Why the Doctor Can't See You

fakebee · Aug 22, 2012

We are already a two tiered health system-those that have insurance and those that don't.

Jolie, BSN · Aug 22, 2012

And we are about to become a 2-tiered system where despite insurance, some can get appointments and some can't. Does that represent any real improvement over our current status?

Not_A_Hat_Person, RN · Aug 22, 2012

With more and more doctors adopting "concierge medicine," taking a smaller number of patients who pay a yearly retainer, a 2-tier system is becoming a 3 or 4-tier system. And it all started before Obamacare.

elkpark · Aug 22, 2012

The scenario presented in the article is based on the idea that everyone in the US is going to take full advantage of every available preventive care service -- huge numbers of people who already have access to and coverage for those services don't pursue them now; why (other than the obvious, well-known political bias of the WSJ, and, presumably, the author of the opinion piece published therein) the presumption that that would suddenly change??

Jolie, BSN · Aug 22, 2012

I've posted this before, but I believe it bears repeating here.

My sister is an internist who now specializes in hospice/palliative care. When she first interviewed for private practice positions, she was offered a job in a concierge practice in a relatively wealthy community. She considered the offer for quite some time, before declining it. Ultimately, she thought it seemed too "elite" and she was bothered by her perception that she would not have the opportunity to "give back" to the community by serving those in need. A friend of hers took the job and has held it for almost 15 years.

My sister took a series of positions that she believed would enable her to provide care for the underserved. She now works 12-16 hours a day in a practice that has to limit its Medicare and Medicaid patient load due to insufficient reimbursement. The practice can not afford to hire another physician to lighten her workload. Her friend, freed up by adequate reimbursement from private payors and the lack of paperwork associated with a non-insured practice, spends 1 full day per week providing "charity" care.

MunoRN, RN · Aug 22, 2012

We've had a system that provides acute/emergent care for all, but disease management and preventative care for some. Essentially, given the choice between treating a person when they are relatively cheap to treat, we chose instead to wait until they become very expensive to treat. Our disinterest in preventative care and disease management is a major to contributor to why we pay more than twice as much on healthcare as any other industrialized country and will likely lead to economic collapse if we don't do something to fix it. Maybe I'm wrong, but healthcare seems to have politicized to the point that there are those that will actually argue for economic collapse if it denies an opposing political group's proposal.

There is no massive shortage of people ready to provide primary care. According to AHRQ there are almost 50,000 NP's who could work as primary care NP's but are currently not. I work with 5 NP's who are still doing bedside Nursing due to the lack of demand in family practice NP's. The more slanted statistics use some questionable methods. Some still assume that all GP's will spend about half their time in the hospital following patients, even though few of them still do that with current trend in Hospitalists. As the article you provided pointed out, in order to meet demand GP's would have to work full time seeing patients in the office, something most already do anyway. We do also need to improve office visit reimbursements, although such proposals have been shot down by those opposed to increases in government spending, even to the point of arguing that we shouldn't reimburse some things at all, such as establishing end of life wishes.

Preventing economic collapse by substituting much of our very expensive acute care for relatively cheap primary care, won't be easy, but it's not really that hard either. We went to the moon just to see if we could, providing more primary care to ensure our survival isn't really optional, those who argue we aren't capable of such a feat unfortunately seem to hope this will be the case to prove a political point.

SC_RNDude · Aug 22, 2012

We've had a system that provides acute/emergent care for all, but disease management and preventative care for some. Essentially, given the choice between treating a person when they are relatively cheap to treat, we chose instead to wait until they become very expensive to treat. Our disinterest in preventative care and disease management is a major to contributor to why we pay more than twice as much on healthcare as any other industrialized country and will likely lead to economic collapse if we don't do something to fix it. Maybe I'm wrong, but healthcare seems to have politicized to the point that there are those that will actually argue for economic collapse if it denies an opposing political group's proposal.
There is no massive shortage of people ready to provide primary care. According to AHRQ there are almost 50,000 NP's who could work as primary care NP's but are currently not. I work with 5 NP's who are still doing bedside Nursing due to the lack of demand in family practice NP's. The more slanted statistics use some questionable methods. Some still assume that all GP's will spend about half their time in the hospital following patients, even though few of them still do that with current trend in Hospitalists. As the article you provided pointed out, in order to meet demand GP's would have to work full time seeing patients in the office, something most already do anyway. We do also need to improve office visit reimbursements, although such proposals have been shot down by those opposed to increases in government spending, even to the point of arguing that we shouldn't reimburse some things at all, such as establishing end of life wishes.
Preventing economic collapse by substituting much of our very expensive acute care for relatively cheap primary care, won't be easy, but it's not really that hard either. We went to the moon just to see if we could, providing more primary care to ensure our survival isn't really optional, those who argue we aren't capable of such a feat unfortunately seem to hope this will be the case to prove a political point.

There is no massive shortage of people ready to provide primary care??? You are one of the few who believe that. Have anything to back that up?

The data I see from AHRQ says that there are about 50,000 NP's not doing primary care. No mention that they are willing and available and ready to do primary care. Aren't many of those 50,000 already doing something else?

The article states that physicians would have to work almost full-time just to do PREVENTIVE CARE. That is not something most are already doing.

And why isn't their a demand for family practice NP's? Why don't physicians' offices hire more NP's? Why don't ones like the people you work with open their own practice? It seems it would be a smart thing to do.

Jolie's post above yours, and the article I posted both perfectly illustrate why. For one, they are not now, and certainly won't in the future, be able to the money they should on Medicare patients for it to be worthwhile.

What political point would someone like me be trying to make? I ahven't seen anyone say we aren't capable of providing better primary and preventive care? I for one strongly believe we can, and I strongly want to. I have even shared alternative ideas on other threads. I believe almost everyone wants to improve our healthcare system. Personally, my spouse is applying to go to NP school to be a PCP, and my future RN aspirations are in the preventative care arena. So I even have selfish reasons for our country's healthcare costs to be shifted to primary care.

It is the manner in which we can get this done is where the disagreements are.

SC_RNDude · Aug 22, 2012

We are already a two tiered health system-those that have insurance and those that don't.

I'm not sure what your point is. Care to elaborate?

SC_RNDude · Aug 22, 2012

The scenario presented in the article is based on the idea that everyone in the US is going to take full advantage of every available preventive care service -- huge numbers of people who already have access to and coverage for those services don't pursue them now; why (other than the obvious, well-known political bias of the WSJ, and, presumably, the author of the opinion piece published therein) the presumption that that would suddenly change??

Isn't that the big benefit of Obamacare is that these services are going to be more accessible and at lower cost for everyone? When something is more accessible and at a lower cost (or free), won't more people be looking to use it. That's basic economics.

elkpark · Aug 24, 2012

Isn't that the big benefit of Obamacare is that these services are going to be more accessible and at lower cost for everyone? When something is more accessible and at a lower cost (or free), won't more people be looking to use it. That's basic economics.

That may be "basic economics," but, as I said in the first place, we are all well aware that plenty of individuals who currently have access to and coverage for lots of preventive services don't use those services -- so why assume that everyone who gains coverage through the ACA is going to suddenly try to schedule lots of tests and office visits?? (Other than that scenario suiting the purposes and political bias of the author of the article and the WSJ.)

NiceOnce · Sep 4, 2012

Anytime just one person is late to a doctors appointment, than all the next appointments will get back up. People need to be more sensitive to this.