I don't know the answer he will come back with, but if I had to guess, it's like everything else. A PA's billing rate is significantly less than an actual physician and if there is a cheaper way to do it, insurance companies are going to force you to the cheaper option. There's likely some threshold which has to be met before insurance will cover a physician. As boomers age, this will become more and more of an issue, unless you're lucky enough to live in an area that has an adequate supply of doctors.
We've never had any trouble getting the OK to visit anyone in our network. So my question is still: Who makes the decision on whether a doctor or a PA will see us in a routine follow-up - the insurance company or the practice, which has dozens of each?
Match Day 2023 a reminder of the real cause of the physician shortage: not enough residency positions It looks like there were about 20 thousand graduates in the US in 2022. You know how many unique job postings there were for MD's in 2022-2023?Over 70 thousand. Average annual openings (so that is really replacement jobs, includes people retiring, etc. + growth) is about 30,000. There are a lot of reasons for MD shortages. So we aren't training enough, the process is SUPER expensive and time consuming (about 10-12 years including undergrad, median debt is 215 thousand), and then this doesn't even take into account geographic issues, like doctors not wanting to work in the ass end of nowhere, which is why some areas are better staffed than others. And then this doesn't touch at all the nursing shortage which is estimated to be over 1 million short. Add in an aging, obese population, and yeah, the US has a problem. This isn't partisan bickering, this is objective fact.
It would be bad enough if our healthcare industry weren’t helping people, but it’s generally acknowledged to be the third-leading cause of death behind heart disease and cancer. And that was before the panic of 2020 turned hospitals and nursing homes into killing fields.
It’s a business decision just as much as “not wanting to work in the ass end of nowhere”. Doctors like anyone else in business want to clear that debt and start making good money sooner rather than later. No different than a car dealership. Do you go where you will have 100 customers come in every day or where you have 15? But you are dead nuts on point about cost and time prohibiting supply. That $215K is heavily skewed by the number of students from affluent families in the sample base. Total cost is much higher than that. Just because it isn’t debt doesn’t mean it shouldn’t be in the discussion.
AI is going to replace at least 50% of what doctors do, so this problem is probably going to solve itself in the near future. Considering my experiences at some of the docs I've been to, I'd rather get an AI diagnosis at this point.
Another issue is that classes are now over 50% women who on average work less days and less years than men. Don’t take this is that I don’t think they are deserving students but it’s just simple math. We even had a couple in my class that never practiced. The only way to solve this is having bigger classes.
Yup ... "Gee, I wish I could spend $2,000 a month on health insurance, then get nothing for that money until I spend another $10,000 out of pocket to cover my deductible, every year..." ... said no Candian ever....
Yeah I'm at 1,800$ a month for my family of 4. The middle class is getting absolutely boned with no lube when it comes to US Healthcare. I really don't understand people against massive reform
That's a big 'yes' from me. Back in 2016 I had an ongoing problem that ostensibly could be taken care of by a D&C. But the Shands gynecologist treating me kept postponing the procedure to align his schedule with the surgical schedule of a 2nd doctor he wanted to participate. Months went by and my hemoglobin plummeted to a dangerous low. After having my levels checked once again in January 2017 it was determined the procedure was immediately necessary and could no longer be delayed. I was transported from the doctor's office on NW 39th Ave to Shands Hospital via ambulance, received 2 units of blood overnight, and went in for an emergency D&C the next morning. The procedure was done in a surgical unit reserved for plastic surgery as it was the only surgical unit with available space. The endometrial tissue that was removed was biopsied and it was found to be cancerous. For months I had pleaded with the gynecologist for a hysterectomy as this problem was one that started back in 1990 and since that first D&C there had been 4 or 5 more. His response was always, "Your condition does not warrant a hysterectomy." His tune changed with the biopsy findings and I was back on the surgical schedule 4 days later for a hysterectomy. If the uterus had been removed 8 months earlier when I first asked, the cancer might not have taken hold and become the monstrous problem it eventually became. My Shands oncology surgeon said the cancer was completely contained in the uterus, they "got it all" and there was no need for post op cancer treatment. It only took another 2 years to find out how wrong that bit of information was when it was discovered the original cancer had metastasized and latched onto my lower vena cava. Shands Healthcare wrecked my life and almost killed me.
Wow that really sucks. Our Family has yet to encounter this. About a year ago I had a hernia, my doctor requested I get an MRI, that took 3 days to get. After that she gave me a referral to a surgeon at North Florida, took a week for the appointment for him to look at the MRI then he scheduled the surgery for 3 weeks later. Similar situation wife my wife's surgery on her knee, she actually was the one who rescheduled hers most recently, didn't want it to interfere with the holidays, so rescheduled it for 10 days later. My father-in-law has a heart condition also had a battle with cancer they always seem to get in easily, never herd him complain about waiting for months to be seen. He does complain about seating in the Doctors office too long. My father goes to the VA, doesn't have any issues making the appointments but it is usually an all-day ordeal.
That's awesome, glad Obama did exactly what you elected him to do. That was your massive reform. All those who don't pay, and some illegals say thank you for your contribution and please be careful not to get hurt their counting on you and others.
Didn't vote for Obama and have said ACA costs the middle class since it was implemented. Not all of us operate in a binary partisan existence.
you’re not one of them unless you support dear leader clearly. It’s sad. Doesn’t matter your other positions or who you voted for. Even if that info counters their expectations.
This is sad and unfortunate but very familiar. Push through ACA and here we are. So what the solution to some? Take a step back and undo some of this mess first ? Noooo they insist on more overhaul and more ACA. It’s lunacy but predictable. It’s no different than any state not named Florida where an influx of people from other states come in wanting different from where they left…….but continue to vote exactly as they did before like some mental disorder. Over time of course their new home starts to resemble then mirror their old home. Results are predictable. Meanwhile those of us who wanted no part of ACA are doing exactly what we said we would do. Using concierge medicine and getting much better care, albeit at a cost. So pretty much everyone loses accept those that don’t financially contribute to the system. Yeah progress.
