How medical practice has changed

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Thursday, March 23. 2023

How medical practice has changed

There are still some private practice, old-time doctors out there, but times have changed.

WSJ: Doctors Are Losing Their Calling. The sanctity of the medical profession has been lost to corporate centralization

Posted by Bird Dog in Medical at 14:15 | Comments (17) | Trackbacks (0)

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You can say that again! Here in MT we have a large and important hospital that lost all of it's "family care" doctors--they all walked within weeks of each other. Hmmm....I wonder why?

This hospital used to be a nonprofit but changed about 7 or 8 years ago to become a for-profit operation. In the years since that change over I have lost four primary care physicians. One after another just left--now the whole lot of them just walked. This hospital belongs to a large chain of hospitals that have been taken over recently for profit.

Because the local newspaper works on the "advocacy" rather than "objectivity" philosophy, there has been no reporting of this event in the local liberal rag.
Interesting side note; I have heard multiple complaints about the woman running the local effort.

#1 Apple Pie on 2023-03-23 14:46 (Reply)

If it's any consolation, the newspaper business is headed for the toilet along with independent doctors and hospitals. I think even Gannett ran into a profitability problem and they are pretty much an amalgam of regional newspapers other than USA Today.

#1.1 indyjonesouthere on 2023-03-23 17:44 (Reply)

I would immediately assume that this is a consequence of Obama's Affordable Care Act. From my experience, which could be biased, the transformation of medical businesses started right around the same time, and the theme was one of increasing administrative duties, and increasing administrative power. Now the bean counters are in charge - they are making policy decisions that go directly to the quality of YOUR medical care. They are not for your benefit.

My internist retired last year and I had a devil of a time finding a replacement. My doctor friends tell me it's a dying breed. Most internists nowadays appear to be 'hospitalists', which is a clinic-walker that punches in & out, works the hours, runs the rounds, checks the charts. They are 9-5'ers and uninterested in knowing patients or handling cases past a simple hospital stay. Or, they are using the 'internist' function as a pathway to specialization and bigger bucks. But I did manage to find a classical internist eventually and we're real happy with him. He's not part of a hospital system. He doesn't stare at a laptop, peppering you with questions and typing away. You get his full attention and the more you bring him, the more he focuses.

#2 Aggie on 2023-03-23 17:36 (Reply)

Incidentally, the WSJ story about Brigham-Young doctors wanting to unionize is (to me) the standard kind of union-talk crap that we always see. Unionizing fights are always about the fight between the workers and the business. And in this case, the medical industry's administrative arm has been flexing for years: every single hospital doctor that I know has suffered 1) increased working hours, (2) increased non-medical & administrative responsibilities and deliverables and (3) effective pay cuts. I am guessing that this is the essence of the union complaint - but they'll still try to sell it as 'caring for the patients' as if this were the driver. It ain't - they're trying to get you on their side and harvest your moral & political support.

#2.1 Aggie on 2023-03-23 17:50 (Reply)

After the Covid fiasco, I have no sympathies for doctors or hospitals. I rather appreciate the AAPS but they are a smaller association although they are fairly active in Missouri.

#2.1.1 indyjonesouthere on 2023-03-23 18:01 (Reply)

Signed into law 13 years ago today, in fact.

#2.2 Aggie on 2023-03-24 00:28 (Reply)

I feel sorry for physicians. They have to subordinate their ideas to the management of the hospital they work for. My PCP still won't prescribe Ivermectin.

#3 snopercod on 2023-03-23 18:07 (Reply)

There may be an AI in the near-future of your doctors office: https://www.youtube.com/watch?v=XmnTd92NqFw&t=650s. No doubt Google will ensure that the AI will prompt you to take your totally safe mRNA vaccines.

#4 Freddo on 2023-03-23 18:49 (Reply)

They've gone to concierge practices. Go concierge...

#5 Crew on 2023-03-23 20:45 (Reply)

That's what we did, but our doc is getting up there and I'm sure will retire soon.

#5.1 Texan99 on 2023-03-24 09:40 (Reply)

Love you BirdDog, but your age is really showing. It's like you were not sentient through the Obama years.

Yes, things have changed. The Marxists took over. Where were you?

