California residents beware of inferior eye care!

[tube fanatic]

Dave, you misunderstand the intent of my comment.  Let me rephrase- I would not seek care from a NP or PA.  Obviously, in an emergency we would all accept care from anyone who could help.

Etc6849 raised the issue of training of an optometrist vs. that of an ophthalmologist.  The issue is this:  the eye does not exist in isolation from the rest of the body.  In fact, the eye is one of the most responsive organs to systemic issues (and has the advantage of it's interior being viewable without an invasive procedure).  With that in mind consider the fact that an ophthalmologist has extensive training in the whole body during medical school and general residency.  Then, during the ophthalmology residency, intensive training in the eye takes place in the context of the whole body!  This latter training in medical and surgical eye care gives the ophthalmologist an enormous advantage over optometrists whose understanding of the relationship of the eye to everything else is more limited.  And this training gains an even greater dimension when one considers the "super specialists" who do an additional residency in select parts of the eye (retina specialists as one example).  There is just no way that the education of an optometrist even remotely touches this kind of training.  Remember too that the ophthalmology residencies take place in hospitals where the assortment of illnesses and diseases is usually huge.  The conditions which the residents encounter there on a regular basis may not be seen by optometrists over their entire careers.

The article which Travis posted from Review of Ophthalmology is excellent.  Unfortunately, the optometrists quoted represent the political arm of the profession, so their response is expected.  The summary by Dr. Prince (ophthalmologist) at the end, however, sums up the real issue:

“Without a doubt, there’s an optometric agenda,” says New York City-based glaucoma surgeon Andrew M. Prince. “The agenda is to ultimately be equal to ophthalmologists with regard to being able to perform all eye-care procedures, including surgery. And while that started with using diagnostic drops ... it’s now moving toward lasers and surgery. The problem is optometry as a profession has sought these expanded abilities via legislative mandate without undertaking and completing the corresponding required ophthalmic education and training, and what’s at risk is patient safety and the quality of eye care."

I have witnessed what Dr. Prince asserts first hand here in NJ, and the same has happened across the country.  When states have enacted TPA (therapeutic pharmaceutical agent) legislation, optometrists had to take a classroom course of around 100 hours and pass a test.  That's it!!!  How can that compare to a hospital based residency where medical and surgical treatments were actually administered to patients and the results observed while working with highly trained physicians?

So, that's my take.  Optometrists' desire to administer vaccines is nothing more than a means to generate additional revenue.  Same for everything else they want to do without proper training.  Optometry has gotten greedy.  The profession should have remained in the territory at which it is best suited- visual training, correcting vision with glasses or contacts, and other optical modalities like sports vision training.  And, one last note- I know of a number of optometrists who decided to go to medical school and become ophthalmologists so they could do things the right way!

Maynard

[Travis In Austin]

California is the third state to enact such legislation. Oklahoma did so back in the late 90's.

What peer reviewed studies are there, not mere speculation from advocates from doctor/optometrist groups, about the complication rates of various eye laser procedures performed by each group?

I'm glad to see that the real issue in this debate has been acknowledged to be one of training and qualifications, not insurance or the Affordable Care Act.

[oscarsear]

California is the third state to enact such legislation. Oklahoma did so back in the late 90's.

What peer reviewed studies are there, not mere speculation from advocates from doctor/optometrist groups, about the complication rates of various eye laser procedures performed by each group?

I'm glad to see that the real issue in this debate has been acknowledged to be one of training and qualifications, not insurance or the Affordable Care Act.

Yes........... there has been a trend towards diversification of healthcare delivery vehicles.  No........... this is also a real matter of the ACA and its perspectives on the definitions of care and which populations will be getting care, who pays for care and who gets care paid for by others.  The ACA now determines benefits and defines cost benefit outcomes.  Bureaucrats now define clinical care plans.  The elderly population faces some cold choices.  Here we discourse on simple eyecare medicine.  Look into elder care.  Look into hospice and palliative medicine.  Did you know that if you die under hospice care that there are no formal inquiries?  If you die in a nursing home - there will be no autopsy?  We are talking about carte blanche when it comes to elder care.  Imagine when assisted suicide gets enacted?  

