call in prescriptions when you run out early. And rarely ever be shown any appreciation for essentially dedicating their whole life to the care of strangers at the expense of their own families and interests.

Most of us take at least some of our job home with us at the end of the day, but a doctor's job FOLLOWS them home and keeps beating on the door through the night.

All we - as consumers of healthcare - do is B&M about how long we had to wait in the waiting room and how much it costs us. We forget (and I mean WE) that we bring up other problems we have when we see the doc in addition to the ones we had scheduled the appointment for. Or we show up a few minutes late and blw the schedule for the rest of the day. Or we call for an early refill on prescriptions that aren't due yet. Your doc only budgets about 15 minutes per patient because there are so many people needing to be seen...chances are they'd rather spend MORE time with FEWER patients but there aren't enough doctors to go around. Supply/Demand suggests that costs would be even higher if they saw fewer people per day.

While NP's and PA's (and nurses too) are extremely knowledgeable and extraordinarilly valuable, you really can't say that they know MORE than the doctor does. Doctors do, after all, go through a minimum of 7 years of education AFTER completing college (med school + residency) and in that time they're not just taking up space and coasting thru life. That's at least 7 years of debts too that you and I don't have to worry about!

While exceptions will always exist, I doubt your doctor is an "idiot". He might be a jerk, but chances are he is smarter than you or I. Perhaps he hasn't found a medical reason for your troubles with weight and instead poorly phrased his attempts to explain that it might be a lifestyle issue that's making you heavier than you want to be. Aside from following you home and observing how you live your life, he is probably at the end of his rope on weight loss assistance.

if you don't think you're getting the best treatment your money can buy, you can always shop around. But, it does sound that you're happy with the care you're receiving...just not the cost.

There are still a few doctors out there that don't accept any insureance and do business on a direct payment basis. They tend to have long waiting lists to get in (both in terms of scheduling an appointment and running behind during the day) and can be more economical for uninsured patients. On the downside they are generally not equipped to deal with serious issues and must refer patients out to another system for tests, X-rays, and other stuff. but perhaps one of these folks can meet your needs better.

There is a real healthcare crisis. Find a politician to back that has a plan that supports your ideals and press them on it.

But it won't be free. It CAN'T be.

Many countries have "socialized" medical programs to porvide uniform healthcare to all. But the US leads the way in QUALITY.

We can provide national healh insurance here, but how would we divide up the cost? make it the same for everybody? Reward those who live healthy lifestyles? Limit benefits to all?

Perhaps a national "medicaid" type system would work where our taxes (which would have to increase by the way) pay for a minimal amount of coverage for every man/woman/child. Then the more affluent of us can "buy" extra coverage as we see fit while the rest of us take our chances and are forced to pay whatever bills we incur.

I don't know how to make it work since I never really gave it much thought, but perhaps one of the gentlemen running for President can explain to us what we are going to get and how we will pay for it.

We can always hope. But with two wars going on now, an economy on the decline, fuel prices up, and other problems we probably shouldn't hold our breath waiting for a solution.

I truely wish you the best of luck with your health and with your frustration. We're all in the same boat on this.

Steve

[BairleaFarm 339]

IIRC the only difference between a NP and A Doctor is the fact that the NP cant prescribe narcotics. So you are really getting the same coverage. I used to run a shop and in order the post a ASE sign 40% of my people have to me ASE certified. I charged the same hourly rate regardless if you got the ASE mechanic or the kid out of high school. I never saw a problem with it as long as the person got the work done that needed to be done and it was correct. malpractice is a joke and they need to put a cap on it. That would help cost a little but wont cure the high insurance cost. I look at it tlike them. My doctor visits cost less than the hourly rates for most services such as Mechanics. Its the crap like Cat scans and xrays that get you. I think that stuff is high. What really gets me is the price of prescriptions. B)

[linen beige 14]

Davids post reminds me of the doctor who had just gotten a repair bill from his plumber.

Dr. "$75 and hour for labor?!", " I'm a doctor, and I don't make half that!"

