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Posted: 1/23/2021 12:36:41 PM EDT
[#1]
Quote HistoryQuoted: [/b] They also aren't training them in the proper use of a paragraph. Are you aware that there are people in this world that have a severe medical condition which causes them to be that way? My mother for instance is one of those people. She is a truck driver that has bad knees and a bad back from driving the truck but you probably do not care about that case either. Oh well I am not one of those people I am 6'4" 245lbs and I exercise every day. I would love to see you say something like to my mother in front of me. Probably never happen though you are probably just an internet tough guy. I doubt very seriously you would say that to someones face. Just my thought.What do you think. Oh I am sorry you probably do not have a brain. I on the other hand will be happy to buy you a plane ticket to come here and see if you have the nerve to say that to someone I know. |
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Posted: 1/23/2021 12:37:44 PM EDT
[#2]
But think of all the new "heros" being created....I bet the people you are bashing are good at making TikTok videos of them dancing and that is all that really matters.
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Posted: 1/23/2021 12:38:56 PM EDT
[#3]
Weren't the entry requirements to medical school lowered back in the 70's - so more minorities could become Doctors?
I'm on my 3rd GP now because the previous two decided to retire to avoid putting up with Obummercare. Quality/competent medical care is still out there...but it seems you have to look harder these days. |
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Posted: 1/23/2021 12:56:17 PM EDT
[#4]
Quote HistoryQuoted: I decided to go back to school in 2018 to take pre-med classes so I could apply to medical school. I took the Mcat back in June and applied to 18 schools a month later. Above average stats and good extracurriculars and I haven't heard anything from any schools other than rejections. Meanwhile people I know who I would not want to have as a physician are getting accepted left and right. I figured I'll reapply once and if I don't get in I'll go back to working in finance. It's still something I want to do but I'm not going to bang my head against the wall if I can't get in cycle after cycle. What has discouraged me the most throughout this process is the feedback I get from so many doctors: most say that I'm crazy and to stay in finance, and that the juice isn't worth the squeeze anymore. They're all overworked, under appreciated and spend less time with patients than ever before. With Uncle Joe wanting universal healthcare I imagine things will only get worse. Maybe me not getting in is meant to be... You've got to play the game. Find an ancestor that was a minority, discover that you're non-binary or trans, something like that. Invent a hard luck story that you've managed to bravely overcome. Learn what the school is looking for...if you apply to Michigan State College of Human Medicine, I'm pretty sure you want to be a small town primary care doc who serves the underprivileged. If you apply to the University of Michigan's medical school, you may want to pursue basic research in addition to a rigorous sub-specialty. Just not being white/asian male is a big leg up. |
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Posted: 1/23/2021 1:12:26 PM EDT
[#5]
Considering I graduated med school i 1976 I have seen lots of changes, mostly for the worse. I live in a rural area and the local HCA hospitals have residency programs???????? these are level 3 community hospitals, not level 1 universities. The quality of these 'residents' leaves a lot to be desired. Example, I get a call from the ER and the 'chief resident' in the ER calls me. I only answered since it was one of my patients, otherwise I do not cover the ER. Tells me my patient has preseptal orbital cellulitis and needs to be seen immediately. Of course they did CT scans and any other test except a simple white count. I see the patient and tell them how to treat their STYE. Thousands of dollars in hospital costs when it would have been a $75 office visit. My partner asked where it hurts and the pt points to the 1st extensor compartment. Positve Finklestein's test. DeQuervain's. Steroid injection, instant pain relief from the local and complete resolution of the symptoms. I like this story anytime people argue about how cost effective gatekeepers are. The dude was off work for 3 weeks because of gatekeepers. |
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Posted: 1/23/2021 1:17:13 PM EDT
[#6]
If you track the financial returns on the heal care industry since Obama care was instituted, you will see the returns are astronomical, if you had invested in a health care ETF in 2010 you could have doubled your money about every 2-3 years. Gee I wonder who benefited from that?
