Poll finds most doctors support public option of health care (http://www.npr.org/templates/story/story.php?storyId=112818960)

Interesting that even though most of their members support it, the AMA doesn't.

When polled, "nearly three-quarters of physicians supported some form of a public option, either alone or in combination with private insurance options," says Dr. Salomeh Keyhani. She and Dr. Alex Federman, both internists and researchers at Mount Sinai School of Medicine in New York, conducted a random survey, by mail and by phone, of 2,130 doctors. They surveyed them from June right up to early September.

"Whether they lived in southern regions of the United States or traditionally liberal parts of the country," says Keyhani, "we found that physicians, regardless — whether they were salaried or they were practice owners, regardless of whether they were specialists or primary care providers, regardless of where they lived — the support for the public option was broad and widespread."

If the public option would essentially sweep up the uninsured, why wouldn't a doctor be for it? It's telling them that their former non-paying customers will become paying customers, or that they will get more paying customers.

I suppose doctors that are already at their capacity for patients might not want it, or would be indifferent to it.

I suppose doctors that are already at their capacity for patients might not want it, or would be indifferent to it.Then the number of doctors will expand to meet the demand.

Well, doctors would rather deal with a system like Medicare than dozens of insurance companies all with different rules, payment schedules and so on. And I think some doctors want to care for patients, not shuffle them through quickly due to low payments.

Then the number of doctors will expand to meet the demand.
Numbers of doctors are artificially kept managed by US med schools. Selected out by admission AND graduation.

As a model.

I run a med school.
I admit 100 students.
I graduate the top 25.
Limited to 25 slots only.
Not those who do better than 75 percent. 75 students do not become doctors.
akes no difference about the scores.
If 50 of the students do 90% or better, still only 25, the top 25, graduate.

The numbers are maintained artificially to keep the numbers of practicing doctors to manageable profitable level.

Well, doctors would rather deal with a system like Medicare than dozens of insurance companies all with different rules, payment schedules and so on. And I think some doctors want to care for patients, not shuffle them through quickly due to low payments.

ost doctors LOATH MediCare. But it does pay the boat payment.

any doctors chose working for a system like Kaiser. They just do the work. And get paid a salary.

No matter how many procedures, or what procedures they do.

I bet that if you polled doctors who did their residency at a KP hospital, but chose to work elsewhere, that most of them would still have a positive review of the system. Their most probable objection is low pay from it, compared to what they are making where ever they are now.

Numbers of doctors are artificially kept managed by US med schools.Then someone should open their own medical school that operates fairly. If what you're saying is correct, that school should have an endless supply of customers, make lots of money, be able to expand nationwide, and outcompete the schools that artificially limit the number of their own customers.

Where are they going to do their residency?

What is your immediate impression of doctors who graduate from Mexican or Caribbean med schools? Or did their residency there?

What if you were in charge of hiring a doc, such as a hospital? Would you want the one who graduated from the University of Grenada/Guadalajara or UCLA/UCSF?

Quote"Where are they going to do their residency"

I hear taking in the other 25 doctors as miltiary doctors is quite popular with the department of defense. Then, go on after their terms of service into the civilian world as pretty good doctors.

Quote"What if you were in charge of hiring a doc, such as a hospital? Would you want the one who graduated from the University of Grenada/Guadalajara or UCLA/UCSF"

I don't really care. Colleges and grades are not a practical application of skill.
I could care less about the doctor with a 4.0 Gpa, that partied their butt off the entire way, or the doctor with a 3.2 GPA that had to work their way through school.

Where are they going to do their residency?In the hospitals that are going to open up, and hire them, because they can make more money that way.What if you were in charge of hiring a doc, such as a hospital? Would you want the one who graduated from the University of Grenada/Guadalajara or UCLA/UCSF?That depends on how much money I'll be able to make.

If, as you claim, the reason doctors are overpriced is that their supply is artificially limited, I will remove that limit and have the same quality doctors, except at a lower price.

We are not talking about doctors from Mexico, or doctors educated or trained under lower standards. Just doctors that aren't subject to artificial graduation limits.

And I bet people will line up to get treated more cheaply at my hospital. Look at all the people in Southern California who take the risk of going to Mexico for procedures, just because it's cheaper. You don't think those people will go to my hospital, where they don't have the risk, but still pay less?

I think a lot of what GPs do could be done by NPs and PAs. In fact, I regularly see a NP for checkups, frankly I like her better, she spends more time with me and I feel like I can ask her anything.

I think a lot of what GPs do could be done by NPs and PAs. In fact, I regularly see a NP for checkups, frankly I like her better, she spends more time with me and I feel like I can ask her anything.

You still need a doc for NPs or PAs to work.
They can't write scrips, orders, or make medical diagnoses.