 

If gov't policy demands a lower standard of care and the practice of that care has no oversight and minimal consequences - what happens to quality of care, the quality of life?  You spend your entire life being healthy and your are healthy.  You are living an active retirement and you suffer a simple accident.  You break a hip.  The best medical solution is a hip prosthesis.  But - the ACA says you're too old.  Makes no difference that you are otherwise in excellent condition, you have no comorbidities.  You do not get your procedure approved.  You now get to be crippled at best.  

 

So, yeah.......... politics now plays a huge roll in healthcare, its quality, its delivery and its economics............. and IMHO, it is not very well done in any regard.  Medicine by gov't committee is not medicine.  You'd better be wealthy if you want to retire and remain healthy.

[Zen Traveler]

 

...So, yeah.......... politics now plays a huge roll in healthcare, its quality, its delivery and its economics............. and IMHO, it is not very well done in any regard.  Medicine by gov't committee is not medicine.  You'd better be wealthy if you want to retire and remain healthy.

 

 

Unfortunately politics plays a roll in pretty much everything that individuals have no control of and rely on government to take care of or remedy--Imo, the healthcare debate was all political in the public forum with most folks shouting out comments they heard on tv....

 

I agree with the quote above, but the wealthy were the only ones assured of healthcare the way the system was going for the long term--Those with insurance are still in the high percentage of bankruptcies because of healthcare costs and the system has been that way for decades.

 

Fwiw, we have the ACA in it's present state because lawmakers couldn't get the 60th vote for a Single Payer System and the minority along with campaign considerations stuck to keeping the Insurance companies involved (and keep it 'Private'). It actually was the old time Conservatives that won in that regard but what is coming to light is that Healthcare is not cheap (especially in this country) and prior to the ACA, folks in the individual market were paying a considerably higher percentage of those costs--I will also add that, again most people have no idea what their actual needs would be in an emergency and all taxpayers pay the cost regardless if they have insurance.

Edited June 7, 2015 by tkdamerica

[oscarsear]

 

 

...So, yeah.......... politics now plays a huge roll in healthcare, its quality, its delivery and its economics............. and IMHO, it is not very well done in any regard.  Medicine by gov't committee is not medicine.  You'd better be wealthy if you want to retire and remain healthy.

 

 

Unfortunately politics plays a roll in pretty much everything that individuals have no control of and rely on government to take care of or remedy--Imo, the healthcare debate was all political in the public forum with most folks shouting out comments they heard on tv....

 

I agree with the quote above, but the wealthy were the only ones assured of healthcare the way the system was going and those with insurance are still in the high percentage of bankruptcies because of healthcare costs.

 

Fwiw, we have the ACA in it's present state today because lawmakers couldn't get the 60th vote for a Single Payer System and the minority along with campaign considerations stuck to keeping the Insurance companies involved (and keep it 'Private'). It actually was the old time Conservatives that won in that regard but what is coming to light is that Healthcare is not cheap (especially in this country) and prior to the ACA, folks on the individual market were paying a considerably higher percentage of those costs--I will also add that, again most people have no idea what their actual needs would be in an emergency and all taxpayers pay the cost regardless if they have insurance.

 

I do agree............. what we had before ACA wasn't very good.  I do feel that the ACA has made it worse for those reasons I stated and others.  The bureaucratic overhead is incredibly more complex and time consuming.  I know many practitioners who have entirely abandoned 3rd party systems now running private pay practices.  Guess what?  They can afford to treat anyone for less than the copays on ACA plans.  In other words w/o the administrative overhead they can deliver healthcare to their patients for far less and the those same patients are now required to pay to the feds.  

 

If America chooses to become a social democracy then do that and do it correctly.  The reasons social medicine works better in some countries is that it is more of a priority.  They do not field 7 battle ready carrier groups.  They take care of their citizenry.  Medicine is not cheap.  Not even close.  It is technical, complex, dirty and dangerous.  Remember changing dirty diapers on your children?  Imagine the care of the incontinent elderly?  What would you expect to be paid to keep and elderly male clean of smeared feces?

