more skilled at treating acutely ill, complex patients, as well as those with unusual diseases. Specialists may play the role of primary care provider for the latter and for patients who have severe chronic illnesses. On the other hand, effective and efficient primary care requires broad knowledge.  Specialists may do a better job in their area of expertise but have deficiencies in other areas outside of their specialty. These will need to be rectified if specialists are to serve the role of primary care provider for selected groups of patients. Importantly, the role of each provider must be defined in the context of a system developed and managed by physicians that emphasizes outcomes, quality, and efficiency. These health systems should be designed to receive capitation or prospective payment to eliminate the perverse incentives that are dividing the physician community. Moreover, it will give physicians control of the system and allow them to be creative in how services are delivered, ultimately focusing on the relationship with and duty to the patient.
If you are contemplating a medical career, one blooming industry is medical imaging. This is a highly specialized position in the medical field, where consultants are also called x-ray technicians or radiologic technologists. Another possible field is the ultrasound career path. Being an ultrasound technician can be a very rewarding and lucrative career path to choose. The demand for these jobs is growing, and the salary range easily justifies the time spent on education and training.

ultrasound career path. Being an ultrasound technician can be a very rewarding and lucrative career path to choose. The demand for these jobs is growing, and the salary range easily justifies the time spent on education and training.

Free medical services would encourage patients to practice preventive medicine and inquire about problems early when treatment will be light; currently, patients often avoid physicals and other preventive measures because of the costs. Because many people are uninsured and those that do have insurance face high deductibles, Americans often forego doctor visits for minor health problems or for preventive medicine. Thus, health problems that could be caught at an early stage or prevented altogether become major illnesses. Things like routine physicals, mammograms, and HIV tests could prevent major problems. This not only affects the health of the patient but the overall cost of the system, since preventive medicine costs only a small fraction of a full blown disease. A government-provided system would remove the disincentive patients have for visiting a medical professional

bv

Keep going Ozark. The longer you go on,
the more you display your ignorance.

asnet said: I once asked a fam how famdocs differed from plain general practitioners.

You probably didnt listen to the answer. You probably had the same insulting tone you have used towards me. All you heard was ‘postcards’.

I will answer your question, even though everyone can tell that you couldnt care less when you first asked it and when you report it now.

A GP goes straight into practice from medical school or i think they might do one year of internship first. An FP spends an extra three years in post doctorate training to specialize in family practice.

All to earn your disrespect! And low pay to boot. It is real medicine though. It is the best.

Your disrespectful and ignorant attitude is explained and probably excused by the difficult illnesses you have to fight against. I am not happy that your health and healthcare is something you have to fight for. Why you feel you must make enemies along the way is something you should ask yourself.

I respect my enemies for what they are, and they had better respect me too.

You dont respect. You know what you want and need. That is all.

The government pay that the specialists get relative to family practice is standardized by medicare. The insurance companies often pay the specialists 170% of what medicare would pay for a procedure. On the other hand, the insurance companies pay family practice at just even to the medicare standard for family practice, which isnt very much.

So when we go to the universal government payor, the specialists are sweating bullets at the thought of being payed on the medicare schedule. heh. welcome to my world.

As you say, A few special interests are trying to keep control of the system they have dominated for so long. The Specialists are a powerful interest group. People with extremely high incomes tend to protect themselves, dont they?

Yes, the specialists get a plenty good share at present. i dont begrudge them their income at all.

So yeah there is a lot of money on the table.  And we know that in the past family doctors have no where near the organization and power to unfluence the payment schedules like the specialists employ.

i would rather be a family doctor than a specialist no matter how much less income i will get from it. And no matter how much more you wish to have lavished on the specialists.

You wont be happy to hear this but your specialist doctors are going to get taken down two notches for every notch you take me down. you can count on it, asnet, so get used to it. There just isnt that much less money that an FP can be payed and still stay in practice.  I have nothing against the specialists making a lot of money.  But where I draw the line is people like you. You would like to see the ‘postcard’ family doctors get paid even less so your specialists make more.

Absurd, ridiculous, ill informed, and it would ruin an already shakey payment system. This is the sort of greed that destroyed our banking sytem. The specialists are the guys at the top of the powerful hospitals, the top incomes, the top political influence. Who can call these powerful people to account before its too late?

• Ozark jumped all over me for punching out Ellen Goodman and the evil family docs. He was pretty nasty. I can’t let that go by.
—————————————————————————————————————————————————-
• I am not going to get dragged down into your Stuff Ozark. I do not write hit pieces for a living. I do it for sheer enjoyment and for delight in truth. This is for anyone else who may have misunderstood:

1) Nonsense is for Ellen Goodman who is peddling the media rap of the week.

