Interested: Universal Health Care

Pre-Med & Medical School Pre-Med Topics
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<p>You seem to bring up that 59% a lot. Let me again remind you that those are mostly internist and primary care. Specialist will not feel the same way. I am confident that although White doctors are more numerous (number only), there Asians overrepresent (by percentage) their 4.4%.</p>

<p>59% of doctors support the bill. Let me ask you something. Of the 41% left, 20 percent will quit medicine should the bill is passed. 20% no biggie right? wrong, you take away 20% and your gonna start have a lot of people dying.
11% of physicians will switch careers while 9% will directly retire.
Source:[Survey:</a> Universal health care would add to U.S. doctor shortage - Atlanta Business Chronicle:](<a href=“http://www.bizjournals.com/atlanta/stories/2008/05/12/daily80.html]Survey:”>http://www.bizjournals.com/atlanta/stories/2008/05/12/daily80.html)</p>

<p>For investment banking, 3rd year associates make 250k to 450k. Another year up will bring that to 500k as the pay seems to increase exponentially rather than linearly. Im pretty sure ill get a U of C MBA should i go into Ibanking.</p>

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<p>As a physician I’m going to assume you have at least a basic understanding of statistics, so ask me to clarify if anything is hazy. As I stated, a random sample means that physicians were chosen in such a way as to ensure each physician (regardless of political leaning or specialty or any other factor except that they were physicians) had an equal chance of being selected for the study(This means that if we select a large enough number of physicians our data will nearly mirror the data that we would obtain if we took a census of all physicians). To test whether this is true those conducting the study would have calculated whether the sampling distribution was approximately normal. In this case this would have been accomplished by ensuring that the sample size was of a sufficient size to satisfy the central limit theorem, and that there were no obvious flawed in the mailing procedure. [Central</a> limit theorem - Wikipedia, the free encyclopedia](<a href=“http://en.wikipedia.org/wiki/Central_limit_theorem]Central”>Central limit theorem - Wikipedia) Generally, it is accepted that any sample size of at least 30 is sufficient, but other times the procedure used requires a slightly different calculation of appropriate sample size. Under any possible procedure a sample size of 2000 would be sufficient unless the population is smaller than 20,000. There are more than 20,000 US physicians so this is irrelevant. Now, the link I gave you does not explain how they selected physicians so it is not possible for me to explain why they did it correctly, but they do state that they used a random sample, which means that professional statisticians were satisfied that there was no procedural bias in the sample that would not be accounted for by the margin of error. The link does give a link to the original poll by kaiser, but I was unable to get to it.</p>

<p>I hope that helps explain things.</p>

<p>Edit:

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<p>They did select physicians from the AMA. I recognize that this is inherently biased. However, the AMA’s bias (I presume) would be towards not having a public option, so the fact that even the AMA sample resulted in 59% in favor of a public option would indicate to me that the rate among all doctors may be higher. Would you contest this? The survey also gave a breakdown by specialty which seems to confirm my assumptions even within the AMA sample. I am no expert on AMA membership, so if there is something concerning to you about their membership that you feel would affect this studies validity I’d be more than happy to listen.</p>

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<p>The way I understand it, they chose doctors from the AMA database. </p>

<p>I take that to mean doctors in the AMA. I believe this represents 1/4 of physicians. </p>

<p>Aside from exploring the meaning of that statistic, would that be considered random?</p>

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<p>“I am no expert on AMA membership, so if there is something concerning to you about their membership that you feel would affect this studies validity I’d be more than happy to listen.”</p>

<p>I DO know, the last time I belonged to the AMA, I worked for somebody else, and THEY paid my dues. Up until now, being able to use your own knowledge and judgment, may have been among the things that drew people to medicine. Oh well. </p>

<p>Are you able to see the actual questions and responses in the PDF? It matches my impression. More than half think something needs to be done, but few can agree on what, and most don’t think those who will decide, are informed enough to make the decisions. Most I talk to think folks won’t realize what this is going to look like, until it’s too late. I think many of us in the trenches ( at least my primary care husband and I, and we are low-average-for-doctors earners, from low income, minority backgrounds, who have been chiefs of departments and medical groups, managing large staffs and budgets ) are thinking…be careful what you wish for.</p>

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<p>That 59% is a representative sample all all physicians in the AMA, which is known for being overly representative of specialists and others that tend to be chiefly concerned with physician income, as noted by their lobbying efforts. This means that 59% is likely a conservative number. As the study notes the only specialties that do not have majority support for the public option are surgical sub-specialties, anesthesiology, and radiology. (All very procedure based specialties) The study also shows an increase in favor of a public option among even these specialties indicating that even those who could stand to lose under a shift away from pay-per-procedure understand the rising need for change.</p>