 

Before the ACA emergent care, etc may have been delivered blindly whereas now the ACA has put a $$$ value to that care and assigned the debt to select Americans to be paid under penalty of law.  The caliber of that care is not better.  The value of the care is not better.  The access to the care is not better.  The cost of that care is exorbitant because the admin relied upon the age old nemesis of the insurance industry to project the coverage and the costs.  The fox was placed in charge of the henhouse.  Hawaii's system has already gone insolvent.  Your premiums are about to rise dramatically.  Your copays are nuts.

 

IMHO the ACA took a bad situation and really made it a disastrous mess and not one to be easily corrected.

[Zen Traveler]

 

.  ...Your premiums are about to rise dramatically.  Your copays are nuts.

 

IMHO the ACA took a bad situation and really made it a disastrous mess and not one to be easily corrected.

 

 

As I mentioned, our premiums were already going up dramatically and at least now most of us are in the same boat. Fwiw, I can't argue against the shortfalls you mention but in the last 3 years I've understood more about our coverage and our rates have gone up less than 5% in each of those years.

 

{Note: There were/are so many caveats  in Healthcare coverage and one of the most dramatic I found was there is something called "Cash Price" when it came to certain procedures--It wasn't until we dropped the ability to have MRIs (Our premiums for 2 Healthy adults was over $1k a month with higher deductible) covered by insurance that I found the cash price was 1/3rd what they would've billed the insurance and if we were insured we still would have paid a considerable amount out of pocket.}

Edited June 7, 2015 by tkdamerica

[oscarsear]

Healthcare providers are just as aghast at how the systems once worked and how they now operate as anyone.   Often you'll hear how disillusioned providers become once they enter practice.  As I said............  the country needs to decide if it wants to be a dominating world power or socially responsible.  Individuals should determine to live safer and healthier lifestyles.  Socialized medicine can affordably work.  But we're delusional thinking we can keep everyone in skittles and take proper care of ourselves too.  It is not working.

 

(NOTE: Your decision to forgo MRI coverage is precisely what I mean by bureaucratic medicine.  The MRI is one of the most useful imaging studies available.  They are not that costly.  They are not rare machines.  There is no shortage of trained MRI personnel.  But they made it a price point issue - artificially.  Now you have limited your coverage through manipulation.  That scan is often the headwaters of accurate treatment, very definitive. If included it opens the gateway to lots of quick necessary procedures.  If eliminated that care continuum panoply is now less accessible.  You did not just give up MRIs.  You gave up the doorway to good medical care.  And they understood that.)

[Zen Traveler]

(NOTE: Your decision to forgo MRI coverage is precisely what I mean by bureaucratic medicine.  The MRI is one of the most useful imaging studies available.  They are not that costly.  They are not rare machines.  There is no shortage of trained MRI personnel.  But they made it a price point issue - artificially.  Now you have limited your coverage through manipulation.  That scan is often the headwaters of accurate treatment, very definitive. If included it opens the gateway to lots of quick necessary procedures.  If eliminated that care continuum panoply is now less accessible.  You did not just give up MRIs.  You gave up the doorway to good medical care.  And they understood that.)

 

Wait! I didn't forgo MRIs and understand completely their usefulness. For the record, we made that decision for the reasons stated and that was almost 5 years ago, prior to the ACA and when our premiums were going to jump  to over $1200 monthly--I didn't find out about any "Cash Price" until we told our doctor that we no longer had MRI coverage and found that paying this lower amount was akin to the difference in premiums that paid for itself in the first 3 months (3 MRIs were about $800, total)--I was told by my insurance person and doctor prior that MRIs were around $1200 a piece and in my profession would highly recommend the extra coverage.

Edited June 7, 2015 by tkdamerica

[Travis In Austin]

California is the third state to enact such legislation. Oklahoma did so back in the late 90's.

What peer reviewed studies are there, not mere speculation from advocates from doctor/optometrist groups, about the complication rates of various eye laser procedures performed by each group?

I'm glad to see that the real issue in this debate has been acknowledged to be one of training and qualifications, not insurance or the Affordable Care Act.

