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Many US doctors plan to quit

Discussions about the economic and financial ramifications of PEAK OIL

Re: Many US doctors plan to quit

Unread postby smallpoxgirl » Thu 20 Nov 2008, 15:03:11

$this->bbcode_second_pass_quote('3aidlillahi', 'Y')ou were saying that adding more dollars decreasing life expectancy when your own graph says the opposite.


The point I was making about the graph is that from zero to $1500 you get huge improvement in longevity. The US is spending almost 4 times that, and is living less long than most of the countries spending $1500. The peak longevity is in the countries spending between 2800 and 4500. Maybe it's just spurious, but it sure seems that longevity starts to drop off with increasing expenditure for those countries spending over $4500.
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Re: Many US doctors plan to quit

Unread postby ohcomeon » Thu 20 Nov 2008, 15:34:28

$this->bbcode_second_pass_quote('Lumpy', '')$this->bbcode_second_pass_quote('ohcomeon', 'L')umpy,

If your claims aren't past timely filing limits I might be able to help you get that money... I can usually audit the claim data with the notes and RA and figure out what it needs to get it through the system. I am not saying you don't know what you're doing or intend to insult your ability. Just to offer some assistance.

Anyway, you can pm me if you are interested and haven't just chalked it up.


I will PM you (thanks), but did want to say the following in open forum:

1. I'm not insulted, because I DON'T know what I'm doing (clearly - or I would have gotten this mess straightened out), but this points to a BIG problem in the system ... Small-time, solo practice can't afford billing guru, doesn't have time to figure out the hell-maze herself/himself, ends up not getting paid. Without meaning to sound paranoid, one wonders if there isn't some design in place to make small-timers like I was (I gave up that private practice and now contract to the State of Idaho) throw up their hands in disgust AND EXHAUSTION. Bottom line - patients got treated - payors did not have to pay. (I.E. Medicare/Medicaid).

2. My biggest problem by far was the coordination (HAH!!!) between the two Big M's. If a person is on both Medicare and Medicaid, Medicare pays first, then the rest is billed to Medicaid. But navigating the Medicare mess was the problem. So the claims never got paid by them ... and thus never got paid by 2nd payor, Medicaid.

3. Someone mentioned electronic filing. Yeah. Great idea, because I am a computer freak - so I like the idea in theory. Except for the HIPPA thing. ARGHHHHHHHHH! And the cost of setting up (lots of up front $$). Solo practices in rural areas and/or primary care where the $$ are the lowest are going to have trouble putting together what it takes to file electronically.

Lumpy


I hear you on all three points. And that's the reason there are so few single private practices anywhere now days. It's easier for providers to pay for the staff when they group or to contract under a hospital system or provider organization.

Setting the electronic billing up is not that hard, but can be expensive depending upon the software you use. The last system we purchased (2 years ago) with electronic medical records for multiple providers and full practice management resources was around $25,000, not including hardware. It is not, by far, the most expensive, but certainly not the least expensive system out there. I have seen systems for a few thousand that would handle a one provider office quite well. The system we bought was MYSIS/TIGER. It's good, but a bit cumbersome until you get used to it. I will say this. Electronic charting makes it a bit more difficult, but with only one provider using it, and with the system only having to cater to your desires and not 8 or 10 other doctors, it would not be such a big deal. MYSIS is pretty good about helping you get all your HIPPA ducks in a row as well. With a good deal of work on the front end, it can pay for itself by increasing your collection rates tremendously. For a single provider, you wouldn't need anyone other than your one receptionist, etc. to do all the work since it's all automated. (AFter the initial set up.)

I know you are contracted now, so not sure how you bill. But in the future if you consider going it alone you might want to look at the options.
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Re: Many US doctors plan to quit

Unread postby dream16 » Thu 20 Nov 2008, 15:47:32

sorry to butt in....but.

Yall are reading way too much into this. It comes down to this...MONEY... If your not making money enough to feed your family at the job your at now you would just be banging your head against a wall to continue to do the same job.
My husband is a DR., he is not primary care but might as well be .. he is a chiro. and treats all kinds of ailments. The hours are long the pay is crap and the stress is out of this world. The insurance companys dont or wont pay the people are usually pretty good with cash but you still get those that try to screw you. and to those who have this false hood dream that we are there only for you and we owe it to you . lol. We are prepping too. He is self employed and has 1 employee.... me. We barely make the bills, we have 2 cars down. 1 of those is our hog truck that we use to hunt and trap in ... 1989 P.O.S. The weekends are piled high with gardening, tending to yet another vehicle emegency, trapping, cutting firewood, trapping, house repairs, tin salvageing for the goat shed.... the list goes on..... and we owe you . Try again.
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Re: Many US doctors plan to quit

Unread postby ohcomeon » Thu 20 Nov 2008, 15:56:21

$this->bbcode_second_pass_quote('dream16', 's')orry to butt in....but.

