[MrGolf]

Excellent analysis and assessment. Many times you hear things need to get worse before they get better. I am afraid the first part is true but not so sure about the second part.

[billethkid]

Beware the establishments that have a huge red stamp that says "Medicare Patient".

Back of the line bottom of the list......then high speed shuffle.

One does not see "Blue Cross/Blue shield" patient or any other.

Any other rationale why they have to stamp the page with so obvious an identification?

[golfing eagles]

Originally Posted by billethkid

Beware the establishments that have a huge red stamp that says "Medicare Patient".

Back of the line bottom of the list......then high speed shuffle.

One does not see "Blue Cross/Blue shield" patient or any other.

Any other rationale why they have to stamp the page with so obvious an identification?

Seriously?????

Who does that?????

In 35 years I've never seen that or even heard of it. Furthermore, no healthcare provider in a hospital setting is the least bit concerned about what type of insurance a patient has---could it have had some administrative meaning?????

[Nursebarb1]

I retired as an RN in 2009. I never knew the patient's method of payment, and I am proud to say that it never would have compromised my care, or any other nurse I worked with.

[rubicon]

Originally Posted by golfing eagles

It's just my opinion, but here is my basis:

1) there is a growing shortage of doctors, especially in primary care. If the Obamacare dream of covering everyone comes to fruition, that's 40+ million more patients in need of primary care with less doctors

2) When I first started medical school in 1978, there were 129,000 American applicants for 17,000 seats. Last I saw numbers about 6 years ago, there were 23,000 applicants for the same 17K seats. Due to a variety of economic and social changes, the talent pool is being diluted, and therefore the "average" physician probably starts out with lower qualifications than in the past.

3) Our residency programs cannot fill with American graduates, therefore the programs are getting filled with FMGs, 5th pathway graduates, and previous practitioners from abroad. Some are good, some are not.

4) Medicare is going bankrupt, some insurers are dropping out of the medicare market, and the cost keeps going up. Add to that the cost of 40+ million new "insurees" that for the most part are subsidized, the cost of advanced technology, the aging of the baby boomers, and the unfunded liabilities of Obamacare. This means either raising taxes to pay for all this, or the dreaded "R" word---rationing health care like they do in Europe. I'm not sure Americans will stand for either.

5) Probably nothing is being done because no one knows what to do, or no one can agree on it, or the issue is too politically charged for any elected official to want to take the lead on it

6) I'm not sure some, if not all of this has been scripted to cause a collapse of our healthcare system so as to carve a path for the Holy Grail of the left---socialized medicine, which is gaining popularity with younger voters anyway. I hope they eventually realized that "Medicare for All" really means VA style healthcare for all, with the attendant triple the cost bureaucracy and one third the efficiency of all government programs. The system would work much better as a benign dictatorship, as long as I am the dictator

spot on and don't forget the piles upon piles of regulations and reporting required of doctors from the government and insurance companies

[skip0358]

Yes the Emergency Room gets backed up just about all the time. Can't be refused treatment so people go there period. Had to take our Granddaughter there the other night. Asthma attack. Walked in , filled out the paperwork and she was brought in and treatment was started end of story. While we were waiting for her I saw a ton of walking wounded as we called them when I rode the Ambulance come in didn't look any sicker then I was. Some watched TV some ate & drank coffee, some took a nap, others I think came in for the Air Conditioning. My point this bogs down the ER period. So yep an other patient coming in who may really have a problem has to wait. Others try the old call an Ambulance trick, if their not down & out enough they to go and sit for long periods of time. Sometimes it just sucks more being sick.

[golfing eagles]

Originally Posted by skip0358

Yes the Emergency Room gets backed up just about all the time. Can't be refused treatment so people go there period. Had to take our Granddaughter there the other night. Asthma attack. Walked in , filled out the paperwork and she was brought in and treatment was started end of story. While we were waiting for her I saw a ton of walking wounded as we called them when I rode the Ambulance come in didn't look any sicker then I was. Some watched TV some ate & drank coffee, some took a nap, others I think came in for the Air Conditioning. My point this bogs down the ER period. So yep an other patient coming in who may really have a problem has to wait. Others try the old call an Ambulance trick, if their not down & out enough they to go and sit for long periods of time. Sometimes it just sucks more being sick.