Yes........... there has been a trend towards diversification of healthcare delivery vehicles. No........... this is also a real matter of the ACA and its perspectives on the definitions of care and which populations will be getting care, who pays for care and who gets care paid for by others. The ACA now determines benefits and defines cost benefit outcomes. Bureaucrats now define clinical care plans. The elderly population faces some cold choices. Here we discourse on simple eyecare medicine. Look into elder care. Look into hospice and palliative medicine. Did you know that if you die under hospice care that there are no formal inquiries? If you die in a nursing home - there will be no autopsy? We are talking about carte blanche when it comes to elder care. Imagine when assisted suicide gets enacted?

If gov't policy demands a lower standard of care and the practice of that care has no oversight and minimal consequences - what happens to quality of care, the quality of life? You spend your entire life being healthy and your are healthy. You are living an active retirement and you suffer a simple accident. You break a hip. The best medical solution is a hip prosthesis. But - the ACA says you're too old. Makes no difference that you are otherwise in excellent condition, you have no comorbidities. You do not get your procedure approved. You now get to be crippled at best.

So, yeah.......... politics now plays a huge roll in healthcare, its quality, its delivery and its economics............. and IMHO, it is not very well done in any regard. Medicine by gov't committee is not medicine. You'd better be wealthy if you want to retire and remain healthy.

That may be true on other types of care, but the opthomologists and optometrists have been in a turf war for over thirty years. Kentucky passed this legislation back in 2011. The market forces indirectly related to insurance may have helped push the legislation to passage for KY, but the Governor who signed it said it was all about availability of care.

Back to the title of the thread, where is the data that this is inferior eye care?

[sheltie dave]

Travis, my thinking has nothing to do with being behind the times.  Rather, it's a matter of wanting to have the best outcome for a medical situation.   I would never accept care from a NP or PA, and their training is far greater than a mere 50 hours of "post-graduate" training.  It's all a matter of one's comfort level.

 

Maynard

 

Maynard, having two brothers, a father, and three first cousins that are medical doctors, a sister that is a pharmacist, a wife that is a BSN RN with three certs and an advanced practice Masters, a cousin that is a PhD nurse anesthetist, a five first cousins that are degreed RN nurses, I will say that your view is prejudiced in the overall spectrum of health care. For your specific situation I do agree, but eye surgeries are a miniscule tip of the medical care iceberg.

 

For folks who are not totally conversant with NPs and PAs, a PA cannot see a patient without having their attending IN THE SAME BUILDING, for consultation when needed. They cannot write scripts. In Missouri, a NP can see patients, proscribe scripts, and diagnose patients on an independent basis, provided their attending is within a 50 mile radius for consultation. There is a marked difference between an advanced practice nurse and a PA.

 

For most people, a nurse held them in their first minute of life, and if they are lucky, a nurse will be holding their hand amongst family members in their last minute of life. At hospitals, nurses bathe their patients, shampoo their hair, give haircuts, trim finger and toenails, bring ice for their patients' drinks, wake them up, tuck them in, feed them meals, check their vitals, round many times a day, administer their meds, keep them comfortable, converse with them and lend an ear when no one is around, and provide the healing touch when needed.

 

Please don't dishonor the nursing profession by saying you would never accept care from their most highly trained of advanced practice nurses. They deserve more respect than you are giving.

[oscarsear]

 

Travis, my thinking has nothing to do with being behind the times.  Rather, it's a matter of wanting to have the best outcome for a medical situation.   I would never accept care from a NP or PA, and their training is far greater than a mere 50 hours of "post-graduate" training.  It's all a matter of one's comfort level.

 

Maynard

 

Maynard, having two brothers, a father, and three first cousins that are medical doctors, a sister that is a pharmacist, a wife that is a BSN RN with three certs and an advanced practice Masters, a cousin that is a PhD nurse anesthetist, a five first cousins that are degreed RN nurses, I will say that your view is prejudiced in the overall spectrum of health care. For your specific situation I do agree, but eye surgeries are a miniscule tip of the medical care iceberg.

