18 June 2009
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16 comments:
Meowww.. pssst.
Many Congrats!
GruntDoc
Awesome, dude. Goodbye, anonymity!
Congratulations.
Nice writing.
congrats. well stated and well deserved.
you've been outed!!
...nice entry.
Worst hair evah!
It's not ANYONE, just hardcore liberals... ;-)
Wow! Congrats!
Nice article. The move to make Primary Care Physicians the contact point for most medical problems is exactly what needs to happen and it can be considered a step backward. Twenty five years ago PCPs took care of their patients by advocating for them, helping them maneuver the gauntlet of specialists, helping them understand risks as well as the benefits of therapy and give them realistic expectations of what is possible medically. As medicine has gotten more technical and complicated Family Doctors has started deferring to their specialist colleagues at their patient's expense in some cases.
What we need is a step back to this role and compensate them for time spent with patients rather than compensating them for 'moving meat'.
Wow, now all the proceduralists know your name! Watch out they will be gunning for you!
i don't agree. these people (including you) are all qualified professionals. besides it is an op-ed and who else would have great opinions on this subject?
If your policy suggestion comes to fruition, I recommend that you obtain some training in simple little procedures like burr holes, ventriculostomies, craniotomies, spinal decompressions and instrumentations, etc., because there aren't going to be many neurosurgeons around to do these things for you.
Ian,
Yeah, like we have so many neurosurgeons competing to take trauma call as it is. Funny, though, how they can always make time on their schedule for another elective laminectomy...
Seriously, the reforms can't be as simple as "cutting the pay" of the surgeons (that's an oversimplification brought on by the 400-word limit of the op-ed). It will have to be a comprehensive rethinking of the RVRBS. Not that it's likely to happen any time soon.
Why are you calling Kevin an idiot?
Well, you're right about one thing--neurosurgeons aren't crawling over each other to cover trauma call. They're doing it when it's properly incentivised, often with payments of up to $3000 per night. Yet almost every neurosurgeon in practice covers traumas as one aspect of his/her practice, the bulk of which is comprised of the elective cases you malign. If the incentives were removed, make no mistake: many surgeons would disappear. Make it such that neurosurgeons earn only as much as internists, and you will soon see that there is a critical shortage of neurosurgical care across the country. There won't even be enough people to handle those elective laminectomies.
Another point: I think it's risible that you make a generalized distinction between "cognitive services" and procedures. I assure you that the cognitive component of diagnosing and extirpating a lesion of the brain or spinal cord is equal or, in many cases, greater than that required to provide primary medical services. A reasonably talented fourth-year medical student can diagnose and manage a heart attack (with the exception of the revascularization--that's the province of specialists!). Ask that same student--even after months of intensive sub-internships--to manage a giant middle cerebral artery aneurysm, and you'll draw a blank stare.
I'm sure your real stance on the issue of specialist reimbursements is, as you suggest, more related to complicated changes in the RVRBS than it is to blanket redistribution of income from the more highly trained to the less highly trained. However, I would urge you to keep in mind that your words were read by millions of people, many of whom may be in a position to influence policy decisions at your behest. This debate is so critical to our nation's future that there is no room for glib 'solutions' and gross generalizations, regardless of the constraints of the medium. The suggestion you offered in the NYT editorial was either ill-conceived or oversimplified into unintelligibility, and at its essence was irresponsible and rather reckless.
It's incumbent upon you as a purported expert to offer well-wrought, carefully supported ideas that, if implemented, wouldn't torpedo our healthcare system. Vilifying an entire sector of medical practitioners is doing nobody any favors.
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