Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 There's a great line in the movie " Doc Hollywood " where George Hamilton is explaining the medicine business to Michael J Fox, " Today, medicine is a volume business. " We might agree that this is terrible, but the fact is that the current payer (or non-payer) system has created a situation where a doctor has to see x number of patient per hour to break even. I'll bet you that nearly every doctor knows that number off-hand. Until their fees are allowed to rise to a level that will allow them to lower this number, we're going to see a continuation of the sort of splap-dash medicine we see now. This assumes that they do lighten their schedules and just don't pocket the profits. This is one reason that I think masage therapy is an unlikely takeover target by physicians. They may try to control it by reserving it for the PTs, but there isn't enough money in it to make it interesting as such. The $50/hour that I'm happy to get from my clients isn't going to go a long way to paying off a quarter million dolloar student loan. They may try to claim that what we do isn't " safe and effecatious " , which is why I feel that we need to put together solid studies, combining their techniques and the special knowledge that we have. Our best defense is knowledge. Ours, the public's, and the physicians that we are able to reach. >Caroline Abreu <crow > > >Re: The Antique GP >Wed, 22 Mar 2000 08:21:50 -0500 > >I don't think it's feasible for medical schools, the way they are >configured now, to train people " the old way " ... there are so many >technological things to learn and absorb that there is little time for >interpersonal skills or complementary data. Between sleep deprivation >and the pressure of knowing they will begin their careers in heavy debt, >I am sure whatever they started out to be, medical students are not the >same afterwards. > >You are right, they are " beaten " at every corner by the system. I don't >know of many who have the initiative or ability to break free, and those >that have do not have an easy go of it. But there is something sad about >losing those old skills for the sake of expediency. > >I thought, at one time, that the advanced practice nurse would replace >the GP, but in most of the venues where they work, they are just as >pressed by the same constraints as their physician counterparts :-( > >Carl Weisbrod wrote: > > > > ~~~~~~~~~~~~~~~~~~~~~~ > > Yeah...I can remember the ol' GP. They were wonderful docs! I grew > > up in a small farming community in the 40s and 50s and that's all we > > had. I think there are lot of new doctors that would love to practice > > medicine like that--but the " system " beats the notion out of them: the > > insurance system/HMOs, the legal system, the bureaucratic system, > > etc. And it would have been so easy, and even cost effective, to hand > > that great process off to the nurse practitioner. > > > > Do you think it will ever return? ...in some small measure? > > >-- >--- >Blessings, >Crow > " Look for Rainbows in the Darkness " >--- ____ Get Your Private, Free Email at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 That sounds about right, just under seven minutes per patient. Got a problem with that? Should be enough time to do a complete work-up, arrive at a diagnosis, determine the appropriate treatment, and deliver/explain it to the patient. (hopefully there's little doubt that I'm being facetious, here) Part of the problem is that physicians have incredible over-head. Most of them start their profession in serious debt. My massage therapy training has cost me around 7-8 thousand, which probably wouldn't cover books at any med school other than the University of Grenada. Their insurance costs are considerably higher than the $250-300 that I pay. They need way more equipment than we do and their interaction with the Health Insurance industry requires them to retain a staff that I don't need. I also lay some of this at the feet of managed care. I heard an NPR piece the other day where a doctor was complaining that his fees for specific services had dropped some two-thirds. This increases the problem because now he needs to see even more patients to hit his break even point. Now, please understanding that I'm not defending the current state of health care. Get me on my soapbox and I'll go on for paragraphs on how they nearly killed my wife. But, it makes sense to me to try to understand how things have gotten to where they have. I'm sure that the majority of physicians would like to offer better care than they do, but they see themselves trapped in a system where they are financially penalized for doing so. Until the insurance industry either starts to look at time spent per patient as an indicator of patient care, or alternatively, is abolished in favor of a single payer system, doctors are going to see us as a threat instead of a body of professionals who can cooperate with them to provide improved care. Until then, we're