Lone Star Posted November 26, 2009 Author Share Posted November 26, 2009 For the vast majority of illnesses and problems, a PA or NP is more than adequate for their needs. Does someone need a Harvard educated doctor to swab their throat and give them antibiotics for their strep? What about treating someone for a yeast infection? Does that need a world famous OB/GYN specialist? We know when a patient presents with a problem beyond our capabilities to handle, and so do NP's and PA's. How many times have you had a well to do patient who has a lac to their arm and demands to see a plastic surgeon to sew up their injury because they feel an ER doc cannot do the job to their satisfaction? This is a matter of perception, and most people have no idea how easy or difficult their problems are to handle. It's not a matter of 'adequacy' here. It's a matter of Doctors getting greedy and catering to the 'well to do' crowd and largely ignoring the 'not so well to do crowd' Our attitudes on what the federal government should or should not have control over stems from how and why our country was founded. I suggest some research. Oh, and I almost forgot- the 10th Amendment. Seems like it's been pretty well ignored in all this. Since this isn't being controlled by the government (whether at local, state or federal level), how is it or the Constitution even being brought to play in this discussion? Link to comment Share on other sites More sharing options...
JPINFV Posted November 26, 2009 Share Posted November 26, 2009 Since this isn't being controlled by the government (whether at local, state or federal level), how is it or the Constitution even being brought to play in this discussion? Err... the entire point of the constitution is to determine what is and is not in the control of the federal government. Just because something 'makes sense' doesn't mean that the government can make a federal law about it. See. United States v Lopez for a good example of a 'common sense' (no guns at school) federal law that was deemed unconstitutional. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted November 27, 2009 Share Posted November 27, 2009 (edited) You guys are totally missing the point on this one. A small percentage of doctors have decided to go into private-private practice for those who can afford it. No one is forced to see these doctors, it is a choice among patients, who have to decide "do I want to pay more to get a higher level of personal care ? No one's doctor has been taken away, those who want to use traditional insurance for medical care, can still choose many physicians to see. These doctors have just chosen a different business model that allows them to provide more personal care. Its like this, I use an oil change place that charges about $45.00 to do an oil change, but with that oil change, my car gets fully detailed (cleaning) inside and out. Now there are plenty of places that I can get an oil change for $29.95 or less, but I just get an oil change. For me, it is worth another $15.00 to get my vehicle washed, waxed, vacummed, and have all of the glass cleaned. If you can not afford $45, then you can change your oil yourself, go to a cheaper oil change place, or go to a standard oil change place, but wash your vehicle yourself. The fact that I paid an extra $15.00 does not mean that your oil change is not as good as mine, or that you have been wronged. I have the means to pay more to get more, and I spent my dollars to attain that. When you supersize your value meal, you get more than the standard guy who just orders the value meal. Under you guys thinking, this guy just starved because the other guy paid more for his meal. They both ate ! Edited November 27, 2009 by crotchitymedic1986 Link to comment Share on other sites More sharing options...
akflightmedic Posted November 27, 2009 Share Posted November 27, 2009 You guys are totally missing the point on this one. A small percentage of doctors have decided to go into private-private practice for those who can afford it. No one is forced to see these doctors, it is a choice among patients, who have to decide "do I want to pay more to get a higher level of personal care ? No one's doctor has been taken away, those who want to use traditional insurance for medical care, can still choose many physicians to see. These doctors have just chosen a different business model that allows them to provide more personal care. Its like this, I use an oil change place that charges about $45.00 to do an oil change, but with that oil change, my car gets fully detailed (cleaning) inside and out. Now there are plenty of places that I can get an oil change for $29.95 or less, but I just get an oil change. For me, it is worth another $15.00 to get my vehicle washed, waxed, vacummed, and have all of the glass cleaned. If you can not afford $45, then you can change your oil yourself, go to a cheaper oil change place, or go to a standard oil change place, but wash your vehicle yourself. The fact that I paid an extra $15.00 does not mean that your oil change is not as good as mine, or that you have been wronged. I have the means to pay more to get more, and I spent my dollars to attain that. When you supersize your value meal, you get more than the standard guy who just orders the value meal. Under you guys thinking, this guy just starved because the other guy paid more for his meal. They both ate ! While I do agree with you Crotchity...I think one point being argued is what do you do when YOUR doctor who was happy to see you for several years decides to switch to this business model. Now to see him, you have to pay premium price, so essentially if you want to stay with him (and we know how humans are creatures of habit and resistant to change) you have to pay his new fee OR see a NP or PA who we have established are just as equally capable, but you still want value for your dollar. This forces you to get "lesser" care or to go out doc shopping and starting anew. Is this right, wrong...I do not know, just pointing out another side of it. Link to comment Share on other sites More sharing options...
Nate Posted November 27, 2009 Share Posted November 27, 2009 I see nothing wrong with a doctor deciding how or what he/she wishes to do with their practice. Life isn't fair, the sooner people realize this they better off they'll be in life. I know that when it comes time for me to retire there probably won't be a social security system, Medicare will be broke as well, and the risk of having cancer is high (family history)for me. Because of those factors I have made sure to plan ahead. So while I may have less now, I won't be without later on in life. It is called responsibility, and to many Americans seem to forget what it is. I'm really getting fed up of hearing "it isn't fair" being thrown out there. -Nate Link to comment Share on other sites More sharing options...
