[Jayhawk]

Originally Posted by skyguy79

I'm in the system and I've been a patient at both Colony and Pinellas, and none of what is stated here is consistent with my experiences with the many appointments I've had. If I want an appointment with the doctor, I get scheduled with my doctor. If I want to see the PA, I'm also free to make my appointment with the PA. No problem! The only reason I can see why anyone would say they can't see the doctor and just the PA is because the doctor isn't available for an appointment when the patient wants their appointment, or they simply didn't communicate that they wanted the doctor when making the appointment.

I've been free to see either one I want so long as they're available when scheduling. I have at least seven or more regular, special purpose or semi-urgent visits per year, and with my next two appointments I have one with the doctor and the other with the PA. No problem, no disappointments, no dissatisfaction!

This matches our experience at Pinellas.

[jojo]

I just started with the Villages Health system in January but am very pleased and have seen the doctor each time. I've never felt rushed with him. The medical team that supports the doctor is very responsive if I have a question or need. I especially like the electronic records that are immediately available with all lab tests etc. I've been recommending the system.

[dgammon6]

Well said skyguy79. That's been my experience also. For an emergency visit I'm scheduled with the PA, who consults with my Dr. if necessary. Another tool I've never had in the past is the secure Patient Portal, and being able to email my Dr. and get a same day response. My regular scheduled Dr. Appointments have always been very thorough and doc has spent at least 30 minutes with me making certain that he has covered all my issues.

[KayakerNC]

Originally Posted by Carla B

Who will we see when they run out of PAs?

A nurse practitioner (NP)

[Dr Winston O Boogie jr]

Originally Posted by ilovetv

Marcus Welby, MD was a fictional television character.

The developer's use of the Welby concept was to convey the goal of paying the physicians an attractive, flat salary so they could hopefully have time enough with the patient to actually learn more about them and their conditions instead of having to see dozens of patients per hour and spending only 3 minutes with them in order to get enough reimbursement from Medicare and insurance to pay the bills of running the practice. Reimbursement is low and going lower, and insurance companies often call "reasonable and customary charges" what Medicare calls reasonable and customary.....and THAT is less than the costs the providers have to pay to keep the place running.

Obviously people are racing to try to get into these practices in TV, thus the length of time to get an appointment.

The good part is that the TV health system is intent upon getting quality primary care doctors, and apparently they are. Any time somebody asks if they like the dr. they have in one of the existing clinics, there are very good reviews of them.

And because the physicians are being paid an attractive flat salary, do people believe that there won't be pressure from those higher up on the corporate ladder to see as many patients as possible?

My experience in dealing with and working for big businesses is that the people on the front lines whoa re dealing with the customers are the ones that want to give good service. It's the people above them that don't allow that to happen.

Did I read that every doctor will have "only" 1500 patients? If you do the math and a doctor sees each of his patients once every six months then he has to see 58 patients a week. If he gives each patient a half hour, that will take up 29 hours of a forty hour work week. That doesn't include time for paperwork or reviewing a patient's record ahead of a visit. Many doctors also need to see their patients when they are in a hospital and of course if the patient is having a specific problem, the doc might need to see him more than twice a year. In fact, my doctors sees me every six months.

[justjim]

The trend in health care is toward the PA'S and NP'S. This is not just in TV it's across the country. The Doctor has become more of a "manager" or "Adminstrator" if you will.

I have a doctor friend who told me recently that the paperwork is just overwhelming. You wonder where the doctor is-----he is doing paperwork on the computer system or overseeing it for the purpose of avoiding or defending a lawsuit.

We have trained too many lawyers and not enough doctors.

Could health care be better, sure, but in TV especially, the facilities and number of health care personnel has been unable to keep up with the growth and expansion.

[ilovetv]

Originally Posted by Dr Winston O Boogie jr

And because the physicians are being paid an attractive flat salary, do people believe that there won't be pressure from those higher up on the corporate ladder to see as many patients as possible?

My experience in dealing with and working for big businesses is that the people on the front lines whoa re dealing with the customers are the ones that want to give good service. It's the people above them that don't allow that to happen.

Did I read that every doctor will have "only" 1500 patients? If you do the math and a doctor sees each of his patients once every six months then he has to see 58 patients a week. If he gives each patient a half hour, that will take up 29 hours of a forty hour work week. That doesn't include time for paperwork or reviewing a patient's record ahead of a visit. Many doctors also need to see their patients when they are in a hospital and of course if the patient is having a specific problem, the doc might need to see him more than twice a year. In fact, my doctors sees me every six months.