 

For folks who are not totally conversant with NPs and PAs, a PA cannot see a patient without having their attending IN THE SAME BUILDING, for consultation when needed. They cannot write scripts. In Missouri, a NP can see patients, proscribe scripts, and diagnose patients on an independent basis, provided their attending is within a 50 mile radius for consultation. There is a marked difference between an advanced practice nurse and a PA.

 

For most people, a nurse held them in their first minute of life, and if they are lucky, a nurse will be holding their hand amongst family members in their last minute of life. At hospitals, nurses bathe their patients, shampoo their hair, give haircuts, trim finger and toenails, bring ice for their patients' drinks, wake them up, tuck them in, feed them meals, check their vitals, round many times a day, administer their meds, keep them comfortable, converse with them and lend an ear when no one is around, and provide the healing touch when needed.

 

Please don't dishonor the nursing profession by saying you would never accept care from their most highly trained of advanced practice nurses. They deserve more respect than you are giving.

 

Very true.  You can find NP's incredibly well trained and often more competent than MD's.  Why?  Because their training can be more specific, less generalized.  Diabetic care is an excellent example.  Most MD's think they understand diabetes and are quite willing to treat the problem.  Unless they're an endocrinologist they are likely pretty clueless about the best way to tailor diabetic care.  But you can find NPs that do know diabetes.

 

I am of the opinion the family practitioner MD's should go the way of the neanderthal.  Most intake can be managed by NP's and PA's - especially when augmented by computers.  MD's should become advanced practitioners able to deal with serious medical issues.

 

And everyone should quit smoking (anything), eat less, exercise more, imbibe a lot less and get more rest.  We all can all contribute good or bad to this conundrum, so we all play our own part in how we conduct our own lives. 

[LarryC]

dwilawyer, on 05 Jun 2015 - 7:49 PM, said: You are apparently way behind the times of terms of where medical care is going in the US that predates the ACA by a decade. Look up Physican's Assistant and Nurse Practitioner and get yourself up to date.    garyrc, on 06 Jun 2015 - 6:51 PM, said:These new professions were designed to make up for a shortage of doctors that existed and was growing long before the Affordable Care Act. The problem seems to have originated with some seriously flawed studies in the seventies and early eighties commissioned by the US Department of Health and Human Services and its Graduate Medical Education National Advisory Committee. They predicted that there would be too many doctors by the year 1990, and that doctors had already been delivering “inflated volumes of service.” So, medical school expansion was not supported. Of course, they were dead wrong (pardon the macabre pun). LarryC would know everything there is to know about those studies, why medical schools didn't expand, etc. He was a member of that committee at various times IIRC.

Gary RC knows his history!  I haven't heard GMENAC referred to in an eternity!  It was before my time, but I had a role to play with the Council On Graduate Medical Education (COGME), which came to the same conclusions.

 

And, like GaryRC says, they were "dead wrong."   No methodology has been developed that can accurately predict demand for physicians and/or other health professionals.  So, what happens is the interpolation of political and philosophical agendas, usually  by the Chairman of the Council.  These are not always what the establishment would prefer, either.  For example, COGME was very oriented to promoting primary care, while medical education organizations were doubtful about that push.

 

The test of time reigns, of course.  No one now seriously believes that we have a "surplus" of physicians.  On the other hand, the role and importance of more primary care physicians has gradually inserted itself into organized health system practice, and there seems to be far less resistance to training and utilizing primary care.  Pay is still too low, however. 

 

Medical schools did not readily expand at the time of GMENAC and early COGME days, because starting and running a medical school is VERY expensive, in both money and medical leadership manpower!  This has gradually changed since the GMENAC days in the 1970s, and the COGME days of the mid-1980s to late 1990s.  Since, then, there has been a quantum expansion of medical school enrollment.  Unfortunately, there is a 10- to 20-year lead time from deciding to increase med school enrollments to the actual entry into practice of well-trained, fully practicing physicians.  That's been the real problem.

Edited June 7, 2015 by LarryC

[Travis In Austin]

Larry, that is very interesting background on the doctor numbers and the ramp up time to educate more of them.