2) I am a frequent flyer in the health care system in New York, so I know when someone hasn’t a clue about what’s actually going on and is merely repeating whatever Stuff they have heard. People are making a lot of money for that lately.

The money is being taken away from medical services that take care of sick people. And the plan is to finish the hit job the HMOs have been doing on the real docs and the public for too many years.

3) I have nothing against “family”  doctors who practice within bounds. I have a problem with the fams who don’t like their limits and won’t recognize them. New York has laws about that and the fams violate them constantly in a propaganda campaign designed to brainwash the public into thinking the fams are the ultimate MDs. On the way home from a meeting trashing the people I consider to be the good guys, I once asked a fam how famdocs differed from plain general practitioners. She got very angry, foamed at the mouth briefly, then said “I SEND POSTCARDS TO MY PATIENTS IN OCTOBER REMINDING THEM TO GET FLU SHOTS!”  (wow ... and what do you do the rest of the year?)

4) I am definitely part of the specialist medical conspiracy to keep people alive and well despite bad genes, bad luck, bad habits and age. I am very connected to specialists. Seven of them to be precise. They are all board-certified in internal medicine and also in one or more specialties. Things like cardiology, infectious disease, gastroenterology, ophthalmological surgery, psychopharmacology and endocrinology. One of them is my principal ..  not primary .. care provider . She is triply credentialed: internal, pulmonary and critical care.

The lack of respect shown to these people by the HMOs is really quite amazing. They end up treating many patients free when these patents can’t get referrals or revisits from their HMOs. My PCP (principal care provider)  does not get paid for keeping up with me, let alone with what my other six docs are doing. And they do not get paid for keeping up with her. I fired all the others long ago. I assume they are back in the Slow Class.

5) At this particular time, we here in the US are in a considerable and unavoidable political battle. I respect my enemies for what they are, and they had better respect me too. A few special interests are trying to keep control of the system they have dominated for so long. But they can’t. Because this is about universal health care. Equality, Fairness. Equity. Diversity. Pluralism. Democracy.  The special interests, including the unethical family docs,  are going to lose. Lose big.  If you can’t stand the heat, Ozark, get out of the kitchen.

asnet says: Nonsense.

who are you talking to? Ellen Goodman? Me? Everyone?

It should not mean cartoons and caricatures of doctors who have more education, experience and expertise while those who know and do less are worshipped.

Who is being worshipped? The family doctor? Have you lost your mind? And then you say this…

We need access to secondary, tertiary, quaternary and quintenary care when we need such expertise, not voodoo by “gatekeepers” worshipped because they are in over their heads, don’t know what they are doing and are singing a happy little song instead.

Is that what primary care is to you? voodoo?...Happy little songs? You sketch quite a cartoon and caricature of Family Practice. Very disrespectful, very wrong. I have never heard primary care more ridiculed or caricatured before. Why are you doing that? Big money floating around to protect the income of Specialists… wonder if somehow you are connected to it?

It should not mean ridicule and lies about modern technology

What ridicule? What lies? You are the one who uses ridicule and lies.

The phrases you used seemed polished. You write little hit pieces for a living? Your words have earned the organization you represent my disrespect.

Nonsense. It is sad to see that people who should know better are being duped by HMO lobby propaganda at just the time when we need the best critical minds in the country to help define what health care “reform” should really mean.

It should not mean coercive, regressive, authoritarian managed care for the poor and the middle class while the political class retains its privileges. It should not mean the abuse of power by the kinds of special interests who dominated the White House forum on health care reform.

It should not mean cartoons and caricatures of doctors who have more education, experience and expertise while those who know and do less are worshipped.

It should not mean ridicule and lies about modern technology while every chiropractic, “holistic,” supplement industry, 11th Century scam is treated with kid gloves.

It should not mean one-size-fits-all oxcart medicine at the expense of those who need something other than managed primary care—those with emergency, acute, catastrophic, chronic, disabling or rare health problems.

It should not mean delusions about “prevention.”  People get sick. People inherit bad genes. People have accidents and bad habits.

The philosophy of the Luddites has little or nothing to offer.

We need health care that is truly comprehensive in fact, not merely in rhetoric. We need access to secondary, tertiary, quaternary and quintenary care when we need such expertise, not voodoo by “gatekeepers” worshipped because they are in over their heads, don’t know what they are doing and are singing a happy little song instead.

You want hand-holding? Go to your local palmist, your mother, your spouse, your best friend. I’ll take 21st Century medicine.

Yes it does cost. So does life. There are germs out there, kiddies. Watch your butt.

