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(Slate)   A million of you are going to post the bogus study that 83% of Doctors want to quit because Socialism over the next few days, So enjoy a preemptive rebuttal   (slate.com ) divider line
    More: Followup, Drudge Report, terminal illness, Pacific Research Institute, socialism  
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6529 clicks; posted to Politics » on 10 Jul 2012 at 9:08 AM (3 years ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-07-10 10:02:47 AM  
A lot of my colleagues who entered more specialist fields, especially the surgical subspecialties, are enraged over this legislation. These are the guys that tend to have busted their asses in med school to get the highest grades, expecting to be extremely well-compensated and enjoy a reasonably nice schedule. The more hippy-ish ones who entered primary care, often putting people over profits, OTOH, tend to support it. No big surprises there, since medical wealth-redistribution is anticipated to result from this legislation.

CMS is expected to roll out a big list of proposals on the 20th of this month where they are anticipated to advocate slashing specialist salaries to increase payouts to primary care physicians, PAs, and NPs. This is a trend is expected to continue as time passes.

I don't necessarily think this will help to increase the number of primary care physicians in the country for several reasons. The biggest reason is the lifestyle that these doctors have, and med students easily pick up on the problems facing these physicians. Increasingly, they are leaving private practice because compensation models fail to enable them to pay overhead. As a result, they tend to either work salaried positions for either large hospitals or a very large group that owns a large network of practices. They are required by their contract to see a large volume of patients per day, as the hospital/company's bottom line depends upon volume. The end result is a constant flood of patients, which usually results in overflow into their lunch hour if they intend to actually care for their patients instead of rigidly give them 10 minutes of their time and coldly bark at them to schedule additional visits for any complaints not related to their chief complaint. It gives one the feeling of being overwhelmed, and helpless. The monotony and machine-like efficiency that is required often saps the physician of the drive that made them enter the field in the first place. All that keeps them in practice is the necessity to pay off the loans, mortgage, etc. Additionally, changing the compensation model for physicians to essentially mirror the No Child Left Behind Act will likely offset any and all pay incentives that the government puts into play.

The following was posted on a medical networking site by a medical student which I feel does a very good job summing up the problems regarding increasing primary care enrollment by recent medical graduates:


As a medical student, I can tell you that money is only part of the problem. Job satisfaction is a huge issue. The bottom line is that Primary Care is HARD and is only made harder by the current low reimbursement.

Look at it from our point of view: I go to do a primary care rotation. The doctor spends 15 minutes per patient. He knows the patients, I don't. I have only a few short minutes to meet the patient for the first time, establish a rapport, and figure out what's wrong, then present it to my doctor and come up with a plan. It is stressful, fast paced, and very, very HARD. You have to know multiple subjects very well, unless you plan on referring everything. It is not an enjoyable experience for a student.

By comparison, on my radiology rotation, my doctor was well paid, un-rushed (mostly), and happy. He went home at 5 (or earlier) and didn't take work with him. It was easy for a med student to figure out the basics. In a week, I was reading a chest x-ray pretty well, I think. After all, it's just anatomy (mostly) and pattern recognition. Piece of cake, compared to primary care.

So, why don't I do primary care? Lower pay. Paperwork. Huge Debt. Insurance Headaches. High Overhead. Huge Staff Required (more management headaches), Hours, Demanding Patients, on and on and on and on.

Fix all of this, and we'll talk. Students simply aren't "loving" the primary care, PCP experience.


Additionally, funding for residents comes via the GME funds as part of Medicare. This bill did not increase that funding; if anything, it decreased it to create the illusion of being deficit neutral. The end result is going to be less available residency slots for medical graduates; the AAMC has been doing a decent job of increasing medical school admissions, but without available residency slots, this will all be for naught. And this is the part of the PPACA that never made any logical sense to me; why on earth would you attempt to add 30M patients to a system that can already barely handle the current number of patients, without significantly expanding funding to train medical graduates? To me, that just boggles the mind; it's as if they want to manufacture a crisis of access.
 
2012-07-10 10:03:19 AM  

EvilBillGates: lol @ 10poundsofpuke. I'm starting to think he gets paid by how many times his name gets reposted. Disingenuous fark deserves no mentions or replies.