You still need a doc for NPs or PAs to work.
They can't write scrips, orders, or make medical diagnoses.
Are you sure about that? My NP has diagnosed problems (although she may have consulted someone I was unaware of) and she has definitely written me prescriptions. Do the laws governing NPs vary state to state?

Are you sure about that? My NP has diagnosed problems (although she may have consulted someone I was unaware of) and she has definitely written me prescriptions. Do the laws governing NPs vary state to state?

aybe on the state thing. Doubt it.

Check your prescription bottles, whose name is listed as the prescribing provider?

Check your prescription bottles, whose name is listed as the prescribing provider?
It has been a while but I'm pretty sure it was my NPs name. Not to say it wasn't backed by someone else at the practice but, to all appearances, she wrote the prescription.

The job of a nurse practitioner is very similar to that of physician. In fact, nurse practitioners often have working relationships with physicians. Like a physician, a nurse practitioner can perform the duties of a primary health care provider and can offer medical care to patients of all ages. In most states, a nurse practitioner is legally allowed to prescribe medications.
http://www.wisegeek.com/what-is-a-nurse-practitioner.htm

I just reread the regulations regarding NPs in California.

"The NP does not have an additional scope of practice beyond the usual RN scope and must rely on standardized procedures for authorization to perform overlapping medical functions"

An NP can 'furnish' medications under an existing Medical order, or protocol.
An NP can 'dispense' medications, except controlled, upon a physicians order.

Read the link if you want to figure out what the difference is.

http://www.rn.ca.gov/pdfs/regulations/npr-b-23.pdf

An NP, in California, still does not order medications or prescriptions. Regardless of what your wisegeek site states.

Additionally.
The nursing field is still comprised of between 92 to 96% women(depending on which stats one uses).
I find it interesting that some would be advocating giving medical duties, doctor work, to nurses. Nurses, even NPs, who make a fraction of what doctors, still predominately male, make. To reduce cost.

it is still a good idea though Fyrr. Things like stitches have been done without doctors for several 100's of years, ok, so closer to 3k or so. Closing up surgeries with nurses can be done, as well as freeing up the workload of doctors, or allowing doctors to treat more patients. Stuff like drainages, prescribing antibiotics, minor ailments like athlete's feet. Things like traumas can often be stabilized before a doctor is even involved. Whatever can be cheaper and still provide good service.

Things like stitches have been done without doctors for several 100's of years.

Who has been doing 'stitches' without doctors?

Used to be nurses couldn't wear stethoscopes and doctors got really mad when they started using them. That story always cracked me up.
Stethoscopes were also gaining in popularity in the early 20th century, but so were the exclusive province of physicians trained in their use. Nurses were not allowed to use stethoscopes until the 1960s. Even then, nurses were not allowed to call them "stethoscopes," but "nurse-o-scopes" or "assistoscopes," and the nurses' version of the device was made smaller and flimsy to avoid confusion with the "real" doctor's tool.
http://www.healthcentral.com/heart-disease/c/1435/33916/nursescopes

quote"Who has been doing 'stitches' without doctors"

It has been done for many years fyrr. Many women with seamstress skills used to do it, particularly the 1800's and below, why else would they take women near combat situtations, to care for the wounded, cook for the soldiers. Combat Medics do stitches, clamps, in the field. Vetrinarians and animal biologists do. They are quite capable of performing the same techniques on humans as humans are classified as animals. Kinda like the other way of burning the wound closed with a hot iron. Those "butterfly" stitches were used on a gash I received on my forearm with a nurse practioner at a workplace first aid room. Simple procedures like this can be done with other medical personal.

There is no commercial or professional version of 'combat medic' in the real world.

If a skilled medic were to provide 'stitches' in our country to a person other than him or herself, after discharge from the military, he or she would be imprisoned for practicing medicine without a license.

I have no idea what you are referring to with seamstresses. Nurses, nor discharged medics, may suture patients. Removal of sutures is permitted.

If by your 'butterfly' stitches, you mean a bandaid. That is under the scope of practice a nurse may perform without an order. Steri-strips perhaps?(also under nurse scope).

Only doctors may suture patients legally. Anyone else performing that would lose their professional license, face fines and imprisonment.


What you want to be true, what you think, wish, or hope is true, is not true just because you want, think, wish, or hope it is.

quote"If a skilled medic were to provide 'stitches' in our country to a person other than him or herself, after discharge from the military, he or she would be imprisoned for practicing medicine without a license"

This is true. But, it can still be done. Which is the point I am trying to express, many procedures can be done without the aid of a doctor.