Hard to understand why they didn't see the numbers because social security saw it coming, people are living longer and population is increasing. It would be interesting to know the numbers of psysicians (MDs and DOs) per 1000 people, or whatever benchmark, in 70, 80, 90, 00 and 10.

I also wonder if a catastrophic crunch was avoided by granting D.O.s full medical privileges, and pathways to residency and fellowship programs? If so, are we approaching that same situation again?

[tube fanatic]

Maynard

Maynard, having two brothers, a father, and three first cousins that are medical doctors, a sister that is a pharmacist, a wife that is a BSN RN with three certs and an advanced practice Masters, a cousin that is a PhD nurse anesthetist, a five first cousins that are degreed RN nurses, I will say that your view is prejudiced in the overall spectrum of health care. For your specific situation I do agree, but eye surgeries are a miniscule tip of the medical care iceberg.

 

For folks who are not totally conversant with NPs and PAs, a PA cannot see a patient without having their attending IN THE SAME BUILDING, for consultation when needed. They cannot write scripts. In Missouri, a NP can see patients, proscribe scripts, and diagnose patients on an independent basis, provided their attending is within a 50 mile radius for consultation. There is a marked difference between an advanced practice nurse and a PA.

 

For most people, a nurse held them in their first minute of life, and if they are lucky, a nurse will be holding their hand amongst family members in their last minute of life. At hospitals, nurses bathe their patients, shampoo their hair, give haircuts, trim finger and toenails, bring ice for their patients' drinks, wake them up, tuck them in, feed them meals, check their vitals, round many times a day, administer their meds, keep them comfortable, converse with them and lend an ear when no one is around, and provide the healing touch when needed.

 

Please don't dishonor the nursing profession by saying you would never accept care from their most highly trained of advanced practice nurses. They deserve more respect than you are giving.

 

Dave, thank you for sharing the medical credentials of your family.  Impressive indeed!  But, once again you have drawn a totally unfounded conclusion based on my statement that I would not seek care from a NP or PA.  In no way did I make any disparaging remarks, show any "dishonor" about their capabilities, or show any disrespect by my statement.  This is a personal choice issue based on my experiences and those of family and friends.  It's no different from preferring to have one's car serviced by a factory trained tech at a dealership instead of the guy at the local garage, or having one's prized audio equipment serviced by the manufacturer instead of a local tech.  I simply prefer to entrust my care to a medical doctor.  Since you brought your medically credentialed family into the discussion, let's try this track:  ask your family members who they would consult if faced with an attack of acute glaucoma.  This is a true, time of the essence, medical emergency which requires proper treatment if sight is to be preserved.  Would they go to some optometrist who is "certified" to treat this condition (using drops or laser), but may not have ever used this privilege, and who can't perform any kind of surgical intervention if required, or an ophthalmologist who deals with this condition on a regular basis using any kind of intervention required?  I am very anxious to have their input (in fact, I know you have my direct email from some past correspondence- feel free to pass it along to any of them if they want to enter into a dialogue about eyecare education).  This post was intended to point out differences in medical eye care between the two professions, as the general public really is unaware that optometrists are not medical doctors and do not receive anything approaching the training of an ophthalmologist.

And, no, I'm not going to delete all of my posts and leave the forum!!!  As a kid I learned the art of arguing from Mrs. O'Brien and Mrs. Shea who could spend hours arguing about a speck of dirt!  Debate is healthy..........

Maynard    

[sheltie dave]

OK Maynard, I was just confused why you would bring NPs and PAs into a discussion about eye care and Opthas vs Optos. They are two completely different and unconnected types of medical care.

[Marvel]

Look up Physican's Assistant and Nurse Practitioner and get yourself up to date.

My wife had to squeeze in an appointment a year ago, and we had a PA. She was way more thorough than her own doc, and really explained more and seemed more interested in the care. I was actually very impressed.

 

Bruce

[LarryC]

Hard to understand why they didn't see the numbers because social security saw it coming, people are living longer and population is increasing. It would be interesting to know the numbers of psysicians (MDs and DOs) per 1000 people, or whatever benchmark, in 70, 80, 90, 00 and 10. I also wonder if a catastrophic crunch was avoided by granting D.O.s full medical privileges, and pathways to residency and fellowship programs? If so, are we approaching that same situation again?