I’m currently paying about $4500/yr. for Medicare and the Doc only gives my 5 minutes of his time if I’m lucky. And then you need 2nd and 3rd opinions due to the low level of expertise even in a large metropolitan area. As has been previously mentioned health care is the 3rd leading cause of death. They kill thousands a day simply due to incompetence. Yep, work you ass off all your life, play by the rules, pay your taxes, eat right, take care of yourself, then aging deals you a bad hand and you get to deal with the medical system and hope you come out the other end in one piece and alive. I know there are some good Doc’s out there and I’m grateful for them, but they are few and far between. I’ve also talked with many in the last 3 years and each and everyone says the government and the health insurance bureaucracy has destroyed the medical profession and that they whish they hadn’t gotten into the business. New doctors coming into the system is at an all time low, due to government involvement destroying the profession. |
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Posted: 1/23/2021 1:21:14 PM EDT
[#7]
Quote HistoryQuoted: The part that truly cracks me up about all this is that as MD/DO standards drop, PA standards drop, the programs for ARNP's are getting more difficult. I have found that new ARNP's (mostly in their 40's & 50's) know more than doctors out of residency and fellowships.  LOL....NPs know "Z-pack" ultram and "medrol"...that's about it. I work with them everyday. |
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Posted: 1/23/2021 3:08:48 PM EDT
[#8]
Quote HistoryQuoted: That applies to all professions and job classifications. Rigor and apolitical professionalism is racist. Objective knowledge is sexist. Agreed. POC (tm) had preferential treatment in my medical school, for admission, retention,and advancement. If I failed a class, I was out, but these idiots had multiple chances to be drug across the finish line. It was because of “historical prejudice “ even though they were the sons and daughters of professionals who drove BMW and Mercedes cars to class |
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Posted: 1/23/2021 3:20:44 PM EDT
[#9]
Quote HistoryQuoted: LOL....NPs know "Z-pack" ultram and "medrol"...that's about it. I work with them everyday. Dude, don't engage. Don't engage. Its funny how they are so good at not knowing, what they don't know. |
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Posted: 1/23/2021 3:31:14 PM EDT
[#10]
Quote HistoryQuoted: The cost has little to do with the doc. Most of the cost is to pay all the damn admin and middle men docs needs to pay to actually get paid. I could see 2-3 times as many people a day if documentation requirements were significantly lessened. Physian pay accounts for <20% of all expenditures and 1/2 if that is the overhead costs to actually get paid. Hopsitals account for 30-40% The whole system is broken. Imagine my anger of having a fucking ascociate degree holding moron telling me my medical decision making isn't high enough to warrant being paid what ever level I requested. I think an excellent coder is worth their weight. If smart they are at worst revenue neutral. Would you rather spend hours reviewing your chart, making sure the chart is complete, procedures appropriately documented and having the appropriate level? You can go ahead, I’ll hire a smart cider. I graduated emergency medicine residency in 99. No limited hours. Limited backup after hours on off services. You had to do it all. Some residents graduated today have not done many procedures as they are in the hospital less than half the time. You might think that they work fewer hours to improve patient care. Nope, it is for resident wellness and some residents falling asleep while driving home. I teach residents and med students at a level 1 trauma center I spend quite a bit of time trying to bring many up to snuff. While there are a few stellar ones, the quality of the resident student and training is nothing compared to what I experienced. |
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Posted: 1/23/2021 3:48:13 PM EDT
[#11]
OP do you practice in SE Oklahoma??? Your story sounds very familiar to me. The same story you speak of sounds like a Surgeon and his wife that work at the facility I just left. Had a group of great residents at our hospital but it seems like a lot of the medical students passing through are doing the minimum input waiting to get out, find a resident position, and then half ass their way through the profession.
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Posted: 1/23/2021 3:53:53 PM EDT
[#12]
4th year med student here who's applied EM for match...it definitely is interesting seeing all these new programs pop up *cough HCA*. There's a discussion on SDN and reddit that hits all the points you've mentioned. Am I concerned about the job market down the line? Most definitely. It's going to be harder and harder to find open positions in large cities.
