<p>My daughter walked past me one night when I was going through my EPIC tutorial and said, “Dad watch your blood pressure” as I was going through a particularly absurd section on ordering restraints. First, I have not ordered restraints in 20+ years of practice. Second the instructions required detailed instructions for each limb. Third, 99.9% of patients have four limbs so should not this be the default? Lastly should not the nurse who is generally the best positioned to access and deal with the issue be given latitude in this matter?
The EHR, while seemingly a good idea IMHO, in practice has caused more problems than it has solved. It has increased our overhead costs without any improvement in efficiency. This is becoming more true as we are now being advised that we can not carry over previous medical record information as it does not constitute “new work”. It is also a Tower of Babel for me as I do not use hospitals very much but need to be on staff for multiple hospitals due to insurance or medical requirements and all of them use different EHR systems.</p>
<p>“Medicine can still provide you with mansions actually, it’s called private practice.” </p>
<p>@dina4119 I have several doctor friends who have been forced to close their private practice due to obamacare and the overall socialization of medicine. Even several nurse practitioners I know have had to shut down their private practices. According to them the situation is just going to get worse and worse at the rate things are going. It’s definitely not a career you should go into if you want to become rich. Really not looking forward to seeing a repeat of Canadian medical practices in America.</p>
<p>No need to worry @Southerncharm95, Obamacare was only implemented this year and despite popular rhetoric, it was not the cause of private practices closing. Fortunately, our healthcare is not being socialized since Obamacare is a law and not an actual health insurance. No doctor was hired by the government as a result of this law to provide healthcare. Quite opposite, people are being forced to buy private insurance. A big win for private health insurance companies with large market share. </p>
<p>Before this thread gets hijacked by the politics of Obamacare, let me redirect this to something more productive. At some point in the past 15 years, healthcare was taken over by a concept of quality metrics, EHR and patient satisfaction scores equalling improvement of healthcare. These measures have created a nightmare for the private practices who have diligently tried to comply. These requirements have resulted in expenses that were never recovered and disruption in practices. I couldn’t imagine buying a 6 figure software, train, and convert an office to this new system while trying to maintain a practice. Many physicians and nurse practitioners couldn’t either and closed or sold their practices to hospitals and companies that have a much greater economy of scale to do this. </p>
<p>I am confident that these items will work themselves through and will be well managed by future physicians. Other countries have led the way with successful implementation of similar measures in a private market. For now, current physicians will continue to feel the brunt of the trial and errors of these initiatives.</p>
<p>@frugaldoctor Thank you for clarifying the real reason why private practices are closing. That was really helpful. Apologize for not researching more and just spitting out what I’d heard from well-intentioned doctor friends. </p>
<p>@southerncharm95 I must say that I have never read a more sincere rebuttal since I’ve been on CC. You are indeed quite charming. </p>
<p>I just highlighted the common issues and not the all of it. The article mentioned others. But let me tell you, there are so many patients that have brought absolute joy to my life because of their successes, appreciation, and their personalities. I wish there was a way to convey this to the CC crowd who aspire to become physicians. It’s not all doom and gloom. Despite our emotions mirroring the ups and downs of the stock market, we experience multiple acts of kindness from our patients and happiness from our role.</p>
<p>@frugaldoctor Out of curiosity, what is your specialty?</p>
<p>So would having a job with less responsoibility be better? Like Physican Assistant?</p>
<p>@frugaldoctor </p>
<p>If medicare pays $18 per visit for a private practice primary care physician and obamacare is expanding medicare coverage to more and more people, it is slightly responsible for causing physicians to close private practices. If it’s not, then more laws that come after this will hinder private practice physicians.</p>
<p>@MiamiDAP Thanks for the very inspirational words. I want to be a Physician assistant but my parents say I am not dreaming big enough. Truth is I don’t want to spend the best years of my life in school. I like working with people and I had fun taking care of my grandma this summer so I want to be very close to people. I think it will be work that I love. I am an easy going person and truthfully I dont think I would like all the stress being a physician would be put under. </p>
<p>Its funny because my sister and parents say why would you want to be an ‘Assistant’ when my father is an accountant for the state and my sister just got a job. I just look at them funny because inside I am thinking you both are assistants to someone too! I mean come on here. </p>
<p>MODERATOR NOTE: Members are advised to review CCs Terms of Service regarding Politics, Religion, etc.:</p>
<p><a href=“https://auth.collegeconfidential.com/module.php/hobsonspolicies/policy.php?policy=tos”>https://auth.collegeconfidential.com/module.php/hobsonspolicies/policy.php?policy=tos</a></p>
<p>Discussion of the politics of health care will cause this thread to be closed.</p>
<p>@Jweinst1 Obamacare is not expanding Medicare, it is expanding private insurance opportunities as well as Medicaid in the states that choose to expand that service. In certain states, Medicaid pays very well for certain specialties. In my state, I know for sure ObGyns do very well with Medicaid. Other states, anesthesiologists, dentists and etc. Doctors do not have to accept Medicaid patients. But remember, Medicaid is a program made for the poor. There are states such that expansion of Medicaid is the only option for patients who currently have NO health insurance. Unfortunately, more often than not, Medicaid doesn’t pay well. But a private practice does not have to participate in Medicaid.</p>