Plumber, "Neither did I before I gave up my practice to become a plumber."

The practice of charging "professional rates" for labor is almost universal in the repair world, yet the majority of the actual work is done by helpers who are paid a fraction of the hourly charge. Most of the extra money goes back into the company to pay for tools, offices, etc. Same thing with the medical field.

As for "state run" health care. nearly every community in the United States already has it in the form of county health departments, teaching hospitals at universities, etc. If you don't use these facilities, ask yourself why. Then you have your answers as to why they are not the panacea some politicians want us to think they are.

[bustedglass 1]

Thanks guys,

I asked for responses, and I got them. As I said b/4, I was not tyring to offend anyone, and I hope that I did'nt.

To wh500special, great "counterresponse". Just a few reply's, if I may. I was not the one making reference to my weight. And, the doctor is the one that has made up his / her mind to accept the expense of the 7 extra years of schooling, malpractice insurance, etc., etc. . I don't believe anyone has held a gun to his / her head to do so . And believe me, your response did NOT "inflame" me. I thank you for your views.

And to duramaxdavid, I guess only in America, can we call ourselves "professionals", when only 40% of our "crew" have "done the time". I was a Union Glazing Contractor for a lot of years, before I had to retire due to having five (5) Heart Attacks, and the following Open Heart surgery. I owe my life to God, and the many doctors that saved me. Believe me, I have no problem paying for a doctor, only their rates, when being seen by a NP or PA. Anyway, in response to your response, I was proud to be a Union Contractor, and ALL of my crew, even the secretary's were Union Members. And YES, I did charge accordingly for their services. I wish I could have gotten by with only 40% of the work force being "professionals". But that is the business that I chose, and I played by the rules........ And please don't get me started on the prescriptions . For me and the wife, I am out of pocket over $1,200.00 a month, just for prescriptions. But, if that is the cost for staying alive, I guess I would gladly pay another $1,200.00 a month, if need be.............

Anyway, thanks again guys for reading my rant, and giving me the right to do so B)

[wh500special 2,053]

Mike,

Well, one mystery solved...I had been wondering where "bustedglass" came from. Now I know!

I meant to split the replies up (weight loss issue versus your original points) but forgot to cut and paste the text to a new message...Sorry for the confusion.

You're right, nobody forces a doctor to be a doctor so the extra headaches they have to deal with are part and parcel to the job. But I think many of them enter the prefession with an eagerness to help people and then get embroiled in all the other BS. Just avoid the common perception that their pay justifies the frustrations because it is a completely different set of responsibilities than what you and I have with our jobs. When we screw up or slack it inconveniences people...but what they are doing impacts peoples' lives and health.

I guess accepting the good and bad comes with any job...certainly police officers, fire fighters, and soldiers know the risks when they choose their careers too so perhaps itm can be said that the occasional bad twists of fate for them should be viewed - in theory - the same way...dunno.

Your Union Pride is showing! My father in law was the business agent for the Laborers Union back home. He was the most union loyal person I ever met! Even though he is gone, the family still won't patronize the local Dominos pizza joint, Aldi (grocery store), or WalMart since they built the places non-union and/or were resistant to letting their employees unionize.

My career path (engineer) doesn't really lend iteself to unionization but a lot of the family are union members so I do relate where you're coming from. I'm free to bargain on my own and ask for what I feel I deserve...but I can also be fired on the spot. Give and take I guess.

Prescription drugs are an interesting issue...One i shouldn't address since I'm not that educated in the subject. But I will make the point that the high costs and profit motives are what it takes to fuel research on new meds and pay for all the failures too. if only the US wasn't carrying the bulk of this burden and placing it on you and others w/o prescription benefits. Somehow it would be nie to share the costs with the rest of society.

There are some states where practicing medicine is less costly than others. Illinois is desperate for new doctors, but the outrageous malpractice insurance premiums commanded there are keeping most of the new ones out. Indiana has a cap and a malpractice case review board and does not suffer the Doctor shortage that our next door neighbor does, but premiums are still high.