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Posted: 1/23/2021 3:57:09 PM EDT
[#13]
when I was an intern I had a med student assigned to me. Now I could do scutt work in no time. When I left med school I did maybe 90-100 blood gasses. So when I offered the med student a chance to do one on a patient his response was' No Thanks, I did one once, you are getting paid to do it" ONE FUCKING blood gas and he was an expert... I sent him to the library and finished all work in half an hour.
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Posted: 1/23/2021 3:59:21 PM EDT
[#14]
Feature....not a bug
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Posted: 1/23/2021 4:09:50 PM EDT
[#15]
Quoted: TLDR: new docs aren't getting trained appropriately. I have bad news for you OP, this is happening pretty much across the board. Everything is going to shit. We're having to do more and more things ourselves. |
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Posted: 1/23/2021 4:10:23 PM EDT
[#16]
Quoted: I graduated my emergency medicine program 9 years ago. I trained at a level 1 trauma center and had 3 years of extremely rigorous training as well as 4 previous years at a state medical school. 2 years ago a medical school opened in my little rural town that accepted applicants that barely made it out of college. I was tasked by one to write a letter of recommendation and I told her "think about other options". She was accepted....horrible grades and lackluster motivation. Fast forward to today when MULTIPLE small hospitals around me are opening up residencies. The goal is to pump out cheap labor and to have the prestige of being a training facility. My wife just graduated from a nurse practitioner program, and it was a joke....by her own admission it was a joke...and she passed her boards with ease and was the honor graduate in her class. In 10 years the US will be flooded with VERY poorly trained US medical grads that never went through any of the academic or professional rigor that prior physicians endured. That rigor is 100 percent necessary to train people to function. Our medical training system is being undermined. You may think that that PA or NP that you're seeing knows what they're doing, but MOST new grads don't. The knowledge is very superficial, and I guess MD/DO education will soon follow suit. They will work for less than I'm making now because they'll have huge loans to pay, but the care won't be equivalent. TLDR: new docs aren't getting trained appropriately. Things have gone to shit in medicine over the last 10 to 20 years, depending on what factors you look at. I graduated in 2001 from my fellowship. The backbone of any medical system is primary care, and it is collapsing. Fresh, inexperienced APRN’s are flooding the market. |
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Posted: 1/23/2021 4:11:32 PM EDT
[#17]
All part of the plan to implement socialist medicine.
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Posted: 1/23/2021 4:11:45 PM EDT
[#18]
Quote HistoryQuoted: Welcome to the past 15 years. I’ve been in imaging for 26 years, CT, IR, Cath Lab. I currently work in a freestanding ED. We have a shortage of experienced Docs, so the corporate bean counters hire fresh grads from UofA. (BTW, the company just opened another MIcro Hospital and is building a medical center in town as well that they can’t staff....lol) I respect their education, but there a quite a few that have no business being in this particular environment without more support like they would have in a larger facility. I feel bad for our nurses who have to baby sit them. All the experienced MDs are getting out if they can, or scaling back hrs. The past 8-10 years medicine has gone more corporate, and less about serving the community. Save $$ by staffing with PA’s and NP’s at all the clinics. The corporate control over medicine is destroying it. |
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Posted: 1/23/2021 4:17:07 PM EDT
[#19]
So you live near LMU?
Also PA/NP programs were always banking on having para medical practitioners with lots of clinical experience and then polishing them up. I think they are accepting too many new grad RN's into NP programs and too many people without clinical experience into PA programs. |
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Posted: 1/23/2021 4:25:22 PM EDT
[#20]
I have quit teaching interns and residents.
