Your PCP has about 15 min to solve your problem and move on to the next patient.

If you have something common no problem.

If not it is time to find a specialist.

Same deal with the specialist.

If you have something in common to their practice you get 15 to 20 min.

The hard stuff is when you need to deep dive. Medical Journals, latest studies, experimental treatments.

AI is really helpful here but it takes a long time to learn to use AI.

Without AI finding relevant stuff is almost impossible.

People know they are not getting helped enough in some cases so they turn to any place they can. Even when is it of no real help or harmful/

quote:

Originally posted by tatortodd:
More and more private practices are being bought by corporations that own hospitals. They're forcing hospital computer systems, metrics, etc. on small practices. The small practices are feeling more and more like they're run by corporate not the doctors. This has eroded my trust.

quote:

Who pays the doctors? Start from there.

People feel like the doctor no longer works for them. The patient has become a necessary inconvenience in the money making operation.

This is remarkably similar with what happened to education when it became controlled by government. It's bureaucratic and top heavy... and way too expensive. Education of the student is no longer the focus.

quote:

More and more private practices are being bought by corporations that own hospitals. They're forcing hospital computer systems, metrics, etc. on small practices. The small practices are feeling more and more like they're run by corporate not the doctors. This has eroded my trust.

This is part of the issue. I know of one physician in my medium sized AL town that had a solo private practice. Now, within the past 12 months, his practice is owned by the local hospital which has provided him with a nurse practitioner to increase thru-put in the practice.

The PCP practice I am forced to see is nothing more than a Medicare gate keeper.

RMD

quote:

The hard stuff is when you need to deep dive. Medical Journals, latest studies, experimental treatments.

^^^^^^^^^^^^
In these instances it is best to go to a large medical center where there are residents in training and physicians who do research and practice. These large medical centers are typically associated with a medical school.

Letting non-MDs invest in medical practices/hospitals, was a disaster.

It would be the same if non-lawyers get to invest in law firms/non-lawyer financing of law suits has probably caused a lot of the issues.

quote:

Originally posted by Aglifter:
Letting non-MDs invest in medical practices/hospitals, was a disaster.

You are 100 % correct !! They have turned a vocation into a business ! It's the reason that I retired early ( and I loved my job).

We had a great private practice female family physician for years. Very efficient staff. She got bought out by a conglomerate national 'health' organization. We can't see a real doctor anymore, just FNPs who get to many patients scheduled for the same time slot and push their high tech tests to bill Medicare for more money.

I think it's part of a globalist goal.

quote:

Originally posted by 12131:

quote:

Originally posted by bcereuss:
It wasn’t the entire medical community.

Yup, generalization is no bueno.

True, victims of the Government and Media hype, however due to liability reasons, most all that I visited in COVID times succumbed outwardly to the hype

Since it's been proved that we were all duped, some doctors included, people don't trust Vaccines, or diagnosis 100% like our parents did, they didn't have the ability to validate diagnosis instantly, as we do today.

In fact it was me that found the correlation between the new found Gout I was experiencing and the BP medication, when I told him he laughed and said he'd never heard it, until I produced print outs from the web from sources he'd trust. Now it wasn't his fault, he had not run across that issue and lucky for me I had instant digital access to the situation.

quote:

The location that your GP sent you to get your testing done is out of your insurance network.

That will only be an extra $700...

Its the patients responsibility to know if the facility they go to is part of their plan, not the doctor, he/she can't know every facilities insurance participation.

If you don't check and you get service at that facility and get a bill, it's not your doctors fault.

As a medical practitioner myself, the concept that somehow big pharma pays Doctors or there is some big conspiracy of such is totally bogus. Now I am not saying that big pharma doesn’t have a lot of influence ( take a deep dive on a lot of the treatment algorithms for chronic illnesses and what is behind them and yes big pharma definitely influences such things)

A lot of the current problems with fragmented care, and limited access to primary care has to do with billing and reimbursement which is greatly influenced by the government, namely CMS -center for Medicare and Medicaid services- which sets reimbursement levels, which in turn are typically adopted as standard by insurance companies.
A typical example ( I do not recall exact numbers but here is an example)
A particular procedure your provider does is billed at $1200. Medicare reimbursement is only $600, but in order to provide care to people with a particular insurance ( typically the most common insurances in a region based on employer plans) you must sign a contract and accept assignment ( agreement to be reimbursed the Medicare rate) in order to see patients using that insurance.
One big sinister ploy CMS uses is to link eligibility for payment to certain metrics. Again a silly example but true - if your female patient had a current mammogram ( which may have nothing to do with the particular procedure done- in my case I do orthopedics so what difference does it make when we do surgery on a fracture?) you get reimbursed more than if they did not.

