"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow
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Workouts by month - Goal 200 from 11/1/09 through 10/31/10
The ACP Advocate Blog by Bob Doherty: "There once was a man named O'Bama ..." http://ow.ly/1nUH3 - HCR limericks and a cold one for BobMarch 18, 2010 5:24
http://ow.ly/1mYi7 - ABIM MOC program - two differing viewpoints - you can guess my voteMarch 16, 2010 5:06
RT @yejnes: My thoughts on the annual exam, etc., final letter ACP Internist, March 2010 http://bit.ly/9FNcXn wel-stated & importantMarch 15, 2010 12:47
A note to the professors, from the "real" world, on the use of ICDs in a fee for service community... http://ow.ly/1jaPy - great postMarch 13, 2010 2:19
RT @paulinechen: New "Doctor and Patient"; Learning to Keep Patients Safe in a Culture of Fear http://nyti.ms/bYA14V - blog post comingMarch 12, 2010 1:35
RT @tom_peters: @kevinmd Spoken like an MD. - true primary care is very complex - it is not simple care -March 11, 2010 12:43
RT @efalchuk: Seriously, what is Nancy Pelosi Talking About? http://bit.ly/9sHSc2 #healthreform #hcr #healthcare think Dazed and ConfusedMarch 10, 2010 7:53
Obama Says Health Overhaul Should Trump Politics - http://nyti.ms/bwKRyo - and he is correctMarch 8, 2010 7:28
That’s all well and good, but perhaps primary care needs to appeal more to the bottom-line. It has been shown that a better lifestyle is a priority in today’s medical students, which is evident by more and more taking the R.O.A.D. to happiness. In comparison, primary care offers the pressure of seeing more patients in the setting of declining reimbursements. It doesn’t take a genius to figure out why interest in primary care is declining: doing more work for less pay isn’t the best way to sell the profession.
Understanding student decision making is not rocket science. Kevin does primary care – and he understands what our leaders apparently do not understand.
“What happened to doctors just wanting to take care of people” is the lay response to the question of incentive in doing primary care.
I’ll tell you what happened – EVERYTHING has gotten more expensive as the economy is flat, and many (if not most) have had commensurate increases in pay. EXCEPT docs in private practice – insurance reimbursements are in the toilet. Medicaid, as well as several private insurers, pays about $30-$40 to see a patient, possibly less than the cabbie gets to bring that patient to the office!
Meanwhile administrators, drug reps, and people outside of medicine with much less time & money spent on school/training, are doing fine. I would guess that plenty of NPs and PAs are netting almost as much as MDs in small (solo) practices. Ridiculous, for the difference in training.
I think the future of primary care is grim, which ultimately will affect radiology & other specialty services too, since they ALL depend on referrals from primary care.
Why don’t people choose primary care? Easy. Less pay for more work. It shows in how things are reimbursed. Procedures pay hansomly, patient care doesn’t. I can spend an hour with a Medicare patient reviewing numerous problems and get paid ~ $80 (much of which goes to overhead since it’s done in my office) or a specialist can do a scope, relocate a dislocated hip prosthesis, or replace a cataract and get paid hundreds in a fraction of the time with barely any overhead (since it’s done in the hospital). Until the thought process & overhead that goes into preventive & chronic care is reimbursed as well as the technical skills of specialists, we’ll have fewer & fewer primary care docs and more & more specialists.
I like what I do (Family Medicine), but I suffer for it financially. For me that’s ok, but not for med students these days who graduate with $200,000 in educational loans.
2 Responses to Why students do not elect primary care
K. Jindal, MD
March 9th, 2005 at 11:43 am
“What happened to doctors just wanting to take care of people” is the lay response to the question of incentive in doing primary care.
I’ll tell you what happened – EVERYTHING has gotten more expensive as the economy is flat, and many (if not most) have had commensurate increases in pay. EXCEPT docs in private practice – insurance reimbursements are in the toilet. Medicaid, as well as several private insurers, pays about $30-$40 to see a patient, possibly less than the cabbie gets to bring that patient to the office!
Meanwhile administrators, drug reps, and people outside of medicine with much less time & money spent on school/training, are doing fine. I would guess that plenty of NPs and PAs are netting almost as much as MDs in small (solo) practices. Ridiculous, for the difference in training.
I think the future of primary care is grim, which ultimately will affect radiology & other specialty services too, since they ALL depend on referrals from primary care.
Bob Rauner, MD
March 9th, 2005 at 8:14 pm
Why don’t people choose primary care? Easy. Less pay for more work. It shows in how things are reimbursed. Procedures pay hansomly, patient care doesn’t. I can spend an hour with a Medicare patient reviewing numerous problems and get paid ~ $80 (much of which goes to overhead since it’s done in my office) or a specialist can do a scope, relocate a dislocated hip prosthesis, or replace a cataract and get paid hundreds in a fraction of the time with barely any overhead (since it’s done in the hospital). Until the thought process & overhead that goes into preventive & chronic care is reimbursed as well as the technical skills of specialists, we’ll have fewer & fewer primary care docs and more & more specialists.
I like what I do (Family Medicine), but I suffer for it financially. For me that’s ok, but not for med students these days who graduate with $200,000 in educational loans.