They just got dumber and lazier each year. And I got crankier. Mrs. CP and I are much happier with me just working 2 days a week and not teaching. And I quit working completely in 5 months. |
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Posted: 1/23/2021 4:28:06 PM EDT
[#21]
Quote HistoryQuoted: I think an excellent coder is worth their weight. If smart they are at worst revenue neutral. Would you rather spend hours reviewing your chart, making sure the chart is complete, procedures appropriately documented and having the appropriate level? You can go ahead, I’ll hire a smart cider. I graduated emergency medicine residency in 99. No limited hours. Limited backup after hours on off services. You had to do it all. Some residents graduated today have not done many procedures as they are in the hospital less than half the time. You might think that they work fewer hours to improve patient care. Nope, it is for resident wellness and some residents falling asleep while driving home. I teach residents and med students at a level 1 trauma center I spend quite a bit of time trying to bring many up to snuff. While there are a few stellar ones, the quality of the resident student and training is nothing compared to what I experienced. An excellent coder is very helpful, corporate medicine breeds medicocracy in the admin branches. I shit you not I've had these people make comments like "you're just a Pulmonologist, you shouldn't bill CCT, You should be billing vent management"  Or the most recent one that comes to mind, as the Intensivist with no consultants on the case, I have a woman who is a) on the vent b) EF of 20% on a lasix drip, c) CKD (came in acute on CKD) d) and having such severe psychosis I'm giving a ton or benzo and anti-psychotics and can't get them off vent. But that's not complex MDM and cct isn't proper |
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Posted: 1/23/2021 4:28:29 PM EDT
[#22]
Quote HistoryQuoted: The cost has little to do with the doc. Most of the cost is to pay all the damn admin and middle men docs needs to pay to actually get paid. I could see 2-3 times as many people a day if documentation requirements were significantly lessened. Physian pay accounts for <20% of all expenditures and 1/2 if that is the overhead costs to actually get paid. Hopsitals account for 30-40% The whole system is broken. Imagine my anger of having a fucking ascociate degree holding moron telling me my medical decision making isn't high enough to warrant being paid what ever level I requested. Quote HistoryQuoted: Quoted: You're not wrong, but people literally can't afford to go to the doctor. I have several family members that drastically need to see a doctor. They work 40 hours a week but still can't afford medical attention. Somethings got to give. I'll admit though, they could take better care of themselves. The cost has little to do with the doc. Most of the cost is to pay all the damn admin and middle men docs needs to pay to actually get paid. I could see 2-3 times as many people a day if documentation requirements were significantly lessened. Physian pay accounts for <20% of all expenditures and 1/2 if that is the overhead costs to actually get paid. Hopsitals account for 30-40% The whole system is broken. Imagine my anger of having a fucking ascociate degree holding moron telling me my medical decision making isn't high enough to warrant being paid what ever level I requested. @ipsilateral_7 And as you’ve probably seen on the outpatient side, Medicare/Medicaid is getting more strict on billing codes, requiring more to get to the next higher level, ie. 99214 vs 99213. Docs are being squeezed more and more every day. |
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Posted: 1/23/2021 4:32:33 PM EDT
[#23]
Quote HistoryQuoted: I constantly hear this argument, but it's not a great one. If boeing thinks that titanium fasteners are too expensive, should they just use aluminum? Docs cost what they cost. Urgent/Convenient care shouldn't even be a thing. You don't need every ache X-rayed or every sniffle treated with antibiotics. If you're fat your joints will hurt, and if you smoke you'll cough. Medicine IS way too expensive because of people with suits and clipboards, not people in scrubs. ACCESS to healthcare isn't the problem. I'd argue that we have too much healthcare. Quote HistoryQuoted: Quoted: You're not wrong, but people literally can't afford to go to the doctor. I have several family members that drastically need to see a doctor. They work 40 hours a week but still can't afford medical attention. Somethings got to give. I'll admit though, they could take better care of themselves. I constantly hear this argument, but it's not a great one. If boeing thinks that titanium fasteners are too expensive, should they just use aluminum? Docs cost what they cost. Urgent/Convenient care shouldn't even be a thing. You don't need every ache X-rayed or every sniffle treated with antibiotics. If you're fat your joints will hurt, and if you smoke you'll cough. Medicine IS way too expensive because of people with suits and clipboards, not people in scrubs. ACCESS to healthcare isn't the problem. I'd argue that we have too much healthcare. There’s definitely too much access to the expensive parts of health care. |
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Posted: 1/23/2021 4:32:36 PM EDT
[#24]
Pretty bad, especially as lackluster as so many of the doctors I ran across during my time at work were.
