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(LA Times)   U.S. faces the difficult problem of finding 52,000 additional people who are smart enough to get through medical school and dumb enough to think that working with family medicine will be a fun and rewarding career   (latimes.com) divider line 87
    More: Fail, primary care doctors, School of Medicine, population ageing, American Made, careers  
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2129 clicks; posted to Geek » on 15 Nov 2012 at 10:37 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-11-15 01:00:00 PM  

natazha: I expect LPNs (licensed practical nurse) will fill many of the slots currently filled by GPs.


Except the hospitals have already tried to go that route (my wife was looking in to it). Some states don't recognize them as qualified to write prescriptions so they have to run everything by a doctor anyway. They also get the joy of working the same grueling pace and hours of a real doctor for just about the same (or in some cases less!) then they were making as a floor nurse.

Three of the four LPN's she talked to said they wouldn't recommend it as a career path right now.
 
2012-11-15 01:29:09 PM  
Create a Domestic Doctors Corp (DDC) which pays for medical school if they agree to serve for a set number of years. Think military academies but for doctors.

A Doctors Academy could be created or a ROTC like program could be created at existing schools.

One of the biggest challenges to becoming a doctor is the cost. This would eliminate that problem.

Doctors could be stationed in areas that there are needs and can be deployed to disaster areas as needed.
 
2012-11-15 01:36:41 PM  

natazha: I expect LPNs (licensed practical nurse) will fill many of the slots currently filled by GPs.


Thank you. I haven't laughed like that in a long time.

When there are LPNs around, ask where the CNA is. You'll get better information in the nursing home. :)
 
2012-11-15 01:49:32 PM  
Primary care could easily be accomplished with a kick ass software package. Input symptoms, get list of tests/exams required to isolate the cause, and proceed from there. Wouldn' be surprised if someone like WebMD would put this online...
 
2012-11-15 01:55:10 PM  

mark12A: Primary care could easily be accomplished with a kick ass software package. Input symptoms, get list of tests/exams required to isolate the cause, and proceed from there. Wouldn' be surprised if someone like WebMD would put this online...


WebMD is farking horrible. Do you know how many patients come in, convinced they know more than their doctor, because WedMD told them they have this disease or that disease? And refuse to believe otherwise, making their doc's job three times harder?

/no, your blood sugar is not fine, fattie
 
2012-11-15 01:57:39 PM  

mark12A: Primary care could easily be accomplished with a kick ass software package. Input symptoms, get list of tests/exams required to isolate the cause, and proceed from there. Wouldn' be surprised if someone like WebMD would put this online...


Said by someone who has never worked in any medical field whatsoever.

Software can support clinical decisions when used right, and help drive care by refreshing provider memory. Any good provider is going to use aids like software and written to help them.

It cannot replace a human being. There's a reason Medicine is an art and a science.
 
2012-11-15 02:09:39 PM  
Why do we need a family doctor to go to school for 8 years to dispense antibiotics and give me referals to specialists?
 
2012-11-15 02:20:57 PM  
If medical schools accepted more students and if there were more medical schools in the US they could probably fill that gap easily. I base this, of course, on my own medical school rejection.
/should have applied to osteopathic schools as well
//and schools in the Caribean
///and the Philippines
 
2012-11-15 02:58:51 PM  

BronyMedic: Software can support clinical decisions when used right, and help drive care by refreshing provider memory. Any good provider is going to use aids like software and written to help them.

It cannot replace a human being. There's a reason Medicine is an art and a science.


Aside from electronic medical records (which Obamacare is going to give a big boost to), what I think is really exciting is bringing NLP and analytics to doctor's offices to expand their base of experience to draw on for diagnoses. Doctor examines the patient, enters in patient details and has the software listen to what the patient is saying during the examination. Patient is complaining about pain in one of their legs. The doctor think it's might just be ordinary pain and doesn't have anything else to go off of.