How much does malpractice insurance cost per year? Depends on the specialty, but it can be on the order of $100k plus per physician per year. More for surgury, OB, and anesthesia, less for other disciplines. But it is a LOT of money. And even though the malpractice is an on-the-job phenomenon, the personal assets of the doctor are at risk too...a somewhat unique phenomenon to the field.

One lawsuit settlement (warranted or not) can cost millions. Wanna make a guess who pays for that?

Thankfully for us though there are countless law firms ready to sue for any mistake that may happen - no matter how forgiveable or understandable it might be. And they take a 1/3 of the settlement amount. Ever wonder WHY doctors order so many tests? a large portion of those tests could be avoided if they were allowed to use their own judgement on diagnosis instead of practicing "defensive medicine" to cover their rear ends from any future lawsuit.

I haven't been a Bush fan from day 1, but he DID want to reform the tort system (not just malpractice either) but those plans went out the window when met with congressional resistance and his jumping into military conflicts. Who knows what the next guy has planned...again, not an issue we should hold our breath waiting so see corrected.

not all lawyers are bad people. In fact, I'd venture a guess that the vast majority of them are sensible, justice minded people. But our society has shifted to one of not accepting RISK and PERSONAL RESPONSIBILITY and has rewarded ambulance chacing and frivolous lawsuits. Rememeber the McDonald's coffee verdict? How about when Merck pulled Vioxx...the commercials seeking plaintiffs aired the SAME DAY. Such actions by the few are costing the many in every part of life and in every product you buy.

But that is another pandora's box...

I'm glad you're hanging in there after 5 heart attacks! You must be one tough cookie! Best wishes in that department and good luck at your next clinic visit!

Gotta run, things to do.

Steve

[BairleaFarm 339]

And to duramaxdavid, I guess only in America, can we call ourselves "professionals", when only 40% of our "crew" have "done the time".

It is what it is. I be 85% of all the "chain" shops in the US have several people that dont have there ASE certs.

Do you ask if your nurse is a RN or a LPN? nope There are alot of LPNs doing RN stuff they shouldnt.

Dentistry - If you have to have your wisdom teeth removed(not talking about pulled but cut out with stitches) do you check to be sure you dentist is a DDS and not a DMD? probably not.

Point is your paying for the service not the persons credentials. As long as they know what they are doing.

[wh500special 2,053]

IIRC the only difference between a NP and A Doctor is the fact that the NP cant prescribe narcotics. So you are really getting the same coverage.

Well, there ARE other differences. But the limitations on prescriptions is certainly one of them.

I can't come up with a way to phrase this that doesn't make it sound like NP's and PA's are inferior, but the training an MD (or DO) receives is significantly more intense and detailed than what a PA or NP needs to know to perform their job.

I can't claim either is better than the other, but the ARE different. To use a tractor analogy: "a Wheel Horse is not a Cub Cadet"

Steve

btw - what does IIRC mean? i've seen that before in other posts but am drawing a blank...

[BairleaFarm 339]

IIRC IF i remember correctly

A PA has the same ability as a NP. The difference between the 2 is the NP was a nurse and earned it and a PA when to school to become one.

They can not prescribe narcotics

They can not preform surgeries

They can not practice medicine on there own. They must practice under another doctor.

They have there own DEA number and are certified by the state.

[dgjks6 6]

NP's and PA's can bill at the Physician rate - as along as the physician is available. He can not be on the golf course - in that case they should only be billing about 80% of what the doctor does.

Medicine is a rewarding profession, and for almost all doctors it is not about money. That is how the system has gotten so messed up. For the most part doctors do not worry about money - as long as they can see patients and pay the bills. But it has become a problem. My malpractice insurance went for $37,000 to $56,000 to $87,000, to $106,000 in 18 months. I have never been sued. It was just the cost of doing business. And guess what, the amount that I was allowed to collect went down by 2%.

In fact the government just stopped a 10% decrease in medicare reimbursement for physicians becasue the physicians said they could not afford to see patients with that low of a reimbursement. So every year cost goes up and reimbrement goes down.

Just a few thoughts.

Greg