Unfortunately the current reimbursement system forces docs to push thru lots of patients to make money. Thus they spend less face to face time than many like. I am privileged to work in a setting (the VA) with no productivity demands and I am salaried. I average seeing about 6-8 patients per half day and I can spend more time with my patients.

second, I disagree with your viewpoint on nurses. I am the ultimate long tail illness and I have made many drs go away befuddled. Nurses are more likely to listen and more likely to admit they don’t know what’s wrong than drs are. They also take more time discussing meds, treatments and followups. Drs get pimped to death I afraid in med school and develop a complex about not knowing the right answer. I had one scream at me once rather than admit she didn’t know what was wrong.

nurses should not replace drs. However I fully support have NPs set up low cost basic care care clinics at walmart. Too many folks can’t afford to see you guys and go without any care. NPs are a way to at least partially provide care to the poor and middle class in america.

The difficulty is alluded to by the other commenters; health care is not capitalism but we don’t really wish it to be capitalism, for many reasons; we wish physicians to be qualified and we wish patients to be able to get needed care, even if they can’t afford it. If health care were really a free market, that is, if patient’s provided demand tied to their own resources and if barriers were removed to physician supply, we would not like the results.

The great divide in health policy regarding our health care system (at least so far as I can tell) is between those who wish to address its shortcomings regarding cost and coverage by making use of market-based mechanisms insofar as is possible, and those who argue that the market is simply an inappropriate model for health care. Those like DB, who favor the market, need to tell us how their measures would solve problems that an unfettered market would either not address or perhaps worsen, such as health care coverage for the less well-off. Advocates of government health care systems need to assuage the anxieties of those of us who blanch at the thought of American health care as a giant version of the VA. There is likely no ideal solution; but DB’s simple invocation of health care capitalism seems a bit facile. More capitalism might abate the “tragedy of the commons” aspect of the health care cost crisis—while worsening other problems.

BUT, do you know what it costs to become a doctor? What is the avg debt coming out of medical school? What do doctors pay for malpractice insurance, esp an OB/GYN? As others have noted it costs alot of money to practice medicine in terms of both financial and emotional cost. Physicians have some of the highest suicide and divorce rates of any profession.

The average physician also works many more hours per day/week than the avg person in america. my plumber charges more per hour than I do. (especially if he has to come out on a weekend)

I have and do work with multiple nurse practitioners in many different settings and their ability to handle anything that isnt 100% typical is well below that of a doctor. Period. “Well”, you say, “they will refer the tough cases to the physicians”. The problem here is that many of them dont recognize that the dont know what they are doing. They definitely cant make the long tail diagnoses and miss many of the short tail ones too.

I agree with this. Healthcare is not capitalism. If it were, then after those patients were rejected -> the market would respond with low-cost alternatives, ie if you cant afford a mercedes, a buick alternative is available… that is capitalism. Captialism is not oligarchy, it is not artificial scarcity. Those MDs that only want to service MDs (pun intended) would have to produce real value for the additional service. Captialism includes competition, not flashing party credentials to expect secure returns.

there is a very real underlying assumption by medical professionals in this country that they are doing the public a favor by doing their job. A very lucrative, well-protected, and secure job…

Solutions:
go overseas:
retain your dignity, experience compassionate care, and enjoy the free market
(planet-hospital, etc)

scripting:
support nurses rights to write prescriptions. Nurses and techs with years of experience are very competent/able (i have been told this by several MDs). A nurse with 10+ yrs of experience has the ability and right to take care of your childs ear infection. the underlying effect of this political measure with get more supply immediately out there. Further, I believe since increasing number of doc would occur through political not market forces in this country, nurses right to script has more hope than say opening medical school admissions/ residency slots… However, even this has very slim chance of ever passing- possible hope lies in the boomers who as they age will need tangible real care- and demand this reform.

my 2 cents