Then the software does its work and then reports that X% of people in the patient's demographic were eventually diagnosed with malady A, Y% were diagnosed with malady B, etc and here are some tests you can do to rule out/in these possible diagnoses. Or maybe it'll tip the doctor off that Z% of people giving these symptoms have read too much WebMD.
 
2012-11-15 03:03:08 PM  
Fartbamacare will ruin this country. Mark my words.
 
2012-11-15 03:10:11 PM  

robohobo: Lol, GP's. Most of the people my wife went to school wife who ended up GP's were the worst students in her class.


The person answering the helpdesk line is not the person who is running traceroutes on the network connection.
 
2012-11-15 03:25:12 PM  

karmaceutical: Maybe... just maybe... medical professionals should be in the profession because they genuinely want to heal, and not let the "half as much as a specialist" drive their decision.


Have a few years in a profession that requires that kind of training and family sacrifice and let me know if you still feel that way.
 
2012-11-15 03:27:43 PM  

Aexia: BronyMedic: Software can support clinical decisions when used right, and help drive care by refreshing provider memory. Any good provider is going to use aids like software and written to help them.

It cannot replace a human being. There's a reason Medicine is an art and a science.

Aside from electronic medical records (which Obamacare is going to give a big boost to), what I think is really exciting is bringing NLP and analytics to doctor's offices to expand their base of experience to draw on for diagnoses. Doctor examines the patient, enters in patient details and has the software listen to what the patient is saying during the examination. Patient is complaining about pain in one of their legs. The doctor think it's might just be ordinary pain and doesn't have anything else to go off of.

Then the software does its work and then reports that X% of people in the patient's demographic were eventually diagnosed with malady A, Y% were diagnosed with malady B, etc and here are some tests you can do to rule out/in these possible diagnoses. Or maybe it'll tip the doctor off that Z% of people giving these symptoms have read too much WebMD.


shutupandtakemymoney.jpeg
 
2012-11-15 03:42:04 PM  

orclover: Much like the "nursing shortage", the problem isnt that you cant find enough people to fill the jobs. You could easily fill all the job openings with the available candidates, and you would fill them with adequately skilled employees. The problem is they want to fill them for as close to minimum wage as they can get away with, and they cant do it. You have enough of a workforce available. But you dont have a glut of employees desperate for work and willing to work for a pittance.

Yea tough shiat.


Kinda like the whole Jobs Americans Won't Do thing. Yes people will do x for y dollars. People will not do x for .25(y) dollars.
 
2012-11-15 03:45:34 PM  

Marcus Aurelius: You can be a GP and work 80 hours a week and pull down half as much as a specialist that works half the hours.

Tough choice, really.


To be fair, being a GP also means spending less time and effort on school and more on making money, and malpractice insurance is much lower. And the patients may be significantly more pleasant, depending on what specialty you're comparing it to (Obstetrics, for instance... christ.)

Plus, to be utterly and completely blunt, GP doesn't require that you be as smart or skilled as most specialties, so it's a good place to go if you can't perform adequately as a specialist. As impolite as it is to say this out loud, to some extent the specialist make more because they're better, if that weren't the case then supply and demand would equalize the payscales as more people moved into the specialties. There is a significant skill-based barrier to entry there.

//Not that there's anything wrong with GPs or anything, obviously.
 
2012-11-15 03:56:55 PM  

KFBR392: karmaceutical: Maybe... just maybe... medical professionals should be in the profession because they genuinely want to heal, and not let the "half as much as a specialist" drive their decision.

Well, then...maybe...just maybe...it shouldn't cost $150,000-$200,000 a year to get a degree and maybe, just maybe...we shouldn't crap on doctors for their first 8 years on the job by over working and under paying them. Also, maybe, just maybe...we shouldn't sue the doctors every chance we get...?


Bah that makes too much sense;it would never work.
 