^
 
2012-07-10 10:03:25 AM  
fark me, this thread is like watching a statistics snuff film. I've seen numbers get less tortured in economics discussions.
 
2012-07-10 10:04:28 AM  

qorkfiend: CreamFilling: Very few doctors are going to outright quit over this. Many may retire a few years earlier than they would have otherwise. However, where we may see the biggest problem is in the number of bright college students who were considering a career in medicine and now decide it's really not worth the additional time/cost/effort in school, residency, fellowship, etc, and decide to do something else.

Why would this be the case? How does the ACA increase a medical student's time in school and residency?


It doesn't, it affects whether it's worth it. Med school is four years where you're paying to work and study. Residency and fellowship are 3-10 years of working 70-100 hours a week for about double minimum wage. And that's not even counting the exam and licensing fees, which add up to around $10k or more, or time away from family. If you thought you would be making $250k a year when you're done, maybe it's worth it to you to go through that. For $160k, a lot more people are going to decide it's not.
 
2012-07-10 10:04:41 AM  

Pockafrusta: 63% of all statistics are made up on the spot.


37% of all people know that. Duh!
 
2012-07-10 10:05:34 AM  

Bloody William: fark me, this thread is like watching a statistics snuff film.


Well, to be fair, 4% of the population enjoys snuff films.
 
2012-07-10 10:06:36 AM  
Anyone know what the response rate is to penis enlargement e-mails?
 
2012-07-10 10:07:56 AM  

tenpoundsofcheese: xanadian: Yeah, 83% of a 4% response rate amounts to dick and squat.

what is a normal response rate for people who call people at home for a survey?


Since the mid-1980's, telephone surveys have become the standard practice for obtaining data on household travel in the U.S. (Stopher, 1996). But, for a variety of reasons including changes to the North American telephone numbering system, the availability of intercepting technologies, such as caller-ID, and the multiple contacts required to complete a two-stage survey, telephone-based travel surveys seem to be suffering from declining response rates. Recent regional telephone surveys of household activity or travel surveys in the U.S. have had household response rates ranging from 20 to 40 percent (Zimowski, Tourangeau et al, 1997).


Link

It's a bit dated but the figures jive with what I remember from my methods class.
 
2012-07-10 10:10:25 AM  
That is funny, I talked to Doctors back in 2006 and 83% of them were quitting due to Malpractice insurance
 
2012-07-10 10:12:28 AM  
My wife's a doctor. All her friends are doctors. Her bosses are doctors.My dad's a doctor

None of them dislike Obamacare.
 
2012-07-10 10:13:34 AM  

Shrew2u: 699 data points from a pool of about 665,000 physicians would have a margin of error of 3.7 percent, if the poll is crafted well and the sample is statistically-reflective of the larger group.

I would be interested in knowing the sourcing of the contact information and seeing how the demographics of the sample size compares to the demographics of the group.


Response rate, grasshopper. The margin of error matters not.
 
2012-07-10 10:14:03 AM  

xanadian: dywed88: tenpoundsofcheese: rta.
where is the rebuttal?

"The survey was conducted by fax and online from April 18 to May 22, 2012. DPMAF obtained the office fax numbers of 36,000 doctors in active clinical practice, and 16, 227 faxes were successfully delivered... The response rate was 4.3% for a total of 699 completed surveys."

Self selecting with a 4.3% response rate. In other words, the results are utterly meaningless.

Yes, but let's not have facts add to this poor guy's cognitive dissonance. People need their illusions.


where is the rebuttal?
Is a 4.3% response rate out of the norm? What is the response rate for phone surveys (e.g. how many calls made before someone responds?). Citation?
How is that person who response not self-selected?
If not using a fax, what type of response rate do you think you would get if you called the office and asked to speak to the doctor about a survey?
 
2012-07-10 10:16:40 AM  

tenpoundsofcheese: If not using a fax, what type of response rate do you think you would get if you called the office and asked to speak to the doctor about a survey?


Who still owns a fax?
 