Arthur Springer
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& Lay Advocate for People With Disabilities
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New York, NY 10024-6313
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                  Nothing about us without us

One country doctor, family practice… keeps his office open from 8am to 5pm 5 days a week. Can see you today or tomorrow if you need a doctor.

Compare that to the cardiology office, which has over a dozen doctors. It is hard to get an appointment there. Oddly, they are closed on Friday! A dozen doctors and they close on Friday.

Why? Because they dont want to see patients in the office. Instead they hang around the cath lab all day.

Why? because with one cardiac cath you can make more money than you can make from being in the office for two days. If one cardiologist manages to do three a day(three would take about 2 hours) not only is it a nice short day of work, but then that cardiologist can retire at age 40.

The specialists with toys get compensated so well that they fight to stay out of mundane tasks like seeing patients in the office. Over the past ten years I have seen the specialists go from ‘glad to see patients in the office’ to ‘sorry, too busy’.

‘Too busy’... but they close on Friday.
‘Too busy’... but if there is a cath to do they fight for the case.

Medicine in the United States is just a sugar pill, a placebo, propped up by the patients hopes, that somehow they will get better when there is little chance that they actuallly will.

Medical care in the United States, is just plain bad, it’s surprising that the public has any respect for the medical profession at all, and maybe it wouldn’t if it hadn’t been brainwashed for generations into believing that “so called Medicine ” in this country has something to offer.

But don’t take my word for it: “at least 40,000 people a year (and perhaps as many as 80,000) die in U.S. hospitals due to complications of misdiagnoses (resulting from no treatment, delayed treatment or wrong treatments).
— one-in-20 autopsies uncover problems that could have been averted — saving the patients’ lives — but weren’t, owing to misdiagnoses
— a Harvard Medical Practice Study found that physician errors were about 60 percent more likely to be diagnostic than due to meds, and misdiagnoses about 50 percent more likely to be negligent than not.
— lawsuits for misdiagnoses are about twice as common as for drug-related errors — and result in the biggest payouts by insurance companies.

This was also headlined in David E. Newman-Toker and Peter J. Pronovost of Johns Hopkins University School of Medicine share these unsettling numbers as the top of their March 11 commentary in the Journal of the American Medical Association.

How many hundreds of thousands died alone from Viox, or from psychotropic medications, that have been shown to cause serious medical problems and do little to help symptoms, yet are still prescribed by the truck load.

This country is without a doubt the most unhealthy industrialized country in the world, with the highest infant mortality, highest rates of drug addiction, and chronic illness..

And oh yes, the Unites States leads the world in diverting presiption medication to the service of drug addiction, Valim, Xanax, Oxycontin, and now Suboxone… and all prescribed by Doctors..

This has a certain luddite appeal, and certainly no one can be opposed to having doctors spend the time to get an adequate medical history.

But, there is a reason for the surge in specialists. Doctors these days can do far more than in the old days, and this is much of the reason that life expectancies are so much higher than in the old days.

  But much of what they can do is complicated and requires expensive equipment which is unaffordable unless it is in constant use. Machines for radiation treatment, for example, cost many millions of dollars. The GP can hardly have one in his office to be used every couple of weeks. And it requires a specialized expertise to use that most doctors have neither the desire or ability to obtain.

  In addition, studies have shown, not surprisingly, that doctors that do many procedures of the same sort get better outcomes for patients. Isn’t that the very definition of ‘specialization’?

  It’s true that, in order to increase their profits, HMOs would prefer to have every procedure done by cheaper and less-well trained medical personnel, but is this what Patients should demand?

  Should we be less happy with the Infectious disease specialist who does a test to find out what your infectious bug is sensitive to and brusquely gives you a prescription which cures you, than with the kindly old doctor who sits by your bed while you die of it

Kaelieh - don’t take up arms just yet. Ever heard of “lost in plain sight?” We don’t live in 1950 anymore. Between a revolution in technology and mass migration from simply being doctors to prenatal cardiologists and geriatric hematology, etc., the medical world has gotten so complicated and fractured that you can’t keep your medical information in a manila folder anymore. I hate to be the one to tell you, but you are floating out there in the electronic medical record universe already. Anyone who really wants to find out about you can today. It just takes some work. Because all this EMR isn’t integrated. Once its integrated, your data becomes part of a much, much larger pool. It’s easier to find, true, but there still has to be intent to get it. In other words, you’re not stopping anyone who wants information you don’t want them to have from getting it by laying down your life to stop EMR, but you are making it a lot harder and more expensive for those out-of-network providers you’re hoping will save your ass to save your ass.

Another benefit of EMR is that it paves the way for eliminating our screwed up universe of competing networks – single-payer healthcare.

You live in a modern world that need modern solutions. The fight you’re proposing would be like a late-19th century man taking up arms against urban public transportation.