Some were just lazy, and didn't want to work, but they were a minor percentage of incompetent. They are test readers any more. Very few doctors in the bunch. |
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Posted: 1/23/2021 4:37:24 PM EDT
[#25]
I think it’s across the board. Nursing school (RN) Quality is lacking. Bryant and Stratton was accredited for a RN 4 year program. There’s no standard of what constitutes a BSN program so they can pretty much do whatever they want.
NP schools are the same. It varies state to state, but in a state where anything goes the NP programs aren’t worth much. |
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Posted: 1/23/2021 4:47:53 PM EDT
[#26]
I know a few brain-dead idiots who passed FNP programs...seems about right...
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Posted: 1/23/2021 4:49:40 PM EDT
[#27]
Quote HistoryQuoted: So shitty "free " medical care is better than none? I guess if they mess up and cut of their leg because they got the wrong paperwork work they can always sue them(will .gov allow that?). That's if you even see them within a few years. Quote HistoryQuoted: Quoted: You're not wrong, but people literally can't afford to go to the doctor. I have several family members that drastically need to see a doctor. They work 40 hours a week but still can't afford medical attention. Somethings got to give. I'll admit though, they could take better care of themselves. So shitty "free " medical care is better than none? I guess if they mess up and cut of their leg because they got the wrong paperwork work they can always sue them(will .gov allow that?). That's if you even see them within a few years. As long as Form 27B/6 is filled out correctly, the wrong leg won’t be cut off. |
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Posted: 1/23/2021 4:56:28 PM EDT
[#28]
Quote HistoryQuoted: Considering I graduated med school i 1976 I have seen lots of changes, mostly for the worse. I live in a rural area and the local HCA hospitals have residency programs???????? these are level 3 community hospitals, not level 1 universities. The quality of these 'residents' leaves a lot to be desired. Example, I get a call from the ER and the 'chief resident' in the ER calls me. I only answered since it was one of my patients, otherwise I do not cover the ER. Tells me my patient has preseptal orbital cellulitis and needs to be seen immediately. Of course they did CT scans and any other test except a simple white count. I see the patient and tell them how to treat their STYE. Thousands of dollars in hospital costs when it would have been a $75 office visit. Oh , and thru the years I have given thousands of dollars of free care. I have never turned away someone with true emergencies due to money. I have even done free cataract surgery on someone who was blind. I got the implant company to donate the lens, the surgery center to not charge and even got anesthesia to not charge. I am one year away from calling it done. I have stockpiled bp meds, antibiotics and other meds. The local older docs have an unofficial agreement to take care of each other rather than go to the new breed of MD. I do not see any way this will get better. More time spent treating the chart than the patient... @Quigley Some of the ridiculous amounts of testing in the ER and hospitalists by recent grads is astounding. They diagnosed a 28 year old healthy guy having a migraine aura with a stroke and gave him t-PA. |
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Posted: 1/23/2021 4:59:17 PM EDT
[#29]
Well, if you are going to offer free healthcare....
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Posted: 1/23/2021 5:04:15 PM EDT
[#30]
My Mom is a Nurse Consultant (read: contract DON to unfuck SNFs that just got their dicks slapped by the State) and regularly deals with new-grad (and some not-new-grad) RNs that can't put an IV in, or have never inserted a catheter, or YOLO the drug cart, or pencil-whip patient records ("I didn't have time to check Mr. Smith for pressure sores, so I just checked the box"), etc.
That's the people in charge of the care for your aged parents and/or loved ones in long-term care. |
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Posted: 1/23/2021 5:19:16 PM EDT
[#31]
somebody has to be willing to work for "Single Payer" wages. Student loan forgiveness and a low salary is just fine for Fobamacare medical workers...
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Posted: 1/23/2021 5:20:52 PM EDT
[#32]
I'm glad I'm in the twilight of my career. I wouldn't recommend med school to my kids.