2012-07-10 10:17:15 AM  

tenpoundsofcheese: ecmoRandomNumbers: My doctor is my old high school biology teacher. She's a total lefty hippie liberal and went to medical school starting in her 40s because she wanted to make more of a difference. She thinks "Obamacare" is brilliant, and the start of what will eventually be a real socialized medical system.

okay. but she isn't a doctor and this article is about doctors.

please don't go off topic.

(p.s. my gardener doesn't like 0bamacare, so we are even)


You're not a very good reader, are you?
 
2012-07-10 10:17:41 AM  

SixPaperJoint: tenpoundsofcheese: xanadian: Yeah, 83% of a 4% response rate amounts to dick and squat.

what is a normal response rate for people who call people at home for a survey?

Since the mid-1980's, telephone surveys have become the standard practice for obtaining data on household travel in the U.S. (Stopher, 1996). But, for a variety of reasons including changes to the North American telephone numbering system, the availability of intercepting technologies, such as caller-ID, and the multiple contacts required to complete a two-stage survey, telephone-based travel surveys seem to be suffering from declining response rates. Recent regional telephone surveys of household activity or travel surveys in the U.S. have had household response rates ranging from 20 to 40 percent (Zimowski, Tourangeau et al, 1997).


Link

It's a bit dated but the figures jive with what I remember from my methods class.


15 year old dated as you noted and it was declining even then.

I should have asked what the response rate for calling a business or a doctor's office and asking to speak to the owner or doctor (vs. someone who may not be as busy sitting at home).
 
2012-07-10 10:18:26 AM  

too-old: tenpoundsofcheese: If not using a fax, what type of response rate do you think you would get if you called the office and asked to speak to the doctor about a survey?

Who still owns a fax?


Every doctor's office in the country?
 
2012-07-10 10:18:54 AM  
LOL @ 83% of doctors quitting. What will they do with their hard-earned education and experience if they quit? And why would they be angry at being paid more reliably by an insurance company than a patient?

Frankly, I wouldn't trust a doctor who thinks that Obamacare will ruin their business to know that inflammable means flammable.
 
2012-07-10 10:18:57 AM  

mainstreet62: Anyone know what the response rate is to penis enlargement e-mails?


1 in 12.5 million emails for spam generally.
 
2012-07-10 10:18:58 AM  

The 4chan Psychiatrist: Wall of very reasonable text that I read top to bottom


One of my closest friends (and singer in our band) is an M.D. I asked his opinion about ACA and his response was very similar. He went down the list of changes that he could recall and told me what he thought of them...a.k.a. digital medical records = good, medical mass production to keep up with quotas = bad, etc.

He also feels that we will see a shortage of specialists because of the risk/reward scenario painted by ACA is not very favorable to the physician.

When asked about his specialty (wound care), he doesn't think he'll be financially hit too hard. Surgeons, however, are going to take a beating, but "F*ck them...They make too much money anyway." (His opinion.)
 
2012-07-10 10:20:01 AM  

Beef Swellington: Shrew2u: 699 data points from a pool of about 665,000 physicians would have a margin of error of 3.7 percent, if the poll is crafted well and the sample is statistically-reflective of the larger group.

I would be interested in knowing the sourcing of the contact information and seeing how the demographics of the sample size compares to the demographics of the group.

Response rate, grasshopper. The margin of error matters not.


from wiki: Holbrook et al. (2005) assessed whether lower response rates are associated with less unweighted demographic respresentativeness of a sample. By examining the results of 81 national surveys with response rates varying from 5 percent to 54 percent, they found that surveys with much lower response rates were only minimally less accurate.
 
2012-07-10 10:20:39 AM  
We know Republicans don't have an alternative to their own plan which is now decided law. Do any of these 699 doctors have one?
 
2012-07-10 10:21:26 AM  

CreamFilling: too-old: tenpoundsofcheese: If not using a fax, what type of response rate do you think you would get if you called the office and asked to speak to the doctor about a survey?

Who still owns a fax?

Every doctor's office in the country?


that is too small a sample size then.
 
2012-07-10 10:21:42 AM  

CreamFilling: Every doctor's office in the country?


Why? It is an unnecessary expense.

Especially with Digital signing
 
2012-07-10 10:22:14 AM  

CreamFilling: If you thought you would be making $250k a year when you're done, maybe it's worth it to you to go through that. For $160k, a lot more people are going to decide it's not.