<p>You make mention of a study that shows that 20% would leave if such legislation was passed. However, as I have stated, there is no firm plan in place that addresses physician pay. This means that this survey measures what doctors would do under the assumption the such legislation would limit their pay and autonomy. Until legislation is actually drafted that is more specific on physician pay and autonomy, these assumptions are premature and do not represent reality, and as such this survey is not necessarily valid. What is does indicate is that legislators need to listen to and include doctors in discussion of future payment plans and potential concerns over autonomy, which they are doing. </p>

<p>A question: This study does not mention where this loss of doctors would come from in the link you provided. I would assume that doctors already making very large salaries would not be as deterred as those barely making it. Those barely making are already noted by politicians and would likely see their pay increase. Additionally there are proposals to reduce the paper work and bureaucracy that so many physicians complain about. I would be more interested in this type of poll after definitive legislation was proposed. Right now it is mere speculation.</p>

<p>As for i-banking. 3rd-year associate means you’ve have been working for 5 years and have your MBA. And the progression from associate to VP (the next level up) doesn’t always happen. There are only so many VPs after all. Actually, not everyone even makes associate. It isn’t just a matter of time; you have to actually perform well enough to move up. And to assume that you will even be selected as an analyst is somewhat presumptuous. Many never make it even that far, regardless of how prestiguous their school(since you seem to think going to the “right” school guarantees you a job when it doesn’t). In any case, making money alone is not going to bring you satisfaction, and if you want to ignore all research showing that, be my guest…</p>

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<p>i laughed. a lot…hahaha. if this were the case, we’d be in trouble.</p>

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<p>If it could be shown that the AMA contained doctors who likely skewed the statistic towards a desire for a public option it would make this study useless. However, since the reality is likely exactly the opposite I don’t find anything wrong with the conclusion of the study. You could say it is not truly random in that it doesn’t consider non-AMA doctors, but as I have said, I think it is safe to say that considering non-AMA doctors would only increase the percentage in favor of a public option.</p>

<p>You mention that the consensus is in favor of change, but not necessarily one particular form of change. I agree with this, but most doctors are open to a public option. I understand the concern among doctors that those making these decisions are not properly informed, and I think that is true of most politicians. Until recently I would have said it is even true of the President, but after listening to him recently I believe he is extremely well informed. Now the question is, despite being informed what will he actually do/propose. Until legislation is more concrete fears will run rampant and speculation will abound, which is fair if such concerns are constructive. </p>

<p>You mention that you are a primary care physician. I can only see you gaining under Obama’s proposals, at least financially. </p>

<p>You seem to actually agree with the AMA in your concern for “being able to use your own knowledge and judgment.” This was actually a question directly addressed to Obama by the AMA president on Primetime’s “Prescription for America” episode that aired earlier this week, and I tend to favor the President’s response over certain physicians concern. Certainly, we can agree that it is frsutrating when insurance companies make decisions for doctors based on some cost-benefit analysis. However, it is also true that many doctors, even well-intentioned ones, make choices that result in unnecessary treatment that does not benefit the patient. By using research, such as that coming from the Cochrane Collaboration, I think we can reduce costs and over-treatment without harming patients or hugely impacting physician choice. In reality, evidence based medicine isn’t about limiting physician autonomy, it is about making sure physicians are using the latest knowledge to treat patients rather than the knowledge they had when they left medical school and residency, which is often out-dated. </p>

<p>There are some good articles on this issue by Dr. Nortin Hadler, MD, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals.</p>

<p>One such article: [Health</a> Care Reform: The Difference Between Rationing and Rational - ABC News](<a href=“Health Care Reform: The Difference Between Rationing and Rational - ABC News”>Health Care Reform: The Difference Between Rationing and Rational - ABC News)
His book addressing the issue: [Amazon.com:</a> Worried Sick: A Prescription for Health in an Overtreated America (H. Eugene and Lillian Youngs Lehman): MD, Nortin M. Hadler: Books](<a href=“http://www.amazon.com/gp/product/0807831875/ref=pd_lpo_k2_dp_sr_1?pf_rd_p=304485901&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=0773527958&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=0V6NHGV3HHQ8JD4M8Q5F]Amazon.com:”>http://www.amazon.com/gp/product/0807831875/ref=pd_lpo_k2_dp_sr_1?pf_rd_p=304485901&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=0773527958&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=0V6NHGV3HHQ8JD4M8Q5F)</p>

<p>What exactly are your largest concerns with current health care reform proposals?</p>

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<p>The data indicates that the doctors will leave if the bill is passed, regardless if their pay is reduced, increased, or stagnates.
A loss will probably not come from primary care. the loss will come from Neurosurgeons, general surgeons, Anathesialogists (have fun writhing in pain), and radiology (no MRI, no Scans, no topography) and cardiologists. This will be FAR more devastating than if just 20 percent primary care were to defect.</p>