To medical students I recommend they become as specialized as possible. An electrophysiologist or something. Most "generalists" (this includes EM) risk being undercut by less expensive, newly-minted NPs, despite the fact that most NPs have only a fraction of the clinical and academic training that residency trained MDs receive. |
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Posted: 1/23/2021 5:29:53 PM EDT
[#33]
Quote HistoryQuoted: The cost has little to do with the doc. Most of the cost is to pay all the damn admin and middle men docs needs to pay to actually get paid. I could see 2-3 times as many people a day if documentation requirements were significantly lessened. Physian pay accounts for <20% of all expenditures and 1/2 if that is the overhead costs to actually get paid. Hopsitals account for 30-40% The whole system is broken. Imagine my anger of having a fucking ascociate degree holding moron telling me my medical decision making isn't high enough to warrant being paid what ever level I requested. Quote HistoryQuoted: Quoted: You're not wrong, but people literally can't afford to go to the doctor. I have several family members that drastically need to see a doctor. They work 40 hours a week but still can't afford medical attention. Somethings got to give. I'll admit though, they could take better care of themselves. The cost has little to do with the doc. Most of the cost is to pay all the damn admin and middle men docs needs to pay to actually get paid. I could see 2-3 times as many people a day if documentation requirements were significantly lessened. Physian pay accounts for <20% of all expenditures and 1/2 if that is the overhead costs to actually get paid. Hopsitals account for 30-40% The whole system is broken. Imagine my anger of having a fucking ascociate degree holding moron telling me my medical decision making isn't high enough to warrant being paid what ever level I requested. It's not really surprising, there's been a huge expansion in managerial overhead, especially in the medical field. https://yewtu.be/watch?v=MN9S0HD8VH8 Interesting segments are at: 9:50 , 17:24 , 19:30 , 23:53 , 25:45 , ... There are a lot of good observations in there to list, but the ones in red are important and sync with what you stated. The guy speaking is a leftist academic, so his conclusions are predictable in perception, but the observations he points out mostly seem to hold water. |
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Posted: 1/23/2021 5:35:45 PM EDT
[#34]
This thread is a perfect example of a selection bias at work.
The market for fresh grads is wacky though. |
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Posted: 1/23/2021 5:37:30 PM EDT
[#35]
Quote HistoryQuoted: You're not wrong, but people literally can't afford to go to the doctor. I have several family members that drastically need to see a doctor. They work 40 hours a week but still can't afford medical attention. Somethings got to give. I'll admit though, they could take better care of themselves. What you say is both absolutely true and totally irrelevant. I have bad news for you because physician salaries are not the problem. edit: Beatn early on by @ipsilateral_7 |
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Posted: 1/23/2021 5:40:11 PM EDT
[#36]
Quote HistoryQuoted: To medical students I recommend they become as specialized as possible. An electrophysiologist or something. Most "generalists" (this includes EM) risk being undercut by less expensive, newly-minted NPs, despite the fact that most NPs have only a fraction of the clinical and academic training that residency trained MDs receive. From speaking to a few 3rd year EM residents during this interview trail, a lot of them are pursing fellowships because of this to hopefully make them more marketable down the line. |
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Posted: 1/23/2021 5:40:48 PM EDT
[#37]
Quote HistoryQuoted: 4th year med student here who's applied EM for match...it definitely is interesting seeing all these new programs pop up *cough HCA*. There's a discussion on SDN and reddit that hits all the points you've mentioned. Am I concerned about the job market down the line? Most definitely. It's going to be harder and harder to find open positions in large cities. The HCA residencies are definitely not to the same level as some of the other residency programs I’ve been involved with. |
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Posted: 1/23/2021 5:42:52 PM EDT
[#38]
Quote HistoryQuoted: @ipsilateral_7 And as you’ve probably seen on the outpatient side, Medicare/Medicaid is getting more strict on billing codes, requiring more to get to the next higher level, ie. 99214 vs 99213. Docs are being squeezed more and more every day. Yup and insurances make it harder and harder to do right by pts. Humana absolutely the worst. They damn near require peer to peer for everything. And they make up their own rules. Can't send someone to an ltac without a trach? Wtf. I haven't seen but 1 out patient consult since Covid started, even before that it was basically oncology needs procedure quickly pts I was seeing. I haven't bothered to read the new billing codes |
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Posted: 1/23/2021 5:43:11 PM EDT
[#39]
Relax. Biden will bring in more cheap "physicians" from other countries.