Yall are reading way too much into this. It comes down to this...MONEY... If your not making money enough to feed your family at the job your at now you would just be banging your head against a wall to continue to do the same job.
My husband is a DR., he is not primary care but might as well be .. he is a chiro. and treats all kinds of ailments. The hours are long the pay is crap and the stress is out of this world. The insurance companys dont or wont pay the people are usually pretty good with cash but you still get those that try to screw you. and to those who have this false hood dream that we are there only for you and we owe it to you . lol. We are prepping too. He is self employed and has 1 employee.... me. We barely make the bills, we have 2 cars down. 1 of those is our hog truck that we use to hunt and trap in ... 1989 P.O.S. The weekends are piled high with gardening, tending to yet another vehicle emegency, trapping, cutting firewood, trapping, house repairs, tin salvageing for the goat shed.... the list goes on..... and we owe you . Try again.


Sorry, dream16, but I never met a doctor, solo or not, who didn't make more than me. And I paid the bills on my salary. So could they. In fact, in the last five years I worked for primary practice (2002-2007), we had no doctors, not even the part-timers, who made less than six digit incomes. And yes, that was their pay check after the practice expenses.

Maybe that's because I was good at my job, though... :twisted: Yeah, that's it... I'll take the credit for it. :wink:

Really, though, I only ever worked for one solo practice. And
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Re: Many US doctors plan to quit

Unread postby ohcomeon » Thu 20 Nov 2008, 15:58:19

Hit send too soon. Sorry.

Meant to say I and that was probably too long ago to count. That doctor did have trouble making ends meet. But it wasn't insurance companies that did him in. It was women and booze. Too much of each.
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Re: Many US doctors plan to quit

Unread postby AgentR » Thu 20 Nov 2008, 15:59:00

$this->bbcode_second_pass_quote('EnergyUnlimited', 'T')he problem is that primary doctors (first contact doctors) are not making much input to treatment altogether.
All their use is in referring patient to specialist if alignment is serious enough.


But how many of them do that because that is what they think the patient is demanding, and if something goes wrong, the patient will sue because they didn't get a specialist.

Short story, skiing, I got a tibial plateau fracture with no displacement; each individual contact I had with a doc assumed I wanted the "take a look, and refer", exercise (aid clinic, and my GP); when I got to my doc and said, "no, you deal with it."... Guess what. He said,... "no problem." Did a couple xrays over the next couple months, made sure I was wearing my little brace right and not being an idiot... leg healed fine.

GP's can, and WILL, treat.

That Americans expect to be sent to an orthopedic surgeon to handle a stupid fracture is at the heart of a lot of our medical practice problems.

PS: Doesn't mean our current payment system isn't completely screwed up.

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Re: Many US doctors plan to quit

Unread postby dream16 » Thu 20 Nov 2008, 16:21:01

$this->bbcode_second_pass_quote('ohcomeon', '')$this->bbcode_second_pass_quote('dream16', 's')orry to butt in....but.

Yall are reading way too much into this. It comes down to this...MONEY... If your not making money enough to feed your family at the job your at now you would just be banging your head against a wall to continue to do the same job.
My husband is a DR., he is not primary care but might as well be .. he is a chiro. and treats all kinds of ailments. The hours are long the pay is crap and the stress is out of this world. The insurance companys dont or wont pay the people are usually pretty good with cash but you still get those that try to screw you. and to those who have this false hood dream that we are there only for you and we owe it to you . lol. We are prepping too. He is self employed and has 1 employee.... me. We barely make the bills, we have 2 cars down. 1 of those is our hog truck that we use to hunt and trap in ... 1989 P.O.S. The weekends are piled high with gardening, tending to yet another vehicle emegency, trapping, cutting firewood, trapping, house repairs, tin salvageing for the goat shed.... the list goes on..... and we owe you . Try again.