If you're only going into medicine because of the money, and you're turning up your nose at a salary that's triple the national average, you a) are doing it wrong and b) won't be missed. Get out and open up spots in med school to people who want to be there.
 
2012-07-10 10:22:47 AM  
The response rate was 4.3%

The 95.7% of doctors who apparently thought the survey itself was without merit and not worth responding to would seem to indicate that the survey itself is bogus and that there really is no massive backlash of Doctors who are angry over the ACA and considering quitting.

/That noted, watching Cheezy attempt to defend the indefensible here is truly some funneh stuff.
 
2012-07-10 10:22:58 AM  
So basically the "poll" has the accuracy of a Fox News internet poll
 
2012-07-10 10:23:18 AM  
I get the feeling that almost no doctors have faxes anymore and you are making that up, just like that poll was made up
 
2012-07-10 10:24:13 AM  

Noekken: I shall definitely take the survey results with a grain of salt.

However, I think I need to take the news reports of this survey with even more distrust. I followed a link to the website of the Doctor Patient Medication Association to see what they had to say about their survey and found that they characterized their findings much differently.

Yes, there is extensive criticism of government efforts to affect health care (although "Obamacare" and the Affordable Care Act are not specifically mentioned.) However, there are other interesting statements as well, including these:

- Health care is on the wrong track in this country
- There is a vacuum in leadership in medical profession, respondents feel abandoned by AMA & organized medicine
- Corporate medicine (including hospital and insurance companies) is intentionally trying to destroy private practice
- Doctors would not recommend that their children follow them into the profession

Don't get me wrong - the thrust of this survey's findings are strongly anti-government and the website stresses statements that healthcare would work better if they just left it to the doctors and the patients.


Except that any survey with a 4% response rate is meaningless.
 
2012-07-10 10:24:13 AM  

too-old: CreamFilling: Every doctor's office in the country?

Why? It is an unnecessary expense.

Especially with Digital signing


so much stuff is still done on paper it would surprise me to find a doctors office that doesn't have a fax machine.
 
2012-07-10 10:24:40 AM  

tenpoundsofcheese: Dr Dreidel: tenpoundsofcheese: Zalan: Spam doctor's offices with faxes, 95.7% of them threw the junk in the trash deeming it not worthy of a response, 4.3% were so passionate about the issue that they bothered to reply, and of those so passionate 83% said that they thought about quitting. If you count the doctors that did not bother to respond to the survey as not wanting to quit over it

Made up interpretations != data.

It is a big leap to say that if you didn't respond, you aren't willing to quit over it.

You can be passionate about an issue and decide that you are too busy to respond, not respond because it doesn't matter anyway, or you get too many surveys about a lot of topics and don't want to bother.

Just think of a faxed survey like a shop workers' vote to unionize. Are those that fail to respond counted as "No" votes, or are non-responses not counted at all?

Using your example, if people don't vote, the results still get reported as X% voted yes.

They don't say X% voted yes, but only Y% voted so therefore the result of the vote is something different than how the people who actually voted wanted.


I use that as the example because your ideological brethren in the party want(ed?) to force unions to count non-votes as "no" votes. It's playing politics with numbers (though the union issue has much more to bear than a fax survey). When non-responses outweigh responses of any valence, the only things you can say with confidence is that X% of respondents feel that way and that most people don't appear to have an opinion strong enough (or motivation strong enough) to merit response. Poking to any depth in the numbers, though, what you'll find is a mess.

Simple statistical theory tells you that a survey requiring self-selected1 responses, with a response rate of ~4%2, that shows such a bias3 toward one answer is probably not a well-done survey, for three reasons.

// bias does not, in and of itself, invalidate the results - it gives you reason to think about methodology and presentation
 
2012-07-10 10:26:25 AM  

Headso: so much stuff is still done on paper it would surprise me to find a doctors office that doesn't have a fax machine.


Scanners are not fax machines
 
2012-07-10 10:26:50 AM  

tenpoundsofcheese: from wiki: Holbrook et al. (2005) assessed whether lower response rates are associated with less unweighted demographic respresentativeness of a sample. By examining the results of 81 national surveys with response rates varying from 5 percent to 54 percent, they found that surveys with much lower response rates were only minimally less accurate.


