Thursday, September 3, 2015

Good news

Just to show I don't stick my head in the sand, here is a link I imagine a few of you are going to enjoy quite a bit   This may actually have an impact on me as my current preceptor, whom I plan to work for, has had a rather large influx of patients to his practice through this co-op. Sadly, a lot of these people who came in through this plan have a lot of issues that are quite manageable with very affordable medications. Prior to coming to his office, however, they went to ERs or urgent care where they received about five minutes of attention and quite often, inappropriate care.

As I compare my experience to that of my classmates, I am finding that the norm in most offices that are ruled by HMOs is to spend literally no more than 15 minutes with a patient, limit them to 1-2 issues at most, and refer them out to "specialists" even though a vast majority of what specialists do can also be done in primary care. In our office, my preceptor will manage quite a bit and take responsibility for managing as much as a patient feels comfortable with him managing. This saves a lot of money for the system and time for the patient. But, it takes an investment of time up front by the doctor that they will not be paid for, or at the least, they will not be paid as well for that one visit versus three, treat em and street em visits.

A lot of patients who have come in have been very grateful and have been very compliant once they received education about their conditions and why they have been taking certain medications.


  1. Built into the plan to get us finally to single payer universal healthcare like every other civilized nation in the world. We are the only industrialized country that plays politics with and profits off of people's health issues.

  2. I love being an uncivilized nation.

    It's a great place to be in the world.

  3. Hey Max. I miss my old doc but the new one is pretty good. When I make an appointment, I see a PA who logs in the issue then the doc comes in. He spends whatever time is necessary to ensure My understanding of my issues and the options. I pay for the doc, I see the doc. He doesn't take medicaid, ACA insurance but will take medicare from existing patients when they reach 65.

    You get what you pay for with healthcare.

    1. Ironically, my preceptor was quite happy with the co-op because they didn't play fuck around. He's still taking other plans through the ACA and he will take medicare or medicaid. He seems to have a bit of a soft spot for those who don't have much money and I have seen him treat people without getting paid.

      In most cases, I would not argue the adage you get what you pay for, but I don't believe it any more in healthcare. I've only been a nurse for ten years, and from the office side, I can only comment on what I have seen since January in this office. Does a patient need to see a cardiologist twice a year for high blood pressure? Or a nephrologist whose only really input is ordering some blood pressure medicine to try and preserve kidney function? Meh, it's same ol same ol with me. I believe that medicine could be run much more efficiently with better outcomes at less cost. Single payer is not a solution per se, when the system is still run under an archaic mentality.

    2. Every practice determines what they can afford to take regarding various types of coverage. A practice that accepts anything and everything may find a problem when over half their patients are medicaid and medicare patients paying less than insured patients. Skew the patient mix and the practice either changes it's policies or fails.

      When a system is run under auspices of government control, expect higher prices. That free physical. BC pills, etc isn't free, the cost is just deferred to the premium. Medicaid isn't. free. The tax payers pck up part of the tab and the physicians pass the rest of the cost to the insured. Wouldn't it be better for costs be upfront instead f buried or passed to others paying the bill?