Sorry, dream16, but I never met a doctor, solo or not, who didn't make more than me. And I paid the bills on my salary. So could they. In fact, in the last five years I worked for primary practice (2002-2007), we had no doctors, not even the part-timers, who made less than six digit incomes. And yes, that was their pay check after the practice expenses.

Maybe that's because I was good at my job, though... :twisted: Yeah, that's it... I'll take the credit for it. :wink:

Really, though, I only ever worked for one solo practice. And


well you evadently were not in a town of 3000 with 75% medicare and the rest medicaid, private ins. and cash. Oh did i mention that we draw from no less than 7 counties around us. And we do work with barter like the old dr.s used to and he will make house calls and we will go in the office if its the weekend and an emergency and we do care about the people if they are old and or poor we work with them, trade out or what ever they can manage. Maybe thats why we dont make a 6 figure income .... because we care and are going to do the best we can to help regardless of what it means. hmmm I have countless jars of jam still waiting to be sampled, have had some of the best homemade bread and sweets you could immagine and dont get me wrong it does help and it is wonderful to have but it dont pay the bills and fix the cars.
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Re: Many US doctors plan to quit

Unread postby IgnoranceIsBliss » Thu 20 Nov 2008, 16:34:41

We're eating ourselves to death here in the US.

Our policies are making it worse (subsidizing corn for high fructose corn syrup but not fresh fruit & vegetables). Junk food is dirt cheap and saves preparation time. Advertisers push this junk on children by advertising on the kid channels (banned in some other countries).

Then you have Medicaid and Medicare - gov't programs for the poor and elderly. Need a motorized scooter because you're too fat to walk? No problem - the gov't will pay for it. Smoked yourself to lung cancer? No problem - the gov't will pay for your "treatments" to prolong certain death at the taxpayer's expense. Eat junk and sit on your butt all day? No problem - the gov't will pay for your diabetes testing supplies and your numerous doctor's appts. Folks, we have an epidemic of diabetes, including children now. Just wait until the real cost of that hits us down the road. Same with kidney stones and childhood obesity. Doctors are now seeing kidney stones in young children due to a high salt diet and not enough water. We have 2 year olds (and younger) drinking Coke. (I've seen it myself - I used to be a teacher)

It's very difficult to buy anything decent at your average grocery store these days. Instead, all you can find is processed, packaged junk loaded with sugar, preservatives, artificial color and sugar.

The vast majority of our healthcare costs here in the US are driven by a handful of chronic conditions (heart disease, diabetes, etc) as well as the high cost of prescription drugs which we use to treat everything, when instead we could simply modify our diet and get more exercise. But you won't hear this from the politicians. They are intent on convincing us that the high cost is due to greedy lawyers and malpractice issues. (true, those are expensive too but the real heavy is these preventable conditions that everyone is developing!) Obesity is growing, which leads to arthritis, knee replacement, motorized carts, and going on disability due to inability to work.

Since we still insist on saddling employers with the cost of medical care for their workers, we can expect further cutbacks in offerings, esp as jobs become scarce. When companies try to provide incentives for workers to get in shape, it doesn't work. So now companies are implementing higher paycheck deductions for smokers (smokers are crying foul because they say they should be able to smoke at home or on their own time if they want), and also some are requiring weigh-ins and charging higher rates if employees don't lose the weight. (the horror! how dare they! I'm entitled to my benefits!) I say bravo. Someone has to take control of this mess.

We also have an abysmal rate of premature birth, which is VERY expensive. That has got to be controlled and soon. Some areas of the US have infant death rates as high as third world countries.

I wonder if we will ever get some common sense and start telling people plain and simple: we can't afford to pay for preventable illnesses. You are on your own! I for one am tired of paying higher premiums for all of the fatsos (and I see plenty of them here in Georgia). We will soon confront a major budget crisis in Medicaid and Medicare (but all you hear about is how bad Social Security is) and maybe that will force the tough decisions. (or the die off that we keep hearing about on here will thin the herd so to speak)

One last issue - pediatrics. Everyone has kids who are constantly sick. Most of the other moms that I know have kids who get constant ear infections (which leads to surgery to implant tubes). We act like this is perfectly ok! We also do not promote breast feeding as we should. My 2.5 year old has only been sick one time and my 3 month old is doing great. Never had ear infections. But we don't want to step on the toes of the formula industry! So when you give birth in the hospital, you get a nice little gift bag of formula from one of the big makers. We are practically pushing this crap on new mothers. Did you know that one of the main ingredients in formula is high fructose corn syrup? Horrid.