likely to see a lot of resistance to what we do from some physicians and naked attempts to catagorize our work as best being done by physical therapists, which are already under their control. >redtail29 > > > The Antique GP >Wed, 22 Mar 2000 11:48:44 EST > >In a message dated 3/22/00 7:39:00 AM Pacific Standard Time, >rayhuntermt writes: > ><< Today, medicine is a > volume business. " We might agree that this is terrible, but the fact is >that > the current payer (or non-payer) system has created a situation where a > doctor has to see x number of patient per hour to break even. I >> > > > Ray, I have to agree with you whole heartily. I work for a physican that >schedules 35 patients in a 4 hour slot. 80% of those are told to return >for >follow up visits in a few weeks or months. While checking patients in and >asking how they are doing they often say great I feel so much better. Then >I >ask why are you here to see the doc today? They reply I dont know he wanted >me to come back in after 2 weeks. >It is very disheartning. I am very disapointed in the medical field. I >entered this career 7 yrs ago. What an eye opener it has been. >Diane ____ Get Your Private, Free Email at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 I don't think it's feasible for medical schools, the way they are configured now, to train people " the old way " ... there are so many technological things to learn and absorb that there is little time for interpersonal skills or complementary data. Between sleep deprivation and the pressure of knowing they will begin their careers in heavy debt, I am sure whatever they started out to be, medical students are not the same afterwards. You are right, they are " beaten " at every corner by the system. I don't know of many who have the initiative or ability to break free, and those that have do not have an easy go of it. But there is something sad about losing those old skills for the sake of expediency. I thought, at one time, that the advanced practice nurse would replace the GP, but in most of the venues where they work, they are just as pressed by the same constraints as their physician counterparts :-( Carl Weisbrod wrote: > > ~~~~~~~~~~~~~~~~~~~~~~ > Yeah...I can remember the ol' GP. They were wonderful docs! I grew > up in a small farming community in the 40s and 50s and that's all we > had. I think there are lot of new doctors that would love to practice > medicine like that--but the " system " beats the notion out of them: the > insurance system/HMOs, the legal system, the bureaucratic system, > etc. And it would have been so easy, and even cost effective, to hand > that great process off to the nurse practitioner. > > Do you think it will ever return? ...in some small measure? > -- --- Blessings, Crow " Look for Rainbows in the Darkness " --- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 I don't see doctors going into massage because it is too labor intensive. Though they may try to fool around with massage credentialing... The biggest problem with our health care system, in my opinion is that it is profit-driven. Since it was set up this way, it will be very hard to change it. MichelleH --- Ray Hunter <rayhuntermt wrote: > " Ray Hunter " <rayhuntermt > > There's a great line in the movie " Doc Hollywood " > where George Hamilton is > explaining the medicine business to Michael J Fox, > " Today, medicine is a > volume business. " We might agree that this is > terrible, but the fact is that > the current payer (or non-payer) system has created > a situation where a > doctor has to see x number of patient per hour to > break even. I'll bet you > that nearly every doctor knows that number off-hand. > Until their fees are > allowed to rise to a level that will allow them to > lower this number, we're > going to see a continuation of the sort of > splap-dash medicine we see now. > This assumes that they do lighten their schedules > and just don't pocket the > profits. > > This is one reason that I think masage therapy is an > unlikely takeover > target by physicians. They may try to control it by > reserving it for the > PTs, but there isn't enough money in it to make it > interesting as such. Talk to your friends online with Messenger. http://im. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 One thing that I would like to see done away with and this does seem feasible is the amount of hours straight a doctor is allowed to work. Now, some states have instituted this - like NY, I think. My cousin is a med student at John Hopkins. He has been turned off practicing medicine by all he has seen especially with managed care. He has just been accepted to John Hopkins Public Health program which he will do along with getting his MD because of this. He hopes to do his residency in a state that has these hour restrictions. I mean what positive purpose is there in having someone there for more than 24 hours straight. It isn't a benefit to the doctors and certainly not to the patients they see! MichelleH --- Caroline Abreu <crow wrote: > Caroline Abreu <crow > > I don't think it's feasible for medical schools, the > way they are > configured now, to train people " the old way " ... > there are so many > technological things to learn and absorb that there > is little time for > interpersonal skills or complementary data. Between > sleep deprivation > and the pressure of knowing they will begin their > careers in heavy debt, > I am sure whatever they started out to be, medical > students are not the > same afterwards. > > You are right, they are " beaten " at every corner by > the system. I don't > know of many who have the initiative or ability to > break free, and those > that have do not have an easy go of it. But there is > something sad about > losing those old skills for the sake of expediency. > > I thought, at one time, that the advanced practice > nurse would replace > the GP, but in most of the venues where they work, > they are just as > pressed by the same constraints as their physician > counterparts :-( Talk to your friends online with Messenger. http://im. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 One thing that I would like to see done away with and this does seem feasible is the amount of hours straight a doctor is allowed to work. Now, some states have instituted this - like NY, I think. My cousin is a med student at John Hopkins. He has been turned off practicing medicine by all he has seen especially with managed care. He has just been accepted to John Hopkins Public Health program which he will do along with getting his MD because of this. He hopes to do his residency in a state that has these hour restrictions. I mean what positive purpose is there in having someone there for more than 24 hours straight. It isn't a benefit to the doctors and certainly not to the patients they see! MichelleH --- Caroline Abreu <crow wrote: > Caroline Abreu <crow > > I don't think it's feasible for medical schools, the > way they are > configured now, to train people " the old way " ... > there are so many > technological things to learn and absorb that there > is little time for > interpersonal skills or complementary data. Between > sleep deprivation > and the pressure of knowing they will begin their > careers in heavy debt, > I am sure whatever they started out to be, medical > students are not the > same afterwards. > > You are right, they are " beaten " at every corner by > the system. I don't > know of many who have the initiative or ability to > break free, and those > that have do not have an easy go of it. But there is > something sad about > losing those old skills for the sake of expediency. > > I thought, at one time, that the advanced practice > nurse would replace > the GP, but in most of the venues where they work, > they are just as > pressed by the same constraints as their physician > counterparts :-( Talk to your friends online with Messenger. http://im. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 At 01:53 PM 3/22/00 -0500, you wrote: >Caroline Abreu <crow > > >A big Amen on this, Ray... and I agree, MDs might like to do something >as labor intensive (but intrinsically wonderful) as bodywork, but they >are limited in too many ways from this. However, I also see this as a >problem for Physical Therapists, who can only work by prescription and >have time limitations, themselves. > >Nobody really wants to do what MTs do... they just don't want them to do >it without being regulated up the wazoo <LOL> And unfortunately, in many >states, energy work is regulated as a form of massage (like Florida) >despite its obvious differences. The issues of " who decides " about a >profession's regulation are very important; if the profession itself >does not grab that control early, they may find themselves enslaved to >someone else's idea of what they can and cannot do. > >I used to work on a surgical unit that was heavilly orthopedic, and the >Orthopedic Surgeons were very verbally disparaging about massage and >other complementary or supportive health methods. Unfortunately, many of >the problems they " fixed " by chopping would have resolved themselves >with a little time and some chiropractic and massage therapy. This is >why the public should be educated at every opportunity that there are >kinder options than rushing at the operating room or the pill bottle. > >Ray Hunter wrote: > > > > > > Until the insurance industry either starts to look at time spent per > patient > > as an indicator of patient care, or alternatively, is abolished in favor of > > a single payer system, doctors are going to see us as a threat instead of a > > body of professionals who can cooperate with them to provide improved care. > > Until then, we're likely to see a lot of resistance to what we do from some > > physicians and naked attempts to catagorize our work as best being done by > > physical therapists, which are already under their control. > > > >Blessings, >Crow > " Look for Rainbows in the Darkness " ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I have always believed it's better to stay unregulated. A professional group is easier to hassle once they get a license...and then there's the in-fighting--turf battles, etc. The best transactions I had were with my patients, not with " peer " groups. Carl http://askcarl.net Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 A big Amen on this, Ray... and I agree, MDs might like to do something as labor intensive (but intrinsically wonderful) as bodywork, but they are limited in too many ways from this. However, I also see this as a problem for Physical Therapists, who can only work by prescription and have time limitations, themselves. Nobody really wants to do what MTs do... they just don't want them to do it without being regulated up the wazoo <LOL> And unfortunately, in many states, energy work is regulated as a form of massage (like Florida) despite its obvious differences. The issues of " who decides " about a profession's regulation are very important; if the profession itself does not grab that control early, they may find themselves enslaved to someone else's idea of what they can and cannot do. I used to work on a surgical unit that was heavilly orthopedic, and the Orthopedic Surgeons were very verbally disparaging about massage and other complementary or supportive health methods. Unfortunately, many of the problems they " fixed " by chopping would have resolved themselves with a little time and some chiropractic and massage therapy. This is why the public should be educated at every opportunity that there are kinder options than rushing at the operating room or the pill bottle. Ray Hunter wrote: > > > Until the insurance industry either starts to look at time spent per patient > as an indicator of patient care, or alternatively, is abolished in favor of > a single payer system, doctors are going to see us as a threat instead of a > body of professionals who can cooperate with them to provide improved care. > Until then, we're likely to see a lot of resistance to what we do from some > physicians and naked attempts to catagorize our work as best being done by > physical therapists, which are already under their control. > Blessings, Crow " Look for Rainbows in the Darkness " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 At 10:17 AM 3/22/00 -0800, you wrote: > " Ray Hunter " <rayhuntermt > >That sounds about right, just under seven minutes per patient. Got a problem >with that? Should be enough time to do a complete work-up, arrive at a >diagnosis, determine the appropriate treatment, and deliver/explain it to >the patient. (hopefully there's little doubt that I'm being facetious, here) > >Part of the problem is that physicians have incredible over-head. Most of >them start their profession in serious debt. My massage therapy training has >cost me around 7-8 thousand, which probably wouldn't cover books at any med >school other than the University of Grenada. Their insurance costs are >considerably higher than the $250-300 that I pay. They need way more >equipment than we do and their interaction with the Health Insurance >industry requires them to retain a staff that I don't need. > >I also lay some of this at the feet of managed care. I heard an NPR piece >the other day where a doctor was complaining that his fees for specific >services had dropped some two-thirds. This increases the problem because now > he needs to see even more patients to hit his break even point. > >Now, please understanding that I'm not defending the current state of health >care. Get me on my soapbox and I'll go on for paragraphs on how they nearly >killed my wife. But, it makes sense to me to try to understand how things >have gotten to where they have. I'm sure that the majority of physicians >would like to offer better care than they do, but they see themselves >trapped in a system where they are financially penalized for doing so. > >Until the insurance industry either starts to look at time spent per patient >as an indicator of patient care, or alternatively, is abolished in favor of >a single payer system, doctors are going to see us as a threat instead of a >body of professionals who can cooperate with them to provide improved care. >Until then, we're likely to see a lot of resistance to what we do from some >physicians and naked attempts to catagorize our work as best being done by >physical therapists, which are already under their control. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Interesting insights, Ray. My biggest problem with physicians, even the MDs I worked with in a clinical setting, was they often didn't come up with a diagnosis--beyond the catch-alls they slap on the insurance forms. My ex-wife was a general internist/pulmonologist and very talented as a diagnostician (we had a private practice together), and even she didn't do what I considered to the kind of diagnosis that the patient deserves. We had a doctor that covered, a former missionary, and what a difference! She would hardly let a patient out the door until she had the best diagnosis she could get...I did most of the in-house lab work and she worked me like a slave doing cultures and collecting samples--she even hauled out our dusty microscope. When she referred, it was with a specific intent, rather than just dumping the patient. When one of her patients had surgery, she insisted on assisting--much to the annoyance of the surgeons--especially since, because of her background, she had experience with most surgical procedures, and wasn't afraid to speak up. My advice to patients was always to make sure both they and the physician had a solid diagnosis--with more than one treatment option, spelled out clearly. It seems like a foregone conclusion, but too often it was not. I was always amazed at the number of patients that had seen physicians for years with a very specific complaint but no " real " diagnosis and treatment options. I sometimes sent patients back to the referring doc for a diagnosis. Carl http://askcarl.net Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 At 04:00 PM 3/22/00 -0500, you wrote: >Caroline Abreu <crow > >Yes, Carl, you're right; and yet, I am seeing a lot of regulation >happening without the consent or input of the people who do the work! I >am of mixed mind regarding regulation, except to the degree that I think >it should be an internal process, not externally controlled. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Here is what I always reminded myself, with regard to the bureaucracy: There are three things they are concerned with: (1) Regulation (control) (2) Commandeering money (3) Maintaining job security/re-election. Getting very busy so I gotta keep these posts shorter. Carl http://askcarl.net Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2000 Report Share Posted March 22, 2000 Yes, Carl, you're right; and yet, I am seeing a lot of regulation happening without the consent or input of the people who do the work! I am of mixed mind regarding regulation, except to the degree that I think it should be an internal process, not externally controlled. For the bodyworkers/energy workers out there who are interested in working to oppose regulation in its various forms, you might want to check out the " Freedom for Bodywork " list at ONElist ( Freedom_for_Bodywork ) It is a slow list but is building in numbers, with some good archives; and it happens to be moderated by my wonderful, talented husband, Mani ;-) Carl Weisbrod wrote: > > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ > I have always believed it's better to stay unregulated. A professional > group is easier to hassle once they get a license...and then there's > the in-fighting--turf battles, etc. The best transactions I had were with > my patients, not with " peer " groups. > > Carl > http://askcarl.net > > -- --- Blessings, Crow " Look for Rainbows in the Darkness " --- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2000 Report Share Posted March 25, 2000 I went into the teaching profession with high ideals. The system has definitely stressed ME out. You would be amazed at the decisions the beaurecrats make on behalf of children. http://community.webtv.net/Talks-withtrees/PrayerChain Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2000 Report Share Posted March 25, 2000 Let's face it, the Pharmacutical companies control the health care in this country. It is BIG business. I personally know senior citizens that take at least 20 pills a day at the tune of thousands of $$. What the individual doesnt pay out of their own pockets, the tax payers do with medicare and medicaid. The scandals there have been outrageous. Not to mention,most physicians dont have a clue to how they all react nor does one doctor consult with the other on meds. We also need to look at a socialistic model of delivery. Maybe then folks would become doctors because it is their calling, not a fashionable thing to do. Parents love to say, " My son is going to medical school. " http://community.webtv.net/Talks-withtrees/PrayerChain Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2000 Report Share Posted March 25, 2000 --- Talks-withtrees wrote:We also > need to look at a > socialistic model of delivery. Maybe then folks > would become doctors > because it is their calling, not a fashionable thing > to do. Parents love > to say, " My son is going to medical school. " I don't disagree. I think the system also ends up turning off those with a calling. I feel my cousin has a calling which he feels is thwarted by the med. establishment. No matter that John Hopkins is a " good school, " the system sucks and when he sees people turned away from care or given cursory care because of managed care, insurance issues, it is very disturbing. He has chosen to go into public policy because of this. MichelleH Talk to your friends online with Messenger. http://im. Quote Link to comment Share on other sites More sharing options...
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