Posted on 06/08/2008 4:33:55 PM PDT by neverdem
Thanks for the link, great timing!
The hospitalist practice model is attractive to many internists. In our organization, they work 7 days on and 7 days off with 12 hour shifts and take no call. They are salaried employees. However, the turnover is incredible. Also, the patient satisfaction is less than optimum. Before my mother died, she was admitted to our largest hospital and asked me to discuss her care with her. While her care was technically fine, she didn't like the endless number of hospitalists and advanced practice nurses sent in to see her. She became particularly disturbed when a nurse practitioner she had never met before told her she needed to go to a nursing home. At that point, she asked me to find her an internist and I went to a competing organization in town to get her one.
Same position here. I see an internist from a competing group in town and would seriously consider being admitted to a competing hospital if the need arose. I imagine I could pull some rank and arrange something like that in our place but it just doesn't seem right when the everyday patient can't do that. I'm 55 and hoping to retire in the next two years. I actually can't wait but there is always the question of security and how much one needs to retire.
It became a goal for everyone to go to college, whether they actually had the aptitude or not. The SAT's have been renormed many times, and college became an industry. Everyone should go, even if they take a useless and stupid major with no occupational value.
Consider this: The best house in my neighborhood was owned by the parts manager of a Ford dealership...Till they moved to a better neighborhood. A really good mechanic, welder, or plumber will always make more than a mediocre engineer, whether it is heresy or not.
The doctor's televison broke and he called a repairman. The repairman replaced a failed part and presented the bill: $360.00.
The doctor exploded, "I am a DOCTOR and I don't make $360.00 an hour!"
"Neither did I, when I was a doctor."
But the way things are going my ace in the hole for my family for routine care under HilerbamaCain Care: we have a vet in the family.
our hospitalist group is salaried as well. WE do not have a set number of days on/off but the schedule varies. We do not employ physician extenders, and try to work it so the pts have one or at most 2 hospitalists responsible for their care during their stay.
Our patient satisfaction is actually very high and I think the hospitalist movement has improved care significantly. Im sorry you had a bad experience. Im glad you were able to find an outpatient internist, that is getting to be a rare breed. MOst of my hospitalist group is like me - about 50ish, and joining a hospital practice after 20 years in primary care because the lifestyle is no longer sustainable.
See my post #68;
The statistics are quite the opposite of what you are saying. Family Practice slots very seldom fill; If anything, there is a glut of Subspecialists - the ratio of PCP:subsp is the exact opposite in America as that of other industrialized nations - 30:70 vs. 70:30.
Yeah, it went hand in glove with "natural" childbirth.
Family practice residency programs are also a boon to medical centers because of the cheap, enforced labor. Now these residency programs can't get American med school grads and are filling up with Muslim immigrants.
However--the other sell for being an FP was a genuine one and appealed to a talented medical student--the desire to have a broad pool of interesting patients, to not do the same thing all day. (Think Lasik surgery). The opportunity to take care of an entire family over years--and this was true in the beginning. FPs would be small-town docs in the tiny regional hospitals and they liked delivering the baby and also being that baby's pediatrician.
But litigiousness stopped that--too much risk. And the little hospitals closed down because they were crtiticized for not being as good as the big hospitals. Well, d'uh.
Now you never hear a doc wanting his kid to go to medical school--which is the most telling development of all. Docs are sick and tired of the resentment of the general public, who are encouraged by the media to blame physicians for the high cost of medical care.
Soon--the cost won't be the problem. Availability will be the problem.
What people here don't realize is that this in itself is horrible--there's nothing better than a seasoned doc with decades of experience.
Remember when Old Doc would cut back gradually on his practice well into his seventies, his patients getting old along with him, and was a resource for all the younger docs in town? Now docs squirrel away every cent to retire early and remove all that experience from the system .
And ask these docs if they like taking care of patients, they almost always say that they love the practice of medicine. It's all the stuff that comes with it now that they can't stand.
One of the most outrageous things about this is that the media constantly fans the flames of resentment toward doctors for making a decent living.
Some of you may know of news anchor Bill Bonds of Detroit. I don’t know he could do this with any conscience, but he once complained that some heart surgeons made as much as a million dollars a year (saving lives!). All the while, he made millions per year reading then news from a teleprompter! What’s the difference in the required skill level here, Bill? How arrogant and self centered can you be?
Doctor’s reimbursement has gone down 350% since 1990. Costs, including overhead of course, have gone up like costs for everything else. Who do you think is pocketing all that medical spending dollars that is a huge chunk of GNP?
No one smart enough and hard working enough to be a doctor would now want to become a doctor. Of course the field is now flooded by women. Medicine is become like teaching and social work - low paying burn out fields with long vacations. (see France during the summer heat of 2003 when 15,000 died). Just try to get any doctor including your own to see you on a weekend or holiday.
We may as well have socialized medicine.
And ask these docs if they like taking care of patients, they almost always say that they love the practice of medicine. It’s all the stuff that comes with it now that they can’t stand.
You nailed it!
Women will soon dominate in medicine--they make up over half of med school students now. There are, of course, a few female subspeciaty surgeons--but typically women choose the less physically demanding specialties and not the ortho or neuro. Once again, the dangerous shortage of trauma surgeons.
Women also design medical careers with a family in mind--working fewer hours and accepting less pay and prestige. And not a few marry doctors and never practice medicine at all.
Every indication is that we will have fewer docs working fewer hours as we get older--and the boomer docs will begin their retirements shortly.
Remember the smug assertion by those envious of the perceived privileges of doctors about the "coming doctor glut"? And Hillary managed to shut down the building of a few new medical schools.
Agreed.
Very seldom fill, NOW.
I am talking about historical swings I have witnessed.
As the pendulum swings into the undesirable, people stop trying to get on it.
In the past 15 years, FP was strongly pushed, women flocked to FP, the new generation had "quality of life concerns", they cut back on OB because of liability, they cut back on hours for "lifestyle" reasons, they stopped doing inpatient care because that's why God created "Hospitalists", they wondered why they were not being paid much more than outpatient Nurse Practitioners and PA's for doing pretty much the same thing and then they bailed out of FP practices altogether to go into the Mommy Track.
I have seen it again and again and again over the last 15 years.
I remember a conversation with our medical director about 18 years ago when 2 physicians had left out group and we tried to figure out what we had done wrong.
Docs, especially in primary care, have become commodities being traded on the open market. This is not good in my opinion for primary care and, more importantly, their patients.
It's like that in a lot of professions these days. Experience is walking out the door. I can't speak for the medical profession, but in the electric utility industry, jobs that normally went to seasoned veterans looking towards retirement are now going to new engineering grads. And the system is trying to replace experience with written procedures. It's not working, but the solution from the top is to write more procedures, somehow expecting different results.
I don't know a great deal about the medical profession, but from conversations with a couple of nurses I know, a good deal of their time is now eaten up with paperwork instead of caring for patients. It's understood that in this profession, things have to be documented, but they tell me that there are a number of government-mandated logging procedures that now exist and must be followed.
Our local not-for-profit hospital administrator made more than that before talking the board into selling the hospital. (Were we all surprised!)
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