Stop quoting liberal sources you libtard.
 
2012-07-10 10:27:19 AM  

quatchi: /That noted, watching Cheezy attempt to defend the indefensible here is truly some funneh stuff.


It was, for about 3 posts. Then the constant "Red 1" background finally got to me.
 
2012-07-10 10:32:04 AM  
As I pointed out in the previous thread, if doctors truly hated Obamacare, then they should also hate Romneycare.

If so, why does Massachusetts have more MDs per capita, by far, then any other state?

Answer: they don't hate Romneycare, and they won't hate Obamacare.
 
2012-07-10 10:32:25 AM  
Now I am interested in this whole fax thing

Off to submit a TFD thread
 
2012-07-10 10:33:06 AM  
They faxed a survey? They might as well have sent it via telegraph.
 
2012-07-10 10:33:29 AM  

Philip Francis Queeg: Who the fark still uses a fax machine?


Probably doctors in smaller practices. Some of these people have been operating the same way for decades. They practice out of the first floor of their house, and their staff is their family*. Not generally very tech-savvy.

*Not getting touchy-feely over here, I mean literally their wife, kids, etc.
 
2012-07-10 10:35:06 AM  

Sock Ruh Tease: Frankly, I wouldn't trust a doctor who thinks that Obamacare will ruin their business to know that inflammable means flammable.


Who knew?
www.archeradvice.com
 
2012-07-10 10:35:11 AM  
Headline: I'll prove that 83% of doctors aren't going to quit!

Article: The author and the people putting out the stats are teh evil republicans! QED.


Sorry, but for however exaggerated the claims are, this article doesn't come close to addressing why doctors might be considering quitting. It doesn't even bother to present a counter argument, or left-wing statistics.

It's not a rebuttal. At best it's a caveat emptor. At worst it's a leftwing talking point that wont shut up whenever someone (who isn't necessarily right wing) starts to economically analyze the new federal health insurance regulations. E.g. "Well, if doctors and insurers are burdened with massing reporting requirements and quotas, they'll have less incentive to be in that line of work, as opposed to veterinary medicine or cosmetic surgery." "OMG SHUT UP, SLATE REBUTTED THAT ARGUMENT!!!111!!!".
 
2012-07-10 10:36:50 AM  
Even if true, don't these people believe the market would step up and fill the void if there is a demand?
 
2012-07-10 10:37:35 AM  

sweetmelissa31: They faxed a survey? They might as well have sent it via telegraph.


Zounds, Matherson! This so-called Obamacare is a serious quandry indeed. Transmit this to the sender...

.. / -.-. .- -. / -. --- / .-.. --- -. --. . .-. / .. -. / --. --- --- -.. / ..-. .- .. - .... / -.-. --- -. - .. -. ..- . / .--. .-. .- -.-. - .. ... .. -. --. / -- . -.. .. -.-. .. -. . .-.-.-
 
2012-07-10 10:37:43 AM  

tenpoundsofcheese: Beef Swellington: Shrew2u: 699 data points from a pool of about 665,000 physicians would have a margin of error of 3.7 percent, if the poll is crafted well and the sample is statistically-reflective of the larger group.

I would be interested in knowing the sourcing of the contact information and seeing how the demographics of the sample size compares to the demographics of the group.

Response rate, grasshopper. The margin of error matters not.

from wiki: Holbrook et al. (2005) assessed whether lower response rates are associated with less unweighted demographic respresentativeness of a sample. By examining the results of 81 national surveys with response rates varying from 5 percent to 54 percent, they found that surveys with much lower response rates were only minimally less accurate.


So if you don't accept the terrible validity of a survey with a minuscule response rate by a partisan organization, how about we look at other factors:

Representative sample? Nope.
80% of respondents say they belong to a single doctor or small practice, however upwards of 50% of medical practices are now in hospital or other large practices and only one third are in single doctor or small practices and another 15% were in 3-5 member group practices.
In addition, the years in practice are not representative of the general physician population; in this study only 8.3% of respondents were in practice less than 10 years whereas 29.3% of US physicians report this level of seniority.