Here are some actual H1B salaries.  Attached File |
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Posted: 1/23/2021 5:43:59 PM EDT
[#40]
Quote HistoryQuoted: The HCA residencies are definitely not to the same level as some of the other residency programs I’ve been involved with. Quote HistoryQuoted: Quoted: 4th year med student here who's applied EM for match...it definitely is interesting seeing all these new programs pop up *cough HCA*. There's a discussion on SDN and reddit that hits all the points you've mentioned. Am I concerned about the job market down the line? Most definitely. It's going to be harder and harder to find open positions in large cities. The HCA residencies are definitely not to the same level as some of the other residency programs I’ve been involved with. My prediction -- you heard it here first -- Major insurers like BCBS and United will begin funding residency programs. Bank it. |
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Posted: 1/23/2021 5:46:27 PM EDT
[#41]
Quote HistoryQuoted: An excellent coder is very helpful, corporate medicine breeds medicocracy in the admin branches. I shit you not I've had these people make comments like "you're just a Pulmonologist, you shouldn't bill CCT, You should be billing vent management" Or the most recent one that comes to mind, as the Intensivist with no consultants on the case, I have a woman who is a) on the vent b) EF of 20% on a lasix drip, c) CKD (came in acute on CKD) d) and having such severe psychosis I'm giving a ton or benzo and anti-psychotics and can't get them off vent. But that's not complex MDM and cct isn't proper Quote HistoryQuoted: Quoted: I think an excellent coder is worth their weight. If smart they are at worst revenue neutral. Would you rather spend hours reviewing your chart, making sure the chart is complete, procedures appropriately documented and having the appropriate level? You can go ahead, I’ll hire a smart cider. I graduated emergency medicine residency in 99. No limited hours. Limited backup after hours on off services. You had to do it all. Some residents graduated today have not done many procedures as they are in the hospital less than half the time. You might think that they work fewer hours to improve patient care. Nope, it is for resident wellness and some residents falling asleep while driving home. I teach residents and med students at a level 1 trauma center I spend quite a bit of time trying to bring many up to snuff. While there are a few stellar ones, the quality of the resident student and training is nothing compared to what I experienced. An excellent coder is very helpful, corporate medicine breeds medicocracy in the admin branches. I shit you not I've had these people make comments like "you're just a Pulmonologist, you shouldn't bill CCT, You should be billing vent management" Or the most recent one that comes to mind, as the Intensivist with no consultants on the case, I have a woman who is a) on the vent b) EF of 20% on a lasix drip, c) CKD (came in acute on CKD) d) and having such severe psychosis I'm giving a ton or benzo and anti-psychotics and can't get them off vent. But that's not complex MDM and cct isn't proper  at the last story especiallyI saved his life and I will bill 99291 and you will fucking like it Assholes My specialty is notorious for under-valuing its own cognitive effort and under-billing in particular circumstances |
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Posted: 1/23/2021 5:50:01 PM EDT
[#42]
There is a huge discrepancy of knowledge and skillset gained between various places where one is trained. Not everyone has the right stuff or is righteous. Great physicians can come from shit holes if they put in the work.