<p>As for Ibanking, no it does not. A MBA automatically secures an associate. Analyst is some one with a BBA, not MBA. A MBA from U of C, Harvard, and Wharton, and Stanford will land you an associate position. Check the career.</p>

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<p>“You could say it is not truly random in that it doesn’t consider non-AMA doctors, but as I have said, I think it is safe to say that considering non-AMA doctors would only increase the percentage in favor of a public option.”</p>

<p>No offense, but you asked if I had a complaint about the sample and I shared it.</p>

<p>(“Do you have a specific complaint about the sampling procedure or do you just not understand statistics?”)</p>

<p>I’m just not as sure of the conclusions as you seem to be.</p>

<p>No I am not a “primary care doc” ( but my husband is) , although some of use Psychiatrists are seen that way. Again, I am not concerned about income. I am concerned about what I have seen happen to mental health patients, and to all the least fortunate and most vulnerable, when resources are limited. If Psychiatrists are in favor of universal coverage, it is because they now how this population get’s treated. We also know, that to give the most vulnerable what they truly need to thrive, is going to mean somebody getting less of something. Maybe a LOT less.</p>

<p>I have been that doctor who does the rationing, who has spent so many moments of so many days saying no! no! no!, to patients, staff, families.The no’s often made sense, still, not fun.</p>

<p>What I don’t see enough of on this or the other thread, is patient accountability. I swear that is more frustrating right now than anything! Any links addressing that?</p>

<p>Maybe everyone should have to read “Worried Sick” before accessing their health benefits?</p>

<p>What exactly are your largest concerns with current health care reform proposals? </p>

<p>I can’t seem to find enough specifics to know where to start, but I feel they will all rely on “physician extenders”. In mental health, even as practiced in primary care, that means a bunch of checklists. Most people have no idea what they DON’T know about Psychiatry. It seems so simple! The checklists always seem to point to some pill, rather than something someone can do for themselves. This increases dependency on the system over time, and with very little in the way of evidence. In part this is because of the grey area between mental health and social services. This is true for much of medicine, especially in the poorest of the population. How much will be considered a health benefit?</p>

<p>I DON’T have a better answer.</p>

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<p>The data shows that based on doctors present perceptions of what change means, 20% will leave. I would like to know where this 20% is coming from. We can both speculate, but that doesn’t really get us anywhere… You claim that the loss will likely come from the largely procedure based specialties, but I really don’t see how a doctor making 400K and year now making 300K a year would be so disrupted as to leave medicine. Where else would they make even that level salary? </p>

<p>And I also disagree that a 20% hit would be harder on specialties rather than primary care. We already have a shortage of primary care doctors and they already have to see too many patients to make ends meet. Many specialists could more easily increase their work load than primary care physicians could theirs. In any event, we can both agree that a 20% cut anywhere in medicine is a big deal. The question then becomes how many would truly leave. We can’t even estimate that until we know how reform will actually change medicine.</p>

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<p>Shrinkrap: I agree with the patient accountability statement. It would be nice to charge non-compliant patients more for their insurance as an incentive to do what they’re told, but I doubt that will ever happen and it could disproportionately affect low income patients who can’t afford insurance as it is. Do you have any policy suggestions for increasing compliance? It seems this is a catch-22 issue in medicine.</p>

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<p>Nothing major, but I think for the most part, everbody needs a little skin in the game. My husband and I chuckle over what has happened with prescription drugs in the last few years. Not long ago folks would harass the heck out of him for a name brand drug. “Oh, I’m allergic to generic”, or “doesn’t work”. The onus was on the doctor to fill out forms and spend time trying to get the name brand. No some plans let you get name brand if you are willing to pay a larger co-pay. Everyone seems to want generic! I think co-pays are important. I don’t know how to decide how much for what, but co-pays and/or deductibles mean “skin in the game”.</p>

<p>And don’t get me started on psychotropics.</p>

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<p>I like that idea actually. Increasing co-pays and deductibles for non-compliance sounds like a good compromise over simply increasing premiums. I wonder if anyone who could change anything has considered that approach…</p>

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<p>Compliance is an outdated term at my school - it’s considered too paternalistic. The name of the game is now adherence. The attitude (at least in the classroom) is that if the patient is not adhering to the regimen, someone on the team (physician, nurse, social worker, student, etc.) needs to sit down with the patient and figure out what about the regimen isn’t working for the patient. Sure, sometimes the problem is that the patient is not motivated (for various reasons) but it can be things like not understanding dosing schedules, not understanding the diagnosis, not being able to afford the prescribed medications, not being mobile enough to pick up the medications, etc. I’m not sure those problems are the sorts of things that should carry a monetary penalty.</p>