Unbiased questions? Nope.
The first question is "How do current changes in the medical system affect your desire to practice medicine?" which might be a valid question, however the only responses are "I'm re-energized," "I'm thinking about quitting," and "no opinion." Where's the option for folks who are half-heartedly going along with it? There's a huge gulf between being re-energized and thinking about quitting that isn't reflected on the survey. While the survey reports that 82% of docs are thinking about quitting, it doesn't provide any explanation for why that is when the 2008 study showed 43% of physicians where somewhat satisfied with their careers and 39% were very satisfied. Can we really assume that all of those doctors are now thinking about quitting when the majority of the ACA reforms haven't even come into effect yet?

How about the analysis of the results? Hey, that is bogus too.
The survey's authors highlight that two thirds of the respondents report "just squeaking by or in the red" in terms of their practices' finances. First off, we have to question whether the ~20% of respondents who are part of large practices are even in a position to know how well their practices are doing. Secondly, an examination of the actual question shows that 32.5% of respondents say their practice is "in the black" full stop, 37.3% that their practice is "in the black, but just squeaking by," 12.3% are "breaking even" and only 14.5% report that they are in the red. That may seem a little damning, but that doesn't mean that doctors themselves are going broke. It is the responsibility of a practice, even a single-doctor private one, to pay out doctors' salaries, so any practice that is in the black, squeaking by, or breaking even is still paying its doctors with no significant problem. Suggesting that two thirds of the doctors are squeaking by or worse ignores the fact that ~70% are operating in the black. Similar chicanery of findings is used on other issues as well.

In summary, the survey is a piece of trash.
 
2012-07-10 10:38:29 AM  

quatchi: The response rate was 4.3%

The 95.7% of doctors who apparently thought the survey itself was without merit



I like how you always make things up.

Apparently....citation?
 
2012-07-10 10:39:27 AM  

Cubicle Jockey: As I pointed out in the previous thread, if doctors truly hated Obamacare, then they should also hate Romneycare.

If so, why does Massachusetts have more MDs per capita, by far, then any other state?

Answer: they don't hate Romneycare, and they won't hate Obamacare.


I guess Doctors would actually like having all their patients to have insurance.

Personally I would find the challenge of over billing some patients to deal with the uninsured ones to be an interesting way of passing the time.

Here's my other prediction (haven't even checked this yet), Massachusetts is having fewer and fewer malpractice suits. Call it a hunch.
 
2012-07-10 10:40:44 AM  
I went to the doctor the other day, and my regular doctor wasn't there, so I met this other doctor, who was a crusty old white guy, and when he was going over the fact that a positive HIV test would go on permanent record, he then said "That can't negatively affect your insurance at all, unless Mitt Romney gets elected", and he gave me a lecture on my iron levels and asked how often I wore sunscreen.

So therefore, every single old white doctor hates Mitt Romney. This is just as statistically relevant as this poll.
 
2012-07-10 10:41:43 AM  

tenpoundsofcheese: I like how you always make things up.


I make things up all the time.

Funny, I guess a lot of doctors offices have fax machines still

Makes no sense to me, but I am not a doctor

I just play one on Fark
 
2012-07-10 10:47:47 AM  

iawai: It's not a rebuttal.


They clearly showed the method used was a clear example of sampling bias. So yes, it is a strong rebuttal of the validity of their results.
 
2012-07-10 10:48:15 AM  
I can't speak for 83% but I know that at least two will. They're getting on in years and mostly just work now because they want to.

Great job Obama, you've managed to make doctors want to quit, but be sure and don't do a thing to mess with those trial lawyers who donate to you.
 
2012-07-10 10:50:54 AM  

SilentStrider: conservative statisticals


Remember, it's not gay if the statisticals don't touch.
 
2012-07-10 10:51:01 AM  
Wait... So there are people out there who actually think 83% of Doctors are going to close up shop because of the ACA.

O.K.

As someone mentioned above, that's not what has happened in Massachusetts. Six years on and we're still ranked as one of the top states for health care and as one of the healthiest, fittest states. 98% coverage, as well.

My god, the Chicken Littles certainly have their panties in a bunch these days.
 
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