Same issue with promoting healthy eating. If the government really came out with a forceful message, the junk food lobbyists would quickly clamp down and force us to shut up.
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Re: Many US doctors plan to quit

Unread postby galacticsurfer » Thu 20 Nov 2008, 16:38:29

After PO you are in the right position as cash might not be so important and high tech treatment won'tbe available as computers adns tuff break down and insurance stops being available or paid. In other words you don't have far to fall whereas a rich city specialist will be unable to adjust to the new paradigm.
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Re: Many US doctors plan to quit

Unread postby dream16 » Thu 20 Nov 2008, 16:47:53

$this->bbcode_second_pass_quote('galacticsurfer', 'A')fter PO you are in the right position as cash might not be so important and high tech treatment won'tbe available as computers adns tuff break down and insurance stops being available or paid. In other words you don't have far to fall whereas a rich city specialist will be unable to adjust to the new paradigm.


Thank you... and mind you we are not thinking of quitting .. all I was stating is that alot of the DR.s are over worked and under paid . Stress is a big killer too . But we love what we do. The red tape is what we hate. I dont envy the big city guys with all thier money and employees. I would rather do it this way and be closer to the ground. We will always be covered the way we have chosen to operate. So what if the money runs out .. the food wont.
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Re: Many US doctors plan to quit

Unread postby 3aidlillahi » Thu 20 Nov 2008, 16:52:57

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('3aidlillahi', 'Y')ou were saying that adding more dollars decreasing life expectancy when your own graph says the opposite.


The point I was making about the graph is that from zero to $1500 you get huge improvement in longevity. The US is spending almost 4 times that, and is living less long than most of the countries spending $1500. The peak longevity is in the countries spending between 2800 and 4500. Maybe it's just spurious, but it sure seems that longevity starts to drop off with increasing expenditure for those countries spending over $4500.


Statistically, those differences in life expectancy are nothing. Plus, you have to remember that we're looking at a 2-D graph with only one independent variable (costs) with one dependent variable (life expectancy) while in real life there are likely dozens of variables that are significant that we're simply not looking at here (genetics, murder rate, suicided rate, accident death rate, etc.).

As to the general thread, one thing that amazes me is the fact that so many patients are treated and the doctor (and thus nurse, PA, recep, etc.) never get paid. I have no idea how long I'd last as a private practice doctor if I had to go through hoops to get paid.
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Re: Many US doctors plan to quit

Unread postby gwmss15 » Thu 20 Nov 2008, 16:53:10

I have no idea why one would need to visit the doctor minor illnesses.

In My city the 1st port of call when your sick or injured is the local high street pharmacy store. Where almost any kind of medicine can be purchased from antibiotics of 50 different kinds to heart medicine. all you do is describe your condition to the staff member in the shop and he asks you a set of detailed questions about your illness and give you some medicine you also have a choice of "western medicine" or "Chinese medicine".

So for something like really bad stomach disorders your out the door in 10 mins for about US$5 and 4 or 5 high quality medicines. Often imported from Europe or even the USA at 10 times lower cost.

If your condition doesn't improve after a day or 2 you can then head off to a govt hospital and see a real doctor and pay only USD$1.10 plus another USD$1 to 5 medicines. All the tests are free.

OR of you prefer a faster service with hotel care go for a private hospital where you get the same service but in nicer surroundings with newer machines etc. The costs at these start from USD$30 including most common medicines. Just pay cash or credit on the way out no insurance needed.

However due to an unfair policy in the immigration laws if you don't have a passport or visa i.e illegal worker. They will not treat you in a hospital either govt or private. SO there are many underground "hospitals" where they can see a doctor. Who is often not fully qualified. But are upfront about it so you will know if you want to trust him to see to your illness.

Suing medical staff is very difficult here and almost impossible for govt operated hospitals. The stuff up would have to be out of this world with very strong support evidence to even get heard in court. Plus the claim would have to be quite large around USD$25000 at minimum. only a few cases have been successful and these where all from doctors stuffing up really bad i.e incorrect procedures for that illness.

I have no idea why its so expensive in the US for healthcare and why there is no govt healthcare system that is open to all at very low prices. The time of this post could not be better as i had viewed a documentary about this very issue on TV and was shocked at the way the US govt treats its sick and poor. It is worse that what is offered in Laos or Cambodia where they have hardly any money to provide it.