Quote"I have no idea what you are referring to with seamstresses"

any threads and sewing techniques have practical applications. Many women had these professions deemed women's work while the male was working the farm, factory or whatever. This is not to say many males would fabricate clothing,tailor clothing and such, because they did. It was fairly common practice for those with that ability to in fact carry over onto injured humans. This practice is also used in many areas without doctors today, Eastern Europe, Africa, India, China, and so on.

quote"Only doctors may suture patients legally"

Human patients this is true in the united states, Biologists get away with it with mountain men. As do morticians, theirs are already dead. However, I am advocating that others can and possess the ability to do such procedures. I am saying perhaps we can license nurses as well as others to do such procedures. I am saying perhaps it might be cheaper to have a nurse stitch someone up on simple flesh wounds, closing surgeries. Prescribing antibiotics and such.

I have been sewing since I was 6.
I tie my own flies.

I can suture better than half the docs who sew 'stitches' in people for a living.

But what you are advocating is changing the nursing and medical laws, and the Nurse Practice Acts, of 50 states. Increasing the scope of practice of nurses, that encroaches on the livelihood of doctors.

Even if Obama, and the Congress, had the will to do such a thing they certainly do not have the power.




http://hshs.csi.edu/surgical_firstAssist/
http://www.rnfa.org/

Even when a surg tech or RN does suture today, which it is rare above rare, it is under strictly the license of that surgeon who allows it.

What is the point of an NP or PA-C then, if they can't really do much more than any nurse can?

I was also under the impression that their license allowed them to diagnose and prescribe, at least to some extent.

quote"I have been sewing since I was 6.
I tie my own flies.
I can suture better than half the docs who sew 'stitches' in people for a living.

But what you are advocating is changing the nursing and medical laws, and the Nurse Practice Acts, of 50 states. Increasing the scope of practice of nurses, that encroaches on the livelihood of doctors.

Even if Obama, and the Congress, had the will to do such a thing they certainly do not have the power
Even when a surg tech or RN does suture today, which it is rare above rare, it is under strictly the license of that surgeon who allows it
"

Yet, more a reason to change many laws. If you can do it better than half the doctors, I don't have a problem with it. There doesn't have to be huge changes in medical laws to set that up. I have no problem with doctors or medical staff consulting and signing off, I would encourage that practice. Would it effect your average nurse, probably not. But, it would encourage nurses to advance by obtaining such licenses that I am proposing.

Even old time pharmacists had problems with their outsourcing, back when they "cooked up" the medicine for prescriptions.

But what you are advocating is changing the nursing and medical laws, and the Nurse Practice Acts, of 50 states. Increasing the scope of practice of nurses, that encroaches on the livelihood of doctors.

There's supposedly a huge shortage of GP's, this would be a great solution. Maybe you don't need to incur a quarter of a million dollar in student loan debt to be a reasonably good at doing what most GP's do.

Yet, more a reason to change many laws. If you can do it better than half the doctors, I don't have a problem with it. There doesn't have to be huge changes in medical laws to set that up. I have no problem with doctors or medical staff consulting and signing off, I would encourage that practice. Would it effect your average nurse, probably not. But, it would encourage nurses to advance by obtaining such licenses that I am proposing.
We RNs, and to some degree RTs, do many things that MDs use to do.

When changing ventilator settings, I will always trust an experienced RT over a non-Intensivist doc to make them. As an ICU nurse we do many 'doc' things that normal docs have no idea what to do, or how much, or how often.

For example, if I were giving Michael Jackson propofol, he would most certainly still be alive.

Even old time pharmacists had problems with their outsourcing, back when they "cooked up" the medicine for prescriptions.

Yep. That is how Coke, and all other sodas were invented. By pharmacists. They would mix powders in soda water for their patients. Found that if you added sugar and flavors to it they tasted better. Voila, Coke.

In May, 1886, Coca Cola was invented by Doctor John Pemberton a pharmacist from Atlanta, Georgia. John Pemberton concocted the Coca Cola formula in a three legged brass kettle in his backyard. The name was a suggestion given by John Pemberton's bookkeeper Frank Robinson.
http://inventors.about.com/od/cstartinventions/a/coca_cola.htm

Aspirin, probably one of the first wide spread tablet form of a drug. Prototypical pharmaceutical drug.
http://en.wikipedia.org/wiki/Bayer_Aspirin


Did not come later that meds were pre measured, or in tablet form.

What is the point of an NP or PA-C then, if they can't really do much more than any nurse can?

I was also under the impression that their license allowed them to diagnose and prescribe, at least to some extent.

If I have not already written it.

A CRNA, probably the highest level of practical nursing, still needs a doctor to sign off on all meds given during an intubation or procedure.

And by the way, if you have your pick between a regular doc(even about half of ER docs) and a CRNA to do your intubation....Choose the CRNA.

Every time over a regular doc. I have participated in some really bad intubations with regular docs.