2012-11-15 03:58:08 PM  

Contents Under Pressure: robohobo: Lol, GP's. Most of the people my wife went to school wife who ended up GP's were the worst students in her class.

The person answering the helpdesk line is not the person who is running traceroutes on the network connection.


Yes I am.
 
2012-11-15 04:07:40 PM  
Perhaps they could bring more people in as GPs if they didn't require long, underpaid, horrible internships and residencies in hospitals for those who simply want to do general family practice. There's really no reason that someone who will MAYBE handle a suture or two needs a serious surgical rotation. Or the debt that comes with making almost no money for years and years after school.

I've got friends who are barely holding it together because their rotations are making them so miserable, but hope to get into family practice when they're done. Seems like a lot of superfluous training for someone who is going to end up treating nothing more serious than a broken arm here or there.
 
2012-11-15 04:10:24 PM  
It cannot replace a human being. There's a reason Medicine is an art and a science.

Disagree. Medicine is no longer an "art". It is all science now. Thanks to us engineers, we have provided you with all the testing systems and chemistry to scan/track/evaluate virtually all body parameters.

Medicine is now just mechanistically examining the symptoms with really good diagnostics and determining/treating the cause. It is eminently suitable for automation. The human body system is longer a huge mystery (except for the brain). There is a finite number of maladies the body can suffer, most have been documented, many are curable.

/no, it's not Fibromyalgia
//no, it's not Epstein-Barr
///MRI reveals no troll living in your stomach
 
2012-11-15 04:29:45 PM  

MorePeasPlease: karmaceutical: Maybe... just maybe... medical professionals should be in the profession because they genuinely want to heal, and not let the "half as much as a specialist" drive their decision.

Some hobbies are too expensive to try to make careers out of.


You're right.

1.bp.blogspot.com
 
2012-11-15 04:31:42 PM  

Jim_Callahan: Marcus Aurelius: You can be a GP and work 80 hours a week and pull down half as much as a specialist that works half the hours.

Tough choice, really.

To be fair, being a GP also means spending less time and effort on school and more on making money, and malpractice insurance is much lower. And the patients may be significantly more pleasant, depending on what specialty you're comparing it to (Obstetrics, for instance... christ.)

Plus, to be utterly and completely blunt, GP doesn't require that you be as smart or skilled as most specialties, so it's a good place to go if you can't perform adequately as a specialist. As impolite as it is to say this out loud, to some extent the specialist make more because they're better, if that weren't the case then supply and demand would equalize the payscales as more people moved into the specialties. There is a significant skill-based barrier to entry there.

//Not that there's anything wrong with GPs or anything, obviously.


Yeah, just like that guy that works on the off-shore oil rig that makes 120k is better, as a human being, than the high school teacher that makes 60k. Or, you know, it could be that his job is 2x the hours, way more dangerous, a thousand miles away from his family and friends, and zero human interaction. But he is probably just "better."

Maybe everyone isn't a butt surgeon specialist because not everyone likes to stare at ass all day, rather than because they don't have the board scores for it.
 
2012-11-15 04:42:24 PM  
Bullshiat.
Now we're being told there are not enough people qualified to go to medical school because we all suck.
I dunnathinkso.
 
2012-11-15 04:46:38 PM  

BronyMedic: Hey, submitter?

Do you know what pisses any healthcare provider, from a CNA to an MD off?

For someone to insinuate they do it for the money, or that their pay is what makes them happy.

/GPs make the world go around.


Also, subby, don't say anything bad about bronies...

/did that once
//ONCE
///fear bronymedic
 
2012-11-15 04:53:29 PM  

KFBR392: karmaceutical: Maybe... just maybe... medical professionals should be in the profession because they genuinely want to heal, and not let the "half as much as a specialist" drive their decision.

Well, then...maybe...just maybe...it shouldn't cost $150,000-$200,000 a year to get a degree and maybe, just maybe...we shouldn't crap on doctors for their first 8 years on the job by over working and under paying them. Also, maybe, just maybe...we shouldn't sue the doctors every chance we get...?