#6 Guest on 2023-03-23 21:28 (Reply)

Medicine needs to be disintermediated, i.e., to go back to a direct cash-payment basis, supplemented by indemnity insurance, and possibly, some basic public support for the very poor. The insurance companies bring no value to routine, or even most acute care. The analogy I like to cite is: You do not insure your car against oil changes or brake jobs. You insure against accidents and liability claims. Why would you insure against routine, predictable medical care? This would allow the market to discover the real prices of various services, and vastly reduce the burden on physicians--especially family care physicians--of the administrative costs that come with third-party (especially including Government) payers.

The same applies to prescription drug insurance. Prescription insurance is not "insurance" per se but rather a "buyer's club". Looking at the statements I get from my insurer, most of the time the insurance company pays nothing towards the drug cost. (I generally need only generic, formulary medicines.) My co-pay is all they get. But if I walk in there any try to buy the same drug without insurance, a $15 co-pay suddenly becomes a $175 charge. This is a scam. All of the money I pay to the insurance company is profit to them for the service of providing me with a negotiated price. The "real" price of medications could be more efficiently discovered through the market, but the insurance companies prefer the situation as it is now.

#7 Hairless Joe on 2023-03-24 09:51 (Reply)

Government wants control of everything. They started shoveling money into the medical business decades ago. And they began interfering in the insurance business with medicaid/medicare and topped it off with obamacare. The more involvement they have the more expensive it becomes as they mandate everything whether you want it or not. There massive interference wipes out individual practitioners and local hospitals as they are buried under red tape reporting with absolutely no privacy from the government snoopers.

The government started shoveling money and student loans into education K thru PHD and what have we gotten except marxist professors, crt, sex ed, gender dysphoria, declining SAT scores, FBI investigation of parents confronting school boards, useless majors, diversity scams, and A's for all.

The commonality is federal government intrusion into areas of life which it has no business being involved in. Once you accept the money they own you and using extortion they add more and more mandates.

#7.1 indyjonesouthere on 2023-03-24 14:48 (Reply)

Medical care has gone to hell as it has been "comglomerated" to death.

It used to be that internists, GP's, or pediatricians were rooted in a community. They were small business men. They payed their own nurses, receptionists, and owned an office, etc. They had an investment in the practice that they owned and a responsibility to their patients.

Then local hospitals started buying practices. Then bigger hospitals started buying smaller hospitals.

This was all in the works - then Obama care hit and that was really the tipping point. Mandates, government money, etc. etc. It wasn't the insurance portion of ACA - it was all the other things like electronic medical records.

Today, doctors are just employees - and think like employees. An old time doctor friend of mine who helps recruit doctors to our small town told me not long ago: "these kids don't ask how much they will make or how they can help the community. The first three questions they ask are - 1. How often do I have to be on call 2. Are you going to pay off my loans 3. How much vacation do I get.

He went on to say "it used to be if you saw a doctor that moved around a lot you wondered what was the matter with them that they can't stay in one place. Today they ask why hasn't he moved to a better job - what is the matter with them that nobody wants to hire them for a better position.

They are employees with no roots. At a broad level, they can pick-up and leave at a moments notice with no consequences and their patients be damned.

One last point - while you have me on my soap box. Gp's have largely been replaced by PA's and NP's. I think they are fine for small things like Strep or sinus infections - but more and more they have taken over all of primary care. It makes sense for BIG Hospital Inc. they work a lot cheaper than MD's and are more plentiful. But, has anyone really looked at the quality of care they provide? Their training is not equal to an MD - so can their observations and diagnostic skill be at the level of an MD?

Everyone I talk to says health care had deteriorated precipitously in the last 10 years.

#8 jg123 on 2023-03-24 10:00 (Reply)

I visited a urologist PA last year and asked her if any hospitals in the area offered the new PMSA PET CT for detecting the spread of prostate cancer. She had never heard of it. Scary.

#8.1 snopercod on 2023-03-24 10:20 (Reply)

Longer than that. My orthopedic surgeon father talked about this affecting his Tacoma practice almost 40 years ago. Said socialized medicine and frivolous malpractice suites would destroy patient care and the medical profession, as it already had in Europe and Canada. He talked me out of med school. I joined the Navy and flew instead. Good call.

#8.2 Bull on 2023-03-24 21:15 (Reply)

Track the % of women doctors over time and that will explain alot.

#9 grant1863 on 2023-03-24 10:04 (Reply)

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Thursday, March 23. 2023

How medical practice has changed