You are correct. A patient can only see what they can see----that is a full waiting room with people sitting around, some people who come after them getting seen first, and a whole bunch complaining about the wait. This is not a first come, first serve situation. About 1/2 the people in that ER waiting room are accompanying a patient, not one themselves. When you tell the receptionist your problem, there is an immediate preliminary triage that shows on the nurses' computer screen. You then see a RN who does a full triage, which the physician uses to prioritize cases. To the casual observer, it looks like nothing is happening, but in reality each patient is already in a queue and probably the ER doc has developed a preliminary plan to evaluate the patient.

When my wife was there in March, there were about 17 patients and a total of about 30 people in the waiting room. Glancing around (and this is just a guesstimate) my impression was that I could treat 15 of the 17 in my office, 1 at urgent care, and the 1 remaining patient was a close enough call to justify her presence. I have no idea of the severity of the illnesses that were already in an ER room.

Also, at least in NY, it was cheaper for a Medicaid patient to take an $800 ambulance ride to the ER than to call a $6 car service, so emergency vehicles were being abused for $3. We eventually fixed some of this by having ambulance crews with non-urgent cases take the patient to the waiting room and register as if they walked in

[CFrance]

Originally Posted by golfing eagles

You are correct. A patient can only see what they can see----that is a full waiting room with people sitting around, some people who come after them getting seen first, and a whole bunch complaining about the wait. This is not a first come, first serve situation. About 1/2 the people in that ER waiting room are accompanying a patient, not one themselves. When you tell the receptionist your problem, there is an immediate preliminary triage that shows on the nurses' computer screen. You then see a RN who does a full triage, which the physician uses to prioritize cases. To the casual observer, it looks like nothing is happening, but in reality each patient is already in a queue and probably the ER doc has developed a preliminary plan to evaluate the patient.

When my wife was there in March, there were about 17 patients and a total of about 30 people in the waiting room. Glancing around (and this is just a guesstimate) my impression was that I could treat 15 of the 17 in my office, 1 at urgent care, and the 1 remaining patient was a close enough call to justify her presence. I have no idea of the severity of the illnesses that were already in an ER room.

Also, at least in NY, it was cheaper for a Medicaid patient to take an $800 ambulance ride to the ER than to call a $6 car service, so emergency vehicles were being abused for $3. We eventually fixed some of this by having ambulance crews with non-urgent cases take the patient to the waiting room and register as if they walked in

GE, with all due respect to your knowledge... If only everyone were a doctor and could diagnose the severity of his own illness/emergency. Or if only (and maybe they did; OP didn't say) the doctors and nurses communicated every single thing in your original reply to her to ease her fears over her condition and the degree of contagiousness of her roommate. The latter may not be possible due to time constraints, but somewhere along the line somebody must have had enough time to convey that information. Or they should make the time, since 16 out of 17 patients, using your experience as a for-instance, in an ER aren't in life-threatening conditions.

[blueash]

Originally Posted by golfing eagles

It's just my opinion, but here is my basis:

1) there is a growing shortage of doctors, especially in primary care. If the Obamacare dream of covering everyone comes to fruition, that's 40+ million more patients in need of primary care with less doctors

2) When I first started medical school in 1978, there were 129,000 American applicants for 17,000 seats. Last I saw numbers about 6 years ago, there were 23,000 applicants for the same 17K seats. Due to a variety of economic and social changes, the talent pool is being diluted, and therefore the "average" physician probably starts out with lower qualifications than in the past.

3) Our residency programs cannot fill with American graduates, therefore the programs are getting filled with FMGs, 5th pathway graduates, and previous practitioners from abroad. Some are good, some are not.

4) Medicare is going bankrupt, some insurers are dropping out of the medicare market, and the cost keeps going up. Add to that the cost of 40+ million new "insurees" that for the most part are subsidized, the cost of advanced technology, the aging of the baby boomers, and the unfunded liabilities of Obamacare. This means either raising taxes to pay for all this, or the dreaded "R" word---rationing health care like they do in Europe. I'm not sure Americans will stand for either.

