Originally Posted by serenityseeker

Its funny that most of what you reference is surgeons and your secondhand information. Also as CEO of Medlink I'm sure you didn't mind taking money from the "thieves".
You had an opportunity to hear another side of the debate, an informed an honest one,and to learn something yet you choose to disregard it with irresponsible comments and preconceived notions. There is something to be learned by all that are willing to look at all sides of a debate, especially when someone knowledgeable is offering a truthful behind the scenes look. It is often easier to hold on to ill informed preconceived ideas than actually opening one's mind to other possibilities or other "truths" within the same subject.
How many docs do I know that drive an Escort? None right off hand..would that make them a better doctor to you? Would the fact that my closest colleague drives a 15 y/o pick up be a more satisfying scenario, or that I have an older model truck myself, or that my boss drives a 15 y/o automobile? This whole preoccupation with the "rich doctors" and failing to even attempt to recognize the major factors that contribute to this mess is part and parcel of the lack of knowledge that is assisting in the death of the system as we know it. It is also attitudes just like that that that do condemn so many physicians that don't fit your stereotypical set up that simply add to the difficulty of practicing today. I have heard many describe practicing medicine as being in an antagonistic environment. Keep painting all physicians with the same broad brush of ill informed negativism as you ask yourself why we don't have enough physicians, why we can't get appointments, why no one will go into primary care. Who could blame them with attitudes like this. There are bad apples in every field, but irresponsible accusations and condemnations of a professional group as a whole serve no positive purpose for those that perpetuate them or those that are falsely accused.
I have said more than enough here. I offered real world experiences with the hope that I could shed some light on some of the truths that a lot of people don't realize. It is not worth any further effort at this point. In fact the whole point of the effort has been lost in this morass of pettiness. My apologies for contributing to that part of it.

Fini

Originally Posted by serenityseeker

Wow! The frustration is palpable here!
I understand exactly what alot of you are saying and experiencing but let me give you some information from the physicians perspective.
Voice menus are definitely irritating to alot of us, but I think many physicians have no choice at some point. Figure the average physician has between 2000-4000 patients. The fielding of those phone calls on a daily basis is an enormous task. Couple that with pre-approval calls to insurance companies for nearly every test and referral, calls about billing issues,lab results and others and you are tying up 1-2 full time people just for phone calls. The typical environment that you never see or hear in the office is one of barely controlled chaos.
The physician doesn't "choose" to have so many patients in most cases, it is a necessity to survive in todays medical/business culture. Reimbursements drop every year from insurance companies and the government payers, but all of us know that costs rise EVERY year, and the overhead to run an office does to. This is a losing battle and physicians are forced to try to see more patients in the same amount of time. It still isn't working. Most physicians (almost all) in primary care are taking salary cuts each successive year. They spend more time with patients and address more problems than the sub-specialists and yet not only are paid the least, but usually are the first to see the cuts.
Things like automated voice menus, giving up in-house labs(very expensive equipment and onerous government regulations) and overscheduling patients are a last ditch effort to survive. In what other fields can a professional spend so much time, effort and money on education and training and know up front they will take a pay cut each year? Many physicians assistants and nurse practitioners salaries rival or exceed those of primary care physicians. Money is not the be all end all but who wants the pressure, responsibility and liability, coupled with long stretches away from family, on top of the pressures of trying to run a business(a full time job in itself) with a non commensurate "reward" for it?
As far as waiting times for new appointments, get ready, it is going to get much worse all around the country. Dramtically less medical students are willing to enter primary care for the above mentioned reasons, we have been seeing it for a few years now. Estimates of the shortage of primary physicians in the next 10-20 years are staggering and frightening. This is happening at the worst possible time as our population ages. Waits are so long for new appointments because their are not enough primary care physicians and the forecast is only that it will get worse.
As far as weekend call coverage goes, let me try to give a couple of bits of information. Many primary care docs have simply given up their outpatient practice and turned it over to hospitalists(groups that specialize in in patient care only) because the time it takes to round on just a few sick hospital patients robs multiple people of office visits.. After 5-6 days a week of long office hours and having been pushed into giving up inpatient practice, most take their 1-2 day weekends(the part that is not used catching up on charts and billing) to have with their families and leave those after hour"emergencies" to others. No one wants to take call. If you do carry your pager and are deluged with calls all weekend there is no reimbursement for your time, expertise, or offset of the liability of prescribing by phone and taking a chance on a poor outcome when you didn't physically see the patient.
What it boils down to is a broken system. The business of medicine and the high cost associated with liability are strangling the system.
As far as specialty care goes, some times a place like M.D. Anderson is a good choice. For the vast majority of care, we all practice according to the leaders in the field, and the difference is scant on many issues. This of course does not refer to specialized procedures that are only done by a few, or places where procedures are noted to have superior outcomes. The bypass surgery at Cleveland Clinic is the same done at hundreds of other hospitals in this country.
For those of you with compassionate and dedicated primary care physicians, take the time to let them know you appreciate them. Educate yourself about the system and talk to your elected officials(how many of you are aware of the yearly battle with looming 5% medicare cuts and last minute bail out efforts) about cuts and reimbursements for primary care physicians.
Please excuse the length of this but their is no short way to address it. We have to become more educated and proactive in the system, and someone needs to advocate for the primary care docs before we hit the shortage/crisis full bore. If you have any doubts just Google info about shortages in Family and Internal medicine.
Just wanted to take the time to let you know a little of what goes on behind the scenes every day.

thanx for listening

From a fellow physician who recently moved to TV but who is NOT able to retire for the myriad of reasons mentioned above the key phrase in this excellent post is ... "we have a broken system". The legal problems and insurance companies have destroyed healthcare in America. We spend more on health care per person than any developed country yet rank near the bottom on most measures of health. When older physicians like myself are asked in surveys if they would go into medicine now most say absolutely not. And, as stated, it's only going to get worse.

Originally Posted by Russ_Boston

**Snip** As you know I'm leaving my current profession of 30 years and going to nursing school for my RN. Will I be happier? Who knows, but I'm trying to alter my path instead of just saying how bad i have it. We make our own destines in life.