Of course there will be pressure to see more patients per hour once the developer is subsidizing the system less after its formation is complete. I was addressing the "Marcus Welby" concept and goal of not having the doctor pay directly dependent on how many patients they see and how many tests they run--because with Medicare and insurance that pays only what Medicare pays (less than cost), which is the only way to both pay the bills of the practice and to stay afloat financially.

To me it looks like they're using the less costly employees (PA's who are good at their scope of practice) to do the less complex work for which medicare and insurance pay less, to free up more time for the drs. to do the most complex work that the more complex patients present. But so far, the mandate to feed the computer files on every patient is eating up time that could/should be spent on patient care.

How many chief financial officers of a large company have to spend 40% of their time doing data entry on an iPad instead of financial analysis and decision-making? That is what the mandated electronic medical records software (different in every practice) is doing to drs.

Marcus Welby didn't have to do data entry and then buy costly malpractice insurance for when he got sued and his patient records would be put under a microscope in court for not doing every expensive, technological test known to man, only to cover his butt for just such an occasion.

[TheVillageChicken]

Originally Posted by gomoho

Villages Pl - I was wondering the same thing. What are the doctors doing if the PA's are seeing everyone??? I was completely and totally disenchanted with the whole system in the beginning, starting with how they "invited" people to join to my experience with what I will loosely refer to as a doctor. Well I don't have Medicare and still have a high deductible so I only go to the doctor when I really, really need to. That situation occurred in the past week when I couldn't even get out of bed because of the back pain I was having. The morning I woke up vomiting with pain beyond belief I called Colony and much to my surprise they asked if I could be there in 15 minute. I assured them I could and was more than pleasantly surprised by my experience with the PA. She was outstanding - listened, asked questions, wrote a script for the pain and off I went. My only complaint - too much typing on the computer. I go back on Monday for my annual physical and supposedly will see the doc. Curious to see how this will go and if I will actually see a doc or the PA.

My urologist at Duke University Medical Center told me that tethering to the computer is due to requirements imposed by the Affordable Health Care Act. During my last visit, he sat there typing and three times dropped his chin to his chest, groaned, and sighed "Obama Care."

[DeanFL]

My first appointment at Pinellas with a doctor is this Monday. I called to schedule about 3 weeks ago, so have no experience yet with any of the doctors or PA's (not "physicians' assistants", but "physician assistants" (more appropriately "physician associates"). I will say something, however, about PA's in general, because my daughter and son-in-law are both PA's, so I am familiar with the training.

After a full, unrelenting year of didactics, the student rotates for another year in various medical disciplines. They have become familiar with all areas of anatomy, physiology and pharmacology during their training. When they go into private practice it is under a doctor's supervision, which allows them to seek advice of the doctor if they are unsure of a set of symptoms. They know your life is in their hands and they don't want to make a mistake.

I have no problem seeing a PA, who is able to spend more time with a patient. Let's face it: This is the direction of healthcare. If the medical condition is beyond the knowledge of the PA, then the doctor will be brought in.

I remember when a doctor would come to the house, but those days are merely fond memories. We need to realize that change, whether for good or bad, is what we have to accept.

[Chi-Town]

Originally Posted by TheVillageChicken

My urologist at Duke University Medical Center told me that tethering to the computer is due to requirements imposed by the Affordable Health Care Act. During my last visit, he sat there typing and three times dropped his chin to his chest, groaned, and sighed "Obama Care."

There are incentives in the ACA to move to electronic records. There are huge administrative and patient benefits to move away from forms and dictation which are cumbersome and lead to errors and non compliance. Of course, with a new system there is a learning curve. But all of us have made it through technological changes before and after a little griping things got better.

[SoccerCoach]

I've been cared for by Dr. Pead in the Santa Barbara office. I always am seen by the Dr., with his nurse practitioner attending. PA's and nurse practitioners spend a great deal of time training to be able to work in their field, under a doctor's guidance. I applaud them. The doctor may not be available due to another patient in greater need of his care. So, try to put yourself in the place of the patient needing the greater care. I'm betting, at that moment you would be glad the doctor is at your side. So, be patient people.

[DouglasMo]

Originally Posted by DeanFL

My first appointment at Pinellas with a doctor is this Monday. I called to schedule about 3 weeks ago, so have no experience yet with any of the doctors or PA's (not "physicians' assistants", but "physician assistants" (more appropriately "physician associates"). I will say something, however, about PA's in general, because my daughter and son-in-law are both PA's, so I am familiar with the training.

After a full, unrelenting year of didactics, the student rotates for another year in various medical disciplines. They have become familiar with all areas of anatomy, physiology and pharmacology during their training. When they go into private practice it is under a doctor's supervision, which allows them to seek advice of the doctor if they are unsure of a set of symptoms. They know your life is in their hands and they don't want to make a mistake.