5) Probably nothing is being done because no one knows what to do, or no one can agree on it, or the issue is too politically charged for any elected official to want to take the lead on it

6) I'm not sure some, if not all of this has been scripted to cause a collapse of our healthcare system ...:

Lots of opinions and a couple of "facts" upon which those opinions were formed.
Easiest to fact check, how many applicants were there for medical schools in 1978? was is 129000 US applicants? Not even close. In 1978 there were under 30,000 applicants. The last year reported in 2014 had the highest number of applicants in history.
Medical School Applicants, Enrollment Reach All-time Highs - News Releases - Newsroom - AAMC
Medical School Applicants, Enrollees Reach New Highs - News Releases - Newsroom - AAMC

Long term trends are here up to 2002 Medical Schools And Their Applicants: An Analysis

So that fact is in error by a huge amount.
Primary care providers no longer means physicians. An increase of 10% in the number of insured lives means that all else being equal, you need 10% more primary providers. This requirement is likely to be met by advanced practice nurses and PA's in large part, freeing the more highly trained MD's and DO's to handle the non-routine patient care.

In 1965 23% of residency positions were filled by foreign medical graduates
Foreign Medical Graduates in the United States - Harold Margulies, Lucille Stephenson Bloch - Google Books
and it is 21% now
Medscape: Medscape Access

When you start with non-factual facts, you might end up with non-reasonable conclusions, or not

As to what we Americans will stand for, that is for the political forum but to suggest that there is some secret conspiracy of people attempting to collapse the health care industry is ....

[rubicon]

I question whether the average person who is experiencing acute pain, feeling disoriented etc cares one bit about politics or statistics. I believe most follow the education provided by health organizations that suggest if you are experiencing.....then better get to a health provider. ( see below) And further, I'll bet most people are aware of the old adage that warns "he who doctors himself has a fool for a patient" ( see below). I have a perfect and personal example of how ER failed me badly and ran up a $6,000 + bill for nothing but to what avail. I also have a perfect and personal example of why going to an urgent care failed and cost me some permanency but again to what avail.

So as referenced above rather than blame people with no medical training for going to the ER why doesn't the ER use their triage skills and separate the ER cases from the urgent care people?

[golfing eagles]

Originally Posted by blueash

Lots of opinions and a couple of "facts" upon which those opinions were formed.
Easiest to fact check, how many applicants were there for medical schools in 1978? was is 129000 US applicants? Not even close. In 1978 there were under 30,000 applicants. The last year reported in 2014 had the highest number of applicants in history.
Medical School Applicants, Enrollment Reach All-time Highs - News Releases - Newsroom - AAMC
Medical School Applicants, Enrollees Reach New Highs - News Releases - Newsroom - AAMC

Long term trends are here up to 2002 Medical Schools And Their Applicants: An Analysis

So that fact is in error by a huge amount.
Primary care providers no longer means physicians. An increase of 10% in the number of insured lives means that all else being equal, you need 10% more primary providers. This requirement is likely to be met by advanced practice nurses and PA's in large part, freeing the more highly trained MD's and DO's to handle the non-routine patient care.

In 1965 23% of residency positions were filled by foreign medical graduates
Foreign Medical Graduates in the United States - Harold Margulies, Lucille Stephenson Bloch - Google Books
and it is 21% now
Medscape: Medscape Access

When you start with non-factual facts, you might end up with non-reasonable conclusions, or not

As to what we Americans will stand for, that is for the political forum but to suggest that there is some secret conspiracy of people attempting to collapse the health care industry is ....

Thank you for the update---my info is about 10-12 years old.
The 129,000 number was just what we were told in 1978, it may have included non-US citizens, or been inflated to emphasize the competitiveness of the process, so my apologies
According to your own citation, medical school applicants dropped from 47,000 to 32,000 from 1996 to 2003--but yes, those numbers have since rebounded
It did not state whether "residency programs" also included fellowship programs. Since many fellowships went from 2 to 3 years, the number finishing each year declined by 33%. In addition, about 50% of medical school graduates are now women, and that is great---however, women physicians tend to work less hours and have career interruptions for maternity leave, numbers alone don't tell the whole story

I still question the qualifications of new applicants. MCAT scores have declined. The pass rate on NBME pat I is now down to 85%---a test that my dog could pass( yes, that's a hyperbole). I sat on the admissions committee at SUNY and we had applicants with 2.3 GPAs and 35 on the MCATs---so not all "applicants" are created equal