I'm glad to see that what I wanted to say here has already been covered. We do, as a society, everything we can to make being a doctor a miserable existence, and then expect "somebody else" to line up to be the next cultural punching bag the minute we have a boo-boo. That's why we are, as a society, farked.
 
2012-11-15 05:23:28 PM  

DubyaHater: Good farking luck. With constant cuts to Medicare reimbursement (and insurance companies following suit), the pay isn't worth a career in family medicine. Maybe if there were more incentives (college and medical school loan forgiveness), you might have a chance.


That's utter bullshiat. It's still a career that pays just fine and also has intangible societal status rewards. It's not always a millionaire job, but ONLY doctors would have the gall to think that they are entitled to such. Plenty of people are very smart, work very hard, and spend a lot of time and money in school and don't have this annointed sense of entitlement to unlimited riches.
 
2012-11-15 05:26:46 PM  

mark12A: Primary care could easily be accomplished with a kick ass software package. Input symptoms, get list of tests/exams required to isolate the cause, and proceed from there. Wouldn' be surprised if someone like WebMD would put this online...


WebMD my ass - it's Lupus or cancer every time.
 
2012-11-15 05:36:56 PM  

karmaceutical: Maybe... just maybe... medical professionals should be in the profession because they genuinely want to heal, and not let the "half as much as a specialist" drive their decision.


When you come out 200 to 300K in debt, and being a GP means fighting HMO's and Medicare for every dollar, getting about half of what you deserve, yeah, "half as much as a specialist" is a big consideration.

You sound like those idiots that say paying teachers minimum wage is acceptable because they should "do it for the love of teaching", regardless of how much of their already meager pay goes to pay for basic supplies that should already have been part of the budget.
 
2012-11-15 05:42:20 PM  

cefm: DubyaHater: Good farking luck. With constant cuts to Medicare reimbursement (and insurance companies following suit), the pay isn't worth a career in family medicine. Maybe if there were more incentives (college and medical school loan forgiveness), you might have a chance.

That's utter bullshiat. It's still a career that pays just fine and also has intangible societal status rewards. It's not always a millionaire job, but ONLY doctors would have the gall to think that they are entitled to such. Plenty of people are very smart, work very hard, and spend a lot of time and money in school and don't have this annointed sense of entitlement to unlimited riches.


Right. Some people spend 6 years getting their PhD in English or History so they can teach to the next group of students. Whew. Rough life. Professors don't have the same responsibilities or stressors that a physician has. Plus, a phyisician's salary is not stable. It is dictated by reimbursement rates year by year, and overall, there has been a downward trend. Unless the physician wants to run a cash-only business (good luck with that).
/Apples to oranges.
//I like my physicians calm, happy and well-paid
 
2012-11-15 06:00:06 PM  

Occam's Disposable Razor: jayhawk88: I don't know, sounds like a pretty sweet gig to me:

- Triple book appointments all day, show up 25 minutes late to each one of them after the nurses have done all the actual diagnostic work
- Listen to the person gripe about whatever for 5 minutes
- Tell them that viruses just have to run their course, they should go home, sleep, and drink plenty of fluids
- If they look at you funny, realize they were complaining about a pulled muscle instead of the flu, write them a script for Loratab
- 3:30 already? Quitting time!

The days of this shiat are coming to an end. If anyone reading this sees a physician who behaves in this manner, find a new one. They're out there, and they're better. That behavior could get by a few generations ago when we didn't have treatments for much, but medical knowledge continues to expand at a shocking rate. It's hard enough to keep up in one field, impossible for all of them, but we can do so much now. And so can patients. The internet allows people to really get a handle on their disease often times, if they can avoid some of the pseudoscience on the web. It's a really great time to be in medicine, and you deserve to be seen by a doctor who thinks so too.