I have no problem seeing a PA, who is able to spend more time with a patient. Let's face it: This is the direction of healthcare. If the medical condition is beyond the knowledge of the PA, then the doctor will be brought in.

I remember when a doctor would come to the house, but those days are merely fond memories. We need to realize that change, whether for good or bad, is what we have to accept.

OK, the PA gets more training but a Physician is a medical student for what? 4 years, then an intern for 1 year, a resident for 4 more years? Now whose experience do you want?
I've gone to a Physician here in The Villages who I was told does not see "clinic patients" - I would have to see only PA. Obviously I don't go there. From what I read and this is my opinion,,,,, we all are in for a very rough ride -- I want a physician who listens to me and does not have to worry about inputting into a computer…No answers please, I won't change my mind…

[ilovetv]

Forbes: Why Is Your Doctor Typing?

"..... In the last year or two, there’s been a shift. Much of my time with doctors has been spent watching them type. In one case, the doctor tapped away on his laptop, occasionally looking up to ask questions before returning to the main focus of his attention: his computer. In another case, the doctor intermittently tapped on an iPad while we spoke. In a third instance, the doctor had a conversation with me and then apologized that he would be spending the next half of our session typing up the results of our conversation. All this typing was required, he said, if he was ever going to be reimbursed for his services. It was getting in the way of being a doctor.

Surely, I said, computerized medical records generate benefits. They are easily retrievable. They can be transferred from one practice to another and accessible to the many different service providers—hospitals, laboratories, specialists, radiology and so on—that might be involved in any one patient.

“In theory, perhaps,” he replied. “But in practice, it’s a horrible and costly bureaucracy that is being imposed on doctors. I spend less time with patients, and more time filling out multiple boxes on forms that don’t fit the way I work. Often I am filling out the same information over and over again. A lot of it is checking boxes, rather than understanding what this patient really needs..........”

Why Is Your Doctor Typing? Electronic Medical Records Run Amok - Forbes

[Bizdoc]

Originally Posted by TheVillageChicken

My urologist at Duke University Medical Center told me that tethering to the computer is due to requirements imposed by the Affordable Health Care Act. During my last visit, he sat there typing and three times dropped his chin to his chest, groaned, and sighed "Obama Care."

The only problem with this is that prior to ObamaCare kicking in, I saw the same problem in hospitals. Really what changed is that docs now have to document what is going on (in part to make insurance happy and their malpractice insurance even happier) - before they could simply note something no one else could read and move on.

Also keep in mind that docs are like the population in general. Some took to computers years ago and some fought against it. The ones that fought it are having trouble adapting to electronic medical records.

In the late 60s, there was a movement from clinical medicine to lab medicine. Doctors started diagnosing not with their observations, but based on lab results. Increasingly, they ordered batteries and batteries of tests before they even saw a patient. I fired my doctor in 2005 because she would never look up from my chart and actually look at me. And in 10 visits, she *never* actually touched me. (which is pretty hard to manage while doing a physical exam!)

Todays doctors are trained to wheel their computer stands around. They can't actually go into the patients room anymore (not enough room for 10 people and their computers), so they stand out in the hall, stare at the screens and discuss the patient. The residents and students don't examine patients - they look at the stats and test results on their screens. Maybe, if you are lucky, one will actually go in and speak to the patient,

Yeah, primary medicine in the US sucks. Complain all you want about "socialized medicine", but primary care under British National Health is much better than here and doctors often do make house calls if the patient is too ill to come to the office. And the district nurse will visit seriously ill folks daily if need. (They have decided to invest the money in primary care. Specialty care, well, sucks really badly)

At least PAs and ARNPs are likely to actually talk to you and examine you.

[Villages PL]

If The Villages healthcare system had been completely explained we wouldn't be having this discussion and confusion. For example, every Sunday they devoted one full page in the Daily Sun to talking about (and showing pictures) of their new doctors and P.A.s. But did they ever explain exactly in what way and under what circumstances a P.A. would be used? No!

They just kept stressing the point that the doctor would have plenty of time to get to know you (20 minutes or more per visit). You have to wonder about their organizational skills if they couldn't come up with a simple plan to educate current and prospective patients as to how this plan would work.

They just assumed that everyone would know what the duties of a P.A. would be? They are there to assist, yes, but in what way? How do their duties differ from that of a nurse who works in a doctor's office? Will those of us who are well be permanently assigned to see a P.A. instead of our doctor? People like to know what to expect and they shouldn't assume that everyone will automatically have it all figured out.

Look at all the heavyweights they introduced like medical doctors with multiple degrees and decades of experience including experience in office management etc.. And not one of them could figure out that the presentation to the public was lacking important information? Yet they kept saying, over and over, that this new healthcare system would be "patient centered".