Now, that takes care of new physicians, and your numbers are accepted. It does not include the accelerated attrition of existing physicians. The AMA estimated that as many as 250,000 current clinical MDs out of 900,000 will be lost to alternative careers and early retirement over the next 5 years. And the demand will only go up. In addition, more physician time is spent on documentation and regulation, so the number of hours in direct patient care has declined, per physician

I love nurse practitioners, but there is a pitfall there also. NPs, on average , will order far more lab tests and imaging procedures for the same condition than an experienced MD would. This drives up cost. They do spend more time with each patient, but therefore see less numbers, so you cannot substitute them for MDs 1 for 1.

So regardless of some of my inaccurate or out of date numbers, I stand by my opinion that the quality of medical in the US is going to go down, not up.

[golfing eagles]

Originally Posted by CFrance

GE, with all due respect to your knowledge... If only everyone were a doctor and could diagnose the severity of his own illness/emergency. Or if only (and maybe they did; OP didn't say) the doctors and nurses communicated every single thing in your original reply to her to ease her fears over her condition and the degree of contagiousness of her roommate. The latter may not be possible due to time constraints, but somewhere along the line somebody must have had enough time to convey that information. Or they should make the time, since 16 out of 17 patients, using your experience as a for-instance, in an ER aren't in life-threatening conditions.

I wish they would communicate everything as well---it makes it easier all around. And frankly, it doesn't really take that much time. Remember, 16 out of 17 was a distant assessment at single moment in time---in real life there are times that serious cases come in droves and times where it is more like a flu clinic. As Momma always said, ER life is like a box of chocolates--you never know what you get

[Bonnevie]

Originally Posted by golfing eagles

Thank you for the update---my info is about 10-12 years old.
The 129,000 number was just what we were told in 1978, it may have included non-US citizens, or been inflated to emphasize the competitiveness of the process, so my apologies
According to your own citation, medical school applicants dropped from 47,000 to 32,000 from 1996 to 2003--but yes, those numbers have since rebounded
It did not state whether "residency programs" also included fellowship programs. Since many fellowships went from 2 to 3 years, the number finishing each year declined by 33%. In addition, about 50% of medical school graduates are now women, and that is great---however, women physicians tend to work less hours and have career interruptions for maternity leave, numbers alone don't tell the whole story

I still question the qualifications of new applicants. MCAT scores have declined. The pass rate on NBME pat I is now down to 85%---a test that my dog could pass( yes, that's a hyperbole). I sat on the admissions committee at SUNY and we had applicants with 2.3 GPAs and 35 on the MCATs---so not all "applicants" are created equal

Now, that takes care of new physicians, and your numbers are accepted. It does not include the accelerated attrition of existing physicians. The AMA estimated that as many as 250,000 current clinical MDs out of 900,000 will be lost to alternative careers and early retirement over the next 5 years. And the demand will only go up. In addition, more physician time is spent on documentation and regulation, so the number of hours in direct patient care has declined, per physician

I love nurse practitioners, but there is a pitfall there also. NPs, on average , will order far more lab tests and imaging procedures for the same condition than an experienced MD would. This drives up cost. They do spend more time with each patient, but therefore see less numbers, so you cannot substitute them for MDs 1 for 1.

So regardless of some of my inaccurate or out of date numbers, I stand by my opinion that the quality of medical in the US is going to go down, not up.

your observations mirror mine having worked in hospitals for over 30 years and seeing the caliber of graduates decrease over that time.

I appreciate your informed insight.

[golfing eagles]

Originally Posted by Bonnevie

your observations mirror mine having worked in hospitals for over 30 years and seeing the caliber of graduates decrease over that time.

I appreciate your informed insight.

Thank you. Obviously you just joined me in the "BS" club

It's OK, we have a lot of company---like 99% of healthcare professionals

I would repeat the misquote "Ignorance is Bliss", but the full quote is "WHERE ignorance is bliss, 'tis folly to be wise" Maybe both apply

[rosygail]

My husband waited 10 hours to see a doctor in the TVRH ER on March 2nd, and he was having chest pain! This is unexcusable care! They must do better!