There are some things like this that make me very glad not to live in the USA. People often think Thailand is 3rd world its not that bad in the end its medical system is better for a start and cheaper for the majority.

Don't get me started on urban mass transport either Thailand beats most of the US hands down on that one even with 50 year old infrastructure.
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Re: Many US doctors plan to quit

Unread postby ohcomeon » Thu 20 Nov 2008, 16:56:27

dream16,

You're right. I wasn't working for a doctor who did any of what you mentioned. Although we are a high percentage Medicare/Medicaid area due to being a textile town that lost all it's jobs years ago to foreign countries. We are definitely a low income area. Higher population, though (about 20,000) and no bartering, house-calling docs.

I applaud you for your ideals. Keep it up as long as you can. I am sure your patients appreciate it as well. The ones with any sense anyway.
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Re: Many US doctors plan to quit

Unread postby dream16 » Thu 20 Nov 2008, 17:06:34

ohcomeon,

Thank you . I believe in what we do . Our patients believe in us as well. Our efforts today have netted us a 4 wheeler that needs new tires, a battery, and some gas. Traded out for... thank you for being there for us.... hmmm . I can use that .... good hunting vehicle!
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Re: Many US doctors plan to quit

Unread postby dohboi » Thu 20 Nov 2008, 18:28:55

Very well put, gwmss15.

The main problem with US medicine (and much else about the culture) is that it is seen primarily as a way to make $$$$$$.

I now avoid doctors, hospitals, even dentists, because it is clear to me that they are primarily driven by the profit motive--I am not looked at as a patient but primarily as a potential enhancement of their revenue stream.

I blame this mostly on the MBA's who now run the system, but the AMA must share blame in strongly opposing any kind of socialization of medicine.

The UK is very far from having a perfect or even adequate system, and many Brits are even worse that Americans about eating poorly and barely exercising. But the top 20% of Americans have worse health on average than the bottom 20% of Brits. This must be almost completely due to our bass-ackwards medical system
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Re: Many US doctors plan to quit

Unread postby smallpoxgirl » Thu 20 Nov 2008, 18:38:43

$this->bbcode_second_pass_quote('ohcomeon', 'S')orry, dream16, but I never met a doctor, solo or not, who didn't make more than me. And I paid the bills on my salary. So could they. In fact, in the last five years I worked for primary practice (2002-2007), we had no doctors, not even the part-timers, who made less than six digit incomes. And yes, that was their pay check after the practice expenses.


You have not met all doctors. My gross income for last year was $19,000.
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Re: Many US doctors plan to quit

Unread postby Snowrunner » Thu 20 Nov 2008, 18:53:56

$this->bbcode_second_pass_quote('smallpoxgirl', 'Y')ou have not met all doctors. My gross income for last year was $19,000.


Was that what your tax return stated or what you actually billed / were paid before any deductions? :)
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Re: Many US doctors plan to quit

Unread postby vision-master » Thu 20 Nov 2008, 18:56:55

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('ohcomeon', 'S')orry, dream16, but I never met a doctor, solo or not, who didn't make more than me. And I paid the bills on my salary. So could they. In fact, in the last five years I worked for primary practice (2002-2007), we had no doctors, not even the part-timers, who made less than six digit incomes. And yes, that was their pay check after the practice expenses.


You have not met all doctors. My gross income for last year was $19,000.


I don't feel sorry for you......... :razz:
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Re: Many US doctors plan to quit

Unread postby smallpoxgirl » Thu 20 Nov 2008, 19:12:29

$this->bbcode_second_pass_quote('Snowrunner', 'W')as that what your tax return stated or what you actually billed / were paid before any deductions? :)


I guess I should say that's the net. It's after business expenses. I was starting up a practice so I had lots of deductions and not a lot of income. And no I didn't cheat on my taxes if that's what you're implying.
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Re: Many US doctors plan to quit

Unread postby vision-master » Thu 20 Nov 2008, 19:16:40

$this->bbcode_second_pass_quote('smallpoxgirl', '')$this->bbcode_second_pass_quote('Snowrunner', 'W')as that what your tax return stated or what you actually billed / were paid before any deductions? :)


I guess I should say that's the net. It's after business expenses. I was starting up a practice so I had lots of deductions and not a lot of income. And no I didn't cheat on my taxes if that's what you're implying.


Maybe you did,,,,,,,,,,, unknowingly.


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