I just switched from a doctor like this. Hadn't seen him in years as every time I went in, I saw the resident or PA. I had intense itching and inflammation on my scalp from infection and his office wanted to write me off and prescribe a muscle-relaxer over the phone. SEE YA.
 
2012-11-15 06:12:52 PM  

robohobo: mark12A: Primary care could easily be accomplished with a kick ass software package. Input symptoms, get list of tests/exams required to isolate the cause, and proceed from there. Wouldn' be surprised if someone like WebMD would put this online...

WebMD is farking horrible. Do you know how many patients come in, convinced they know more than their doctor, because WedMD told them they have this disease or that disease? And refuse to believe otherwise, making their doc's job three times harder?


That's why what the medical profession needs is trained dispatchers, not more GPs. If we educate and certify some people to recognize a large number of symptoms, prescribe tests for further diagnosis if needed, and quickly route the results to a specialist for analysis, everyone would win.

The entry point into the medical system having to be a brilliant, sacrificing, jack-of-all-trades is the worst practice.in any industry.
 
2012-11-15 06:16:51 PM  

rolladuck: KFBR392: karmaceutical: Maybe... just maybe... medical professionals should be in the profession because they genuinely want to heal, and not let the "half as much as a specialist" drive their decision.

Well, then...maybe...just maybe...it shouldn't cost $150,000-$200,000 a year to get a degree and maybe, just maybe...we shouldn't crap on doctors for their first 8 years on the job by over working and under paying them. Also, maybe, just maybe...we shouldn't sue the doctors every chance we get...?

I'm glad to see that what I wanted to say here has already been covered. We do, as a society, everything we can to make being a doctor a miserable existence, and then expect "somebody else" to line up to be the next cultural punching bag the minute we have a boo-boo. That's why we are, as a society, farked.


Teachers fall under that umbrella as well. I did a cost/benefit analysis and decided that even if I found a job right out of school, the student loan payments would be $400-500/mo right off the bat. Not to mention being one false accusation or angry parent away from losing my career entirely.

I like the warm and fuzzy idea of teaching, helping young people succeed, etc -- but it's not worth it. Yeah, there are loan forgiveness programs, but you have to teach special ed most of the time to qualify for that. And once you've got special ed on your resume, you'll be hard-pressed to get hired for teaching anything but.

No thanks.
 
2012-11-15 09:30:24 PM  

Pick: Fartbamacare will ruin this country. Mark my words.


I think it's more likely idiot followers like Aexia with their faces all aglow that will do it.
 
2012-11-16 12:10:13 AM  
Perhaps there could be a program where certain people get to go to med school for free + forgiveness for 75% of their undergraduate pre-med education as long as they are willing to work directly for the government (state or federal) for a period of fifteen years post residency. The will be good but not phenomenal. This will be offset by the fact that these state doctors will not be mired in debt.
 
2012-11-16 10:09:12 AM  

DeaH: Perhaps there could be a program where certain people get to go to med school for free + forgiveness for 75% of their undergraduate pre-med education as long as they are willing to work directly for the government (state or federal) for a period of fifteen years post residency. The will be good but not phenomenal. This will be offset by the fact that these state doctors will not be mired in debt.


A good idea, but 15 years is too long. Indentured servants were only compelled to stay with their master for 7 years. Marines only have to serve for six years. Bring it down to two to four years and I'm on board.
 
2012-11-16 10:38:12 AM  

Lunaville: DeaH: Perhaps there could be a program where certain people get to go to med school for free + forgiveness for 75% of their undergraduate pre-med education as long as they are willing to work directly for the government (state or federal) for a period of fifteen years post residency. The will be good but not phenomenal. This will be offset by the fact that these state doctors will not be mired in debt.

A good idea, but 15 years is too long. Indentured servants were only compelled to stay with their master for 7 years. Marines only have to serve for six years. Bring it down to two to four years and I'm on board.