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Posted: 1/23/2021 5:52:22 PM EDT
[#43]
Quote HistoryQuoted: I decided to go back to school in 2018 to take pre-med classes so I could apply to medical school. I took the Mcat back in June and applied to 18 schools a month later. Above average stats and good extracurriculars and I haven’t heard anything from any schools other than rejections. Meanwhile people I know who I would not want to have as a physician are getting accepted left and right. I figured I’ll reapply once and if I don’t get in I’ll go back to working in finance. It’s still something I want to do but I’m not going to bang my head against the wall if I can’t get in cycle after cycle. What has discouraged me the most throughout this process is the feedback I get from so many doctors: most say that I’m crazy and to stay in finance, and that the juice isn’t worth the squeeze anymore. They’re all overworked, under appreciated and spend less time with patients than ever before. With Uncle Joe wanting universal healthcare I imagine things will only get worse. Maybe me not getting in is meant to be... @DVC_117 Apply at the University of Mississippi Medical Center in Jackson,Mississippi. No one we know that applied failed to be accepted and no one we know of has ever failed or dropped out. A good friend's granddaughter is there now and said it is just about impossible to fail. |
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Posted: 1/23/2021 6:04:12 PM EDT
[#44]
Quote HistoryQuoted: Don’t worry! Everyone has access to doctor Google, so they can diagnose and treat themselves. They just need you to prescribe medicine, and they wouldn’t even need that if they had a DEA number.  I know your not being serious but I think even a misinformed patient is a good thing. It shows that they are taking responsibility for their own care. Patients need to be their own advocates. Can’t do that if you’re ignorant. |
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Posted: 1/23/2021 6:07:29 PM EDT
[#45]
Welcome to the late stages of an empire. Improved Technology means we probably won't need to wait a couple hundred years for the dark ages like the romans did.
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Posted: 1/23/2021 6:08:43 PM EDT
[#46]
Quote HistoryQuoted: Relax. Biden will bring in more cheap "physicians" from other countries. Here are some actual H1B salaries. https://www.ar15.com/media/mediaFiles/126713/H1b_Physician_Salary_jpg-1793409.JPG Those are all most likely FMGs starting their residency training. |
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Posted: 1/23/2021 6:10:48 PM EDT
[#47]
Quoted: I graduated my emergency medicine program 9 years ago. I trained at a level 1 trauma center and had 3 years of extremely rigorous training as well as 4 previous years at a state medical school. 2 years ago a medical school opened in my little rural town that accepted applicants that barely made it out of college. I was tasked by one to write a letter of recommendation and I told her "think about other options". She was accepted....horrible grades and lackluster motivation. Fast forward to today when MULTIPLE small hospitals around me are opening up residencies. The goal is to pump out cheap labor and to have the prestige of being a training facility. My wife just graduated from a nurse practitioner program, and it was a joke....by her own admission it was a joke...and she passed her boards with ease and was the honor graduate in her class. In 10 years the US will be flooded with VERY poorly trained US medical grads that never went through any of the academic or professional rigor that prior physicians endured. That rigor is 100 percent necessary to train people to function. Our medical training system is being undermined. You may think that that PA or NP that you're seeing knows what they're doing, but MOST new grads don't. The knowledge is very superficial, and I guess MD/DO education will soon follow suit. They will work for less than I'm making now because they'll have huge loans to pay, but the care won't be equivalent. TLDR: new docs aren't getting trained appropriately. |
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Posted: 1/23/2021 6:14:24 PM EDT
[#48]
Quote HistoryQuoted: LOL. The new doctors are coming up from South of the border in Caravans.  Interesting you say this. My wife had surgery last year, and our best choice was a doctor in Mexico. The office was just over the border. We met up with some of his staff in a hotel parking lot on this side. The has an “expedited” crossing, and we spent 3 days at the compound/hospital. They gave us a tour of the facilities the first thing. The place was immaculate. I’ve been in several hospitals here and this place was a big step up from them. The whole staff was there to take care of the patient and their companion. As the companion we were taken out for dinner and “entertained” while the patient was being dealt with. I would do it, and according to my wife she would also. The cost was 60% less than what you pay here, and the doctor was one of the best in the world. So there are some good docs down there. |
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Posted: 1/23/2021 6:15:42 PM EDT
[#49]
They will just need more time to “practice” medicine before they get mediocre at it......
I have been dealing with an injury for over a year. 2 “DRs” throwing shit a the wall to see what stuck. Finally found a guy that knew what he is doing, and in 5 minutes firgured out what the issues was. All but told the the first two did more harm than good. |
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Posted: 1/23/2021 6:17:31 PM EDT
[#50]
What is an FMG?
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