When I started practice in the early 90’s there were still some “ cradle to grave” primary care physicians- family practice that would deliver babies do office procedures and colonoscopy and non surgical fracture care. Over time, organizations like CMS forced them to stop providing comprehensive care by extensively decreasing reimbursements or refusing to pay altogether for procedures done by primary care that today all go to specialists. So it forced primaries to limit greatly what they do and made them referral generators.
Organizations like CMS and JCHO constantly come up with new rules or change interpretations of older ones to make it ever harder to practice, which results in physicians giving up and joining big group or hospital practices to avoid all the headaches.
I plant the “opioid epidemic” blame directly at the foot of JCHO - they were the ones in the 90’s claiming providers were not adequately treating pain, and coerced us into giving more narcotics, made pain the “5th vital sign”. Now the same organization that greatly contributed to the problem is unwilling to share the blame, and hounds us to limit use of pain medication

Forty plus years of one man being at the helm of government's powerful health agency, thanks Anthony Fauci, you may not have singlehandedly caused this, but you were and still are a major conspirotor, enjoy the pardon.

This is the “corpratization” of medical practice. Under the current rules, physicians, nurse practitioners,and physicians assistants are simply assembly line workers. Crank it out or hit the road.

RMD

quote:

If you don't check and you get service at that facility and get a bill, it's not your doctors fault.

^^^^^^^
You ask when you make an appointment. The insurance company often lists names of deceased physicians and those that dropped network participation long ago. Granted it is a pain in the ass.

Another vote for a loss of faith over the Covid fiasco. Pharmacists are culpable as well. When My son needed a meningitis vaccine for school, I asked the pharmacist at CVS if it was an mRNA vaccine. He was very put out and got a bit flustered and glared at me for saying it out loud in a somewhat crowded scenario- I suppose because “I was one of those maga nutjobs that didn’t trust the science. And this was well after it was common knowledge that mRNA vaccines were at minimum, suspect.

Medicine, like the rest of the country is political. If your healthcare provider doesn't reflect how you want to be treated fire them and get others. We all need to be our own advocates. Don't be wimpy, know your medical history and the Rx you are on including dose. Dress up a bit, come in looking like you are a thinking person. It helps. It's a challenge to get competent doctors. Get ones that are the best you can fine. Don't go for bedside manner. If that kind of care you want get a dog.

Fair is where you get cotton candy and pigs win prizes. Nothing fair about healthcare, there is a way out of most of the drama but it takes money.

I'm 74 and have lived in southern Indiana 70 years. Started in 1955 at age 4 with a doctor that lived 4 doors down the street and made house calls. A couple years later Dr Tom and his brother opened their private practice. It thrived and I basically had concierge grade healthcare until 2019 when the last son of the founders retired and big chain hospital bought them.

I tried them for a couple years and hated being a number and a nobody so I fired them. Tried a couple other practices and they sucked.

Got in on the ground floor of a new concierge practice and signed up. I'm in year 3 and am totally satisfied. I consider the $2750 annual membership another insurance policy.

link to CCSI
https://www.conciergecaresi.com/why-us

quote:

Originally posted by mutedblade:
My experiences reflect tatortodd's and I deal exclusively with the VA.

From 2013-2024 at the same hospital, I had 44 visits to neurology for TBI with severe migraines and I ended up seeing 43 different doctors. Complete step 1 before moving on to step 2 kind of stuff, but you can never make it to step 2 because you're next appointment is with someone different altogether, so you just get to repeat step 1. Egos are huge in the medical community too. Doc's rarely accept what others have already concluded, so they do the same redundant tests/treatments and it gets exhausting. Groundhog Day loop that you can't get out of.


There isn't really any kind of critical thinking on their part anymore either. These "medical professionals" are plugging your symptoms into a system that spits out the highest probable cause. You can do the same on WebMD and not have a copay

Low level light therapy/cold laser has helped many persons with TBI. Also stay away from TV, movies, and the computer as much as possible. As a D.C. I see a lot of motor vehicle accident patients. Often they have TBI like symptoms. Carefully realigning C1 helps many. By careful, I am referring to D.C.'s who only works on C1, and who measure the improvement with before and after x-ray imaging.

I've been dealing with insurance billing issues since I retired 8 months ago and got forced from my top of the line policy to an HSA. I dread calling them and having to try to explain the same issues over and over to the non English speaking customer service desk drones. This is why no ones really all that upset with ol' Luigi.

quote:

There isn't really any kind of critical thinking on their part anymore either. These "medical professionals" are plugging your symptoms into a system that spits out the highest probable cause. You can do the same on WebMD and not have a copay

^^^^^^^^^^^
Perhaps a few. Read your assertion again and realize how insulting it is. Critical thinking goes well beyond Google. Practicing medicine is an art. I have a number of friends who are internists and they frequently speak about how patients diagnose themselves using Google and how far off they are.

quote:

Originally posted by HRK:

Its the patients responsibility to know if the facility they go to is part of their plan, not the doctor, he/she can't know every facilities insurance participation.

If you don't check and you get service at that facility and get a bill, it's not your doctors fault.

True.

My GP of ~17 years was corporatized by Piedmont.

They said they no longer do bloodwork in house and referred me to Piedmont's new central facility a few blocks down the street.

Same name was on both buildings, the coverage was not.

If I liked my plan, I could keep my plan. Right?

My doctors here in Florida are from Haiti, Puerto Rico and generally are Spanish-speaking. In addition, many of the medical techs are Spanish and cannot pronounce English meds properly so I can understand them. It is not a joy.