Lone Star Posted November 28, 2009 Author Share Posted November 28, 2009 While I do agree with you Crotchity...I think one point being argued is what do you do when YOUR doctor who was happy to see you for several years decides to switch to this business model. Now to see him, you have to pay premium price, so essentially if you want to stay with him (and we know how humans are creatures of habit and resistant to change) you have to pay his new fee OR see a NP or PA who we have established are just as equally capable, but you still want value for your dollar. This forces you to get "lesser" care or to go out doc shopping and starting anew. Is this right, wrong...I do not know, just pointing out another side of it. You've hit the nail on the head, AK. Just because the family doctor has decided that he wants to line his pockets further by catering to only those that can afford the extra premiums while those that can't are forced to leave that doctor and find another in my book is immoral and unethical. As far as the oil change analogy goes, why should I have to pay extra fees to be able to have my oil changed by an ASE Certified, state licensed mechanic or be forced to go to some 'fly by night' company that throws anyone in the grease pit that can hold a wrench? To me, this whole move toward catering to the money as opposed to treating those that need care (regardless of the size of their bank accounts) smacks of nothing more than pure unadulterated GREED. Is it legal? Probably, since the article specifically states that there isn't a law against it or that can be used to stop it. The biger question one must ask is this: "Is it really ethical?" Link to comment Share on other sites More sharing options...
JPINFV Posted November 28, 2009 Share Posted November 28, 2009 Lone... again, since you haven't answered my question. If you transport a patient who doesn't pay, you give up your pay for that part of your day, right? So if a transport takes an hour from dispatch to clear and your patient doesn't pay, you don't get that hour of pay, right? Link to comment Share on other sites More sharing options...
Lone Star Posted November 28, 2009 Author Share Posted November 28, 2009 Lone... again, since you haven't answered my question. If you transport a patient who doesn't pay, you give up your pay for that part of your day, right? So if a transport takes an hour from dispatch to clear and your patient doesn't pay, you don't get that hour of pay, right? I fail to see how that even applies. Since when did we move to treating only those that can afford medical care as opposed to treating those that NEED it, no matter how rich or poor they are? Will I treat a 'well to do patient' over one that is flat ass broke? Only if their condition warrants it through triage. I don't believe in treating those with a bank account better than those that don't have one. All of my patients recieve the best care that I'm able to provide. The company I worked for in Detroit wrote off over $6,000,000.00 in 'bad debt' in one year, which means that I treated A LOT of people that couldn't afford the services I provided. That's not the issue at hand here. Will I continue to treat people to the best of my ability even if they can't afford to pay the bill that will most assuredly arrive in the mail in a week or two? You bet your buttons I will! If I have to give up that whopping $10.00 so that someone who is 'down and out' can get the medical treatments that they NEED, then I guess I'll just have to live without that one hour's pay. Will I forfeit my entire paycheck? Probably not, because I've got bills to pay as well. Link to comment Share on other sites More sharing options...
JPINFV Posted November 28, 2009 Share Posted November 28, 2009 I fail to see how that even applies. Since when did we move to treating only those that can afford medical care as opposed to treating those that NEED it, no matter how rich or poor they are? ... Will I forfeit my entire paycheck? Probably not, because I've got bills to pay as well. ...but you aren't willing to stake you're personal pay on your patient's ability to pay like private practice physicians are doing. Why are you expecting physicians to forgo their paycheck when you aren't willing to forgo your own? Shouldn't a physician be allowed to charge more as their experience increases? Shouldn't physicians get raises too? Would you forgo a raises as long as your company is writing off patients who can't pay? Link to comment Share on other sites More sharing options...
HERBIE1 Posted November 28, 2009 Share Posted November 28, 2009 You've hit the nail on the head, AK. Just because the family doctor has decided that he wants to line his pockets further by catering to only those that can afford the extra premiums while those that can't are forced to leave that doctor and find another in my book is immoral and unethical. As far as the oil change analogy goes, why should I have to pay extra fees to be able to have my oil changed by an ASE Certified, state licensed mechanic or be forced to go to some 'fly by night' company that throws anyone in the grease pit that can hold a wrench? To me, this whole move toward catering to the money as opposed to treating those that need care (regardless of the size of their bank accounts) smacks of nothing more than pure unadulterated GREED. Is it legal? Probably, since the article specifically states that there isn't a law against it or that can be used to stop it. The biger question one must ask is this: "Is it really ethical?" Most people cannot afford extra fees on top of their insurance premiums to retain the services of a favored doctor, or one that limits their practice to those willing to pony up for their elite fee. It is a very specialized niche that some doctors are willing to fill, but it simply does not affect most people. I wouldn't say we are moving towards concierge medicine- it has always been, and will always be there. It's like a very specialized subspecialty of medicine that most people will never take advantage of. Regardless of the type of health care system we end up with, there will ALWAYS be special privileges for those with power and money- one of them being able to get any doctor, at any time, if you have enough money. Ethical? Right? Wrong? We can debate those points forever, but it won't change anything. The vast majority of doctors will be stuck- just like we will be- with whatever system our government decides is best for us. (Just don't think for a moment that John Q Public has anything to say about it unless we are willing to remove every current lawmaker from office and start over with them, too) Link to comment Share on other sites More sharing options...
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