I think the debt paid should at least be as long as the training. Eight years' school and two years' residency. Plus, unlike an indentured servant, doctors will be making from $60-75K as they perform their duties. That's a very fair wage when one is not burdened with student debt. I think 12 years is as low as it should go and 15 is optimal. That way, doctors who have at least 10 year's field experience can also train new people for a few years. Of course, if they are good enough to train, there should be a bonus.
 
2012-11-16 03:06:21 PM  
I think a lot of people are focusing on the wrong things here. The title actually got it right.

I chose a sub-specialty when I graduated med school. I felt like I studied too hard, scored too high, and published too much to spend the rest of my career seeing people with the sniffles. It might sound conceited, but most med students I've met have felt this way.

Instead of spending all my time alone with a group of people that act like cheese is a vegetable and cigarettes are a vitamin, I spend my time working with other (mostly) intelligent physicians, nurses, etc to take care of patients too sick to walk into a clinic and go home after the visit. I spend more, not less time, talking to my patients and colleagues, and waste less of it writing letters to teachers for healthy students to skip a day of school.

Pay has very little to do with it. If I wanted to make money as a PCP, I would manage a multi-physician office practice or do concierge medicine. There is money to be made in primary care, but most (not all!) people going into primary care barely understand how medicine works, let alone practice management.

Most of the people that I know who find primary care intellectually stimulating are the sort of people that could barely keep their head above water during our fundamental clinical year rotations, and often failed Step 1 of the US Medical Licensing Exams on their first attempt.

I know you'd probably like to think the doc who listens to you complain about your cough graduated top of his class at Hopkins, but that guy is probably in a lab advancing the field of medicine, and making less money chasing grants.
 
2012-11-16 03:18:20 PM  

Pharmdawg:
In pharmacy school rotations, we followed different physicians a week at a time. Most of them met us at the hospital at 7 am to check on inpatients, got to their office at 9, then took an hour and a half or 2 hour lunch during which they went back to the hospital, then back to the office for more appointments til 4 or 5, then they let us go home while they went back to the hospital AGAIN.

I do not begrudge physicians in general one penny of their income. Most of them are very dedicated, well educated, hard workers and they do their best to treat people who are quite often doing their best to make themselves sicker by eating too much, sitting too much, and smoking and drinking too much.


Sounds familiar.

I'm a family medicine intern. Want to know what my schedule has been this month? I get to the hospital at 0630, see patients until about 1, grab a quick sandwich from the cafeteria, chase lab results and new patients until sign out at 1730.

That's a light day. Yesterday was 0630-1900. Call nights? You get there at 0630, and if you're lucky, you're only on for 16 hours. Most are 24. Last night of call I had, I crashed at 0100, got paged at 0230, crashed at 0400, got paged at 0500, sign out at 0700, left at 0900. That was 26 hours, I can only log 24.

We are capped at 80 hour workweeks, with four mandatory days off per month, but those are pretty routinely ignored. I typically work 85-90, log 80, and even days "off" I'm still working writing notes, dictations, other stuff.

All this for $47,000 a year. It's not even truly that. There's a mandatory 10% to the pension, so now I'm at 42,000. Loans? I have $314,000 in federal loans thanks to grad school and medical school. If I were to try and pay at the ten-year plan rate, it would be $5300 a month- more than my entire salary before taxes.

Am I in it for the money? Obviously not. On a per-hour basis, I make $11.75. Working as a locksmith, as I did for fifteen years in high school and later? I topped out at $35 an hour, more for emergencies, where I went to $70. I could set my own hours, pick up as many as I wanted.

Why am I in it, then? It's because I honestly feel that among the diabetics who ignore my advice, the obese who wash down a pizza with a diet coke, the hypertensives who don't take meds, there are some where I make a difference.

Will it pay eventually? Sure. Is it still worth it now? Yes.
 
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