I can't answer your docs per 1000 question without researching it, but the steady increase in med school enrollments leave little doubt that it's increasing, unavoidably.  Again. the lead time is very long. 

 

DO production increased GREATLY, beginning in the 1990's, and this may have helped save physicians' and medical schools' bacon by making emerging shortages less severe.  DOs are increasingly seen in ordinary practice situations and more recently in medical leadership, including in academic medical leadership positions.  Moreover, DOs go into primary care and rural practice to a much greater degree than MD docs, so the big DO increase has surely reduced pressures on the MD establishment for more docs in primary and rural health care.

 

That's been a long struggle by DOs to finally gain prestige and acceptance where they and their hospitals were once pariahs among MDs.  It took HUGE and deeply dedicated DO leadership to accomplish this!  That is also true of the battles that family physicians had to wage to establish themselves as a fully trained, accredited, and respected specialty, and to leave the old GP behind.  The podiatric profession has also had to fight its way upward to achieve similar success in moving from nails and calluses to demanding foot surgery.

 

A final note:  Medicare has played a very important role, by contributing key supporting dollars to hospital residency programs regardless of discipline or specialty -- DO and podiatry programs, for example.  It's still too oriented to in-hospital training, however.

Edited June 8, 2015 by LarryC

[CECAA850]

 

Look up Physican's Assistant and Nurse Practitioner and get yourself up to date.

My wife had to squeeze in an appointment a year ago, and we had a PA. She was way more thorough than her own doc, and really explained more and seemed more interested in the care. I was actually very impressed.

 

Bruce

 

 

 

I've seen this as well.  We have one PA that we take our daughter to that I'd much rather have my daughter see than the actual DR.

[Travis In Austin]

Hard to understand why they didn't see the numbers because social security saw it coming, people are living longer and population is increasing. It would be interesting to know the numbers of psysicians (MDs and DOs) per 1000 people, or whatever benchmark, in 70, 80, 90, 00 and 10. I also wonder if a catastrophic crunch was avoided by granting D.O.s full medical privileges, and pathways to residency and fellowship programs? If so, are we approaching that same situation again?

I can't answer your docs per 1000 question without researching it, but the steady increase in med school enrollments leave little doubt that it's increasing, unavoidably. Again. the lead time is very long.

DO production increased GREATLY, beginning in the 1990's, and this may have helped save physicians' and medical schools' bacon by making emerging shortages less severe. DOs are increasingly seen in ordinary practice situations and more recently in medical leadership, including in academic medical leadership positions. Moreover, DOs go into primary care and rural practice to a much greater degree than MD docs, so the big DO increase has surely reduced pressures on the MD establishment for more docs in primary and rural health care.

That's been a long struggle by DOs to finally gain prestige and acceptance where they and their hospitals were once pariahs among MDs. It took HUGE and deeply dedicated DO leadership to accomplish this! That is also true of the battles that family physicians had to wage to establish themselves as a fully trained, accredited, and respected specialty, and to leave the old GP behind. The podiatric profession has also had to fight its way upward to achieve similar success in moving from nails and calluses to demanding foot surgery.

A final note: Medicare has played a very important role, by contributing key supporting dollars to hospital residency programs regardless of discipline or specialty -- DO and podiatry programs, for example. It's still too oriented to in-hospital training, however.

27 physicians in active patient care per 10,000 in population. This does not include D.O.s. One quarter of U.S. physicians in active patient care were educated in foreign medical schools.

I guess between foriegn medical schools and D.O.s the system is keeping up.

[LarryC]

One quarter of U.S. physicians in active patient care were educated in foreign medical schools. I guess between foriegn medical schools and D.O.s the system is keeping up.

Yes. I failed to mention "international medical graduates" (IMGs) who have contributed mightily to easing what would be a much worse situation in rural and physician shortage areas.  One increasingly sees them in academic leadership positions, as they seem to specialize an attempt to move up in those tracks.  You're exactly right (as usual).