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<p>The devils in the details.</p>

<p>I wouldn’t be comfortable with the word compliance. I think it should be co-pays and deductibles for more “choices”…but isn’t that sort of how it works now? Someone who shares office space with me has some sort of deductible thingy. Another doctor, essentially healthy family, and there is a LOT of motivation for them to stay that way. HUGE deductible, and I’m guessing they never use it all…( but they take in feral cats who get GREAT care…)…hope he’s not reading this…</p>

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<p>A few years ago, our insurance company requires us (employees only, not their family members) to have a physical exam every other year; otherwise, the premium will be increased significantly (like 50% increase). Hmm…I had better double-check whether this policy is still in place as of today. The company seems to change the insurance company every other year – The deal becomes worse each time they switch to a new insurance company :-(</p>

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<p>i personally work for an endocrinologist and am considering that as i really like the specialty. however, my question regarding endo and compliance, or “adherence,” is that with the obesity epidemic in this country rising at a rapid rate (~60% of the population is overweight, and 30% of them are obese), how do you ensure that a near-type II diabetic, whose pre-diabetes is a result of poor diet and inactivity, that he should diet and exercise before needing to prescribe oral agents that will eventually be followed by insulin? and not to mention the testing supplies. with the mentality in this country, there is almost no way to convince a diabetic, or pre-diabetic, to cut down on calories and increase his activity level when his lack of motivation is what caused his condition in the first place. i’m sure cardiologists would see the same problems with overweight and obese patients not complying with daily living regimens and requiring further testing and increasing amounts of prescription medication. i guess i’m just looking for a current physician’s thoughts on THIS catch-22, or anyone who knows more than i do about the proposed guidelines for healthcare reform.</p>

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<p>Ugh, please don’t insult Coulter like this. Coulter, extreme though she may be, spells correctly and uses whole sentences so that people at least know what she means; she may use disputed statistics but never makes them up out of thin air; she expresses controversial thoughts but is never this out-and-out racist about greedy Asians being absurdly smarter (and higher-earning) than anybody else.</p>

<p>Seriously, let’s keep this politically neutral here. The OP is incorrect on several specific arguments; I see no need to drag generalizations into this.</p>

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<p>Id like to point out that the stats for Asians are true.
I cannot be racist towards asians; I am one. Asians have the highest average salaries in US. I believe Indians have the highest (by ethnicity) earning potential in the US.
[Indian-Americans:</a> A Story of Achievement](<a href=“UKMoney.net and Indianembassy.org - UK Money”>UKMoney.net and Indianembassy.org - UK Money) - Indian Embassy
44% of Asians have Bachelor Degree, 64% for Indians. About 20 some percent nationally.</p>

<p>Average Indian Family Salary:“$61,322”
Average American Family Salary:“$41, 994”</p>

<p>150% richer. It is not a racism thing to assume that Asians are by and by make more than the Average American. It is A FACT that the average Asians make more than the average Caucasians. Statistics do not lie.</p>

<p>On Asian American as whole:
They have the LOWEST poverty rate, HIGHEST median and average Income (10k more than white families).</p>

<p>Source
IF you dispute this source, you have serious issues: <a href=“http://www.census.gov/Press-Release/www/releases/archives/income_wealth/005647.html[/url]”>http://www.census.gov/Press-Release/www/releases/archives/income_wealth/005647.html&lt;/a&gt;
US Government Census</p>

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<p>No one said you were being racist towards Asians… You are being racist towards any group that is not Asian. There are many factors that cause Asians and Indians living in the US to, on average, make more than some other groups living in the US. If you adjust for those factors, you will realize they are no different than any other race. In other words, if you were to put the a group of average white, black, native american, arab, etc… children under the same conditions as a group as average Asian and Indian children they would perform equally well. You also seem to assume that US Asians and US Indians are identical to the entire world population of those two ethnic grouos, which may or may not be true.</p>

<p>And you seem to misuse statistics. A mean or median value, by its very nature, is not representative of individual values, so to assume that any particular individual Asian or Indian will perform “better” is fallacious.</p>

<p>Your argument also only considers income. Unless one measures success purely in terms of income your point is moot. </p>

<p>So you are racist, don’t care about poor people, think only people who make lots of money as doctors are actually doctors (are you also one of those people who believe you can be “barely” pregnant? I think those people follow your same line of reasoning…), and believe success in life revolves completely around how much money you make (I suppose Mother Teresa and other people who devote their lives to non-profits and low-paying causes to help people are completely unsuccessful in life…). You may want to consider seeking help…</p>