<p>The ACA also expanded private insurance for preexisting conditions. So, we are seeing patients receiving surgeries for preexisting conditions that could not receive coverage last year such as spine surgery. </p>
<p>@absentions I am an anesthesiologist. Despite what people think, we have opportunities for high yield interactions with our patients if we take advantage of it. </p>
<p>I do not advise anyone to forgo their dreams in order to pursue a career with less responsibilities unless that dream interferes with other personal goals. If your dream is to pursue a career as a PA then pursue it. If it is to become a physician, please look at every opportunity to pursue that dream or you may spend a lifetime with regrets. </p>
<p>I love al the anesthesiologists at my hospital. They are all so friendly, nice and add a lot of humor to an otherwise stressful work setting. They always seem to be having fun. </p>
<p>@southerncharm95 Please don’t spread false propaganda about the affordable care act, it’s ridiculous. Canadian doctors actually get paid as much, if not more, than American doctors. So if you care about the pay, I’m not sure why you’d be upset at their highly functioning system. But I also think it’s admiral that you listened to an explanation. </p>
<p>I know we’re not supposed to discuss politics and this is the last I’ll write of it, but @Jweinst1 I suggest you do some real research into the affordable care act. </p>
<p>@frugaldoctor I’m pleasantly surprised that you still have a lot of passion for your work because I’ve seen on Youtube videos of “a day in the life of an anesthesiologist,” and the work, although very highly paid, seems more mundane than those of other specialties with more problem-solving and patient interaction.</p>
<p>@dina4119 I honestly wasn’t trying to spread false propaganda, I retracted my statement in a latter post. It was just ignorance on my part. That said, I do believe Canada’s healthcare system is flawed. I have several Canadian friends, one of which came here for colon cancer treatment because there was a year long waiting list in Canada, another who had a similar experience but with knee surgery. Pay is not what I was worried about. It’s just an insufficient system that I don’t think America needs to emulate. That will be my last word on politics as well to any worried adcoms. </p>
<p>@frugaldoctor Thank you for mentioning the positives of being a doctor in your reply. Those are the reasons I wanted to become a doctor in the first place and I love that you’re still passionate about your work. It was a reassuring and refreshing change from all the negative examples my doctor friends use to discourage me from pursuing medicine. They really are well-intentioned, just exhausted and perhaps in the wrong line of work.</p>
<p>^I don’t think they’re necessarily discouraging you because they don’t like their work, just that they may want you to see the reality of it to keep you and other pre-meds from naive notions about physician life. Obviously I don’t know for certain what they believe, that’s just what I think when I hear of physicians discouraging students. </p>
<p>@southerncharm95 Canadian doctors have very similar salaries to the US.</p>
<p>Now, doctors in the UK have MUCH lower salaries than US doctors, many do not earn $100,000 equivalent in pounds. <a href=“Pay for doctors | Health Careers”>Pay for doctors | Health Careers;
<p>This is a real socialized system, and you see the effects of this not just in the lower salary, it carries into other things like rationing medications and treatment.</p>
<p>@dina4119 The ACA has expanded medicare coverage in California <a href=“http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx”>http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx</a> </p>
<p>but i am not sure if this was present in other states, sorry.</p>
<p>First a fact check to Jweinst!: I have no idea where you get your information, but the Affordable Care Act is not increasing :Medicare; it is increasing the eligibility of MEDICAID to 133% of the poverty level. Second, as you seem to blissfully miss, no physician-none, zero-is required to take either Medicaid or Medicare patients. Period Full Stop. So let’s get the facts straight.</p>
<p>To OP: I couldn’t disagree more strongly; this type of journalism is not intended to inform, but to scare. NO one should read it. It’s poorly written and given to hysterics(Physician suicide! Well, see <a href=“http://www.cnn.com/2014/01/19/us/lawyer-suicides/index.html”>Why are lawyers killing themselves? - CNN; and a plethora of other articles). I do hope that all those obsessed with physician reimbursement-that means you Jweinst1-stay out of the profession completely.
I am married to, and have two siblings, who deliver care as primary care physicians. The one thing the article got right was the change in ABIM rules-they are grousing mightily about it, and I don’t blame them. That’s an onerous rule change.
But being physicians-well they all said they’d do it again, and would want their children to be MDs also. None are rich, though, so if that’s the goal find another line of work.
So anyone who reads my post-ignore this article and the money obsessed who often post here. If you want to be a physician-go for it. It’s not a road to riches, and it’s not all sunshine and rainbows, but it is a genuine way to be intellectually challenged and do some good.<br>
And ignore those in the profession who discourage you; that’s part of the I’m Smarter and
Tougher than You mentality that some adopt-and it’s baloney. And look at every profession-do teachers have it easy? lawyers?
America’s getting older-there’s going to be even more of a need for physicians in the coming years. So no riches, but challenging rewarding work-and I say go for it!</p>
<p>@jalfred </p>
<p>Perhaps you did not read the entire thread, but in my post just above yours i posted a direct link from the california department of healthcare services that stated Medi-cal, California’s version of Medicare did expand coverage to a few million more people beginning on Jan 1, 2014. <a href=“http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx”>http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx</a></p>
<p>I also apologized because I didn’t realize before this is only something happening in California, and not all states, and thus would not affect patients on a national scale. Sorry.</p>
<p>I did read your post-Medi-Cal is NOT Medicare-it’s California’s version of MEDICAID. These are two very different programs.</p>