Concierge Doctors

[fireflymedic]

No, but does it not still have a trickle down effect to us as well with poor pay overall (and yes I know here we go jumping into the education debate). But bottom line, the poor counties are going to pay less than the rich counties. Go work where the half million dollar houses are and you're going to get paid decently with the newest trucks and the best equipment with good pay and a nice station. Go work in rural BFE where people live in shacks in hollers and you'll be lucky to get a truck that starts and equipment that works sometimes and even a paid staff on a station that doubles as a mechanics garage that floods when it rains (been there that's why I picked that). That's just how it goes - people can't pay with what they don't have, and poor people don't have much. You take two docs, both of which have spent an ungodly amount of money putting themselves through school. One chooses to work rural poor area, the other in an upper class city. Doc number 1 sees double the patients of doc number 2 but guess who is going to pay off his loans faster? Prolly doc number 2 'cause his patients are going to pay. Is another reason for the mass exodus out of general practice like family/internal/pediatric medicine. It just doesn't pay and at the end of the day, you have to pay the bills.

On another note, there was an entire show - Royal Pains on USA - that is based on conceirge doctors as that's what this failed ER ended up as because he chose to save the life of an inner city kid over a big whig with the hospital.

Edited November 25, 2009 by fireflymedic

[WolfmanHarris]

No, but does it not still have a trickle down effect to us as well with poor pay overall (and yes I know here we go jumping into the education debate). But bottom line, the poor counties are going to pay less than the rich counties. Go work where the half million dollar houses are and you're going to get paid decently with the newest trucks and the best equipment with good pay and a nice station. Go work in rural BFE where people live in shacks in hollers and you'll be lucky to get a truck that starts and equipment that works sometimes and even a paid staff on a station that doubles as a mechanics garage that floods when it rains (been there that's why I picked that).

Odd... here the province provides 50% funding w/ the muncipalities providing the balance. Generally speaking trucks and stations are comparable service to service and pay varies, but are in the same ball park province wide. Equipment and vehicle standards are set by the province and trucks must be retired at a standard mileage (can't recall the exact number but where I work it results in no front line truck older then 2006; busy suburban service). Sure the rich suburban service where I work has newer bases and trucks then the rural service in the area I live, but the one service is also far busier and in a growing area and even the service where I live replaced their HQ only 5 years previous to meet increased demand and is building a new base in the N end to ensure coverage.

While rural areas generally have smaller, less equipped hospitals, thanks to an integrated and fully provincially funded critical care transfer system, high acuity patients are transferred to regional facilities with top care as required, including into the United States if a closer bed isn't available immediately.

I don't expect to convince anyone here to suddenly become a pinko pseudo commie like those of us in Canukistan, Oz, Europe or the UK. The attitude we take towards government and it's involvement (or not) in our lives is very much a product of our national cultures and our individual upbringing and political slant. However, let's not forget that things are done very differently in other parts of the world and there's much to be learned from both sides.

I for one would love to see the USA provide full coverage to their citizenry and landed immigrants regardless of income. I'd also like to see our individual hospital and health regions adopt some of the management techniques of some of the best performing system in the states to increase efficiency. See we can see eye to eye on individual issues. Now don't y'all have the warm and fuzzies?

[Lone Star]

There is nothing elitist about this, it is just the free market working, and it has been around for years. Following you guy's logic, there would be no need for any vehicle with more standards than a Ford Focus. If you can and are willing to pay for a BMW, Lexus, or Mercedes does that make you elitist because some people can't ? If you do not eat Ramen noodles at least twice per week, are you elitist ? If you can afford a good steak restaurant instead of Krystals are you elitist ? How many times have you been really sick, and called your Doctor to find out that they were booked solid ? How many of your Doctors will call you in a script without seeing you, or doing a bunch of expensive labs you dont need ? And this is great for the Doctors because they dont have to see 40 patients a day just to keep the lights on (because insurance reimbursement sucks).

If it's not elitist, then why are people having to find other doctors because they can't afford the $1,600.00 'maintenance fees'? Why are patients that can't pay those extra fees suddenly being seen by Nurse Practitioners and Physicians Assistants instead of the Doctor they USED to be able to see?

If it's not elitist, then why are those that CAN pay suddenly being offered better service than those that can't?

If it WEREN'T elitist, then everyone would be treated the same, have access to all the same 'perks' and services.

[HERBIE1]

If it's not elitist, then why are people having to find other doctors because they can't afford the $1,600.00 'maintenance fees'? Why are patients that can't pay those extra fees suddenly being seen by Nurse Practitioners and Physicians Assistants instead of the Doctor they USED to be able to see?

If it's not elitist, then why are those that CAN pay suddenly being offered better service than those that can't?

If it WEREN'T elitist, then everyone would be treated the same, have access to all the same 'perks' and services.

For the vast majority of illnesses and problems, a PA or NP is more than adequate for their needs.

Does someone need a Harvard educated doctor to swab their throat and give them antibiotics for their strep?

What about treating someone for a yeast infection? Does that need a world famous OB/GYN specialist?

We know when a patient presents with a problem beyond our capabilities to handle, and so do NP's and PA's.

How many times have you had a well to do patient who has a lac to their arm and demands to see a plastic surgeon to sew up their injury because they feel an ER doc cannot do the job to their satisfaction? This is a matter of perception, and most people have no idea how easy or difficult their problems are to handle.

[HellsBells]

There is nothing elitist about this, it is just the free market working, and it has been around for years. Following you guy's logic, there would be no need for any vehicle with more standards than a Ford Focus. If you can and are willing to pay for a BMW, Lexus, or Mercedes does that make you elitist because some people can't ? If you do not eat Ramen noodles at least twice per week, are you elitist ? If you can afford a good steak restaurant instead of Krystals are you elitist ? How many times have you been really sick, and called your Doctor to find out that they were booked solid ? How many of your Doctors will call you in a script without seeing you, or doing a bunch of expensive labs you dont need ? And this is great for the Doctors because they dont have to see 40 patients a day just to keep the lights on (because insurance reimbursement sucks).

This is a ridiculous argument, and I think you know it. There is a difference between getting good health care and having luxuries in life. Health care is not a luxury, its a basic human right. If you're driving a Ford Focus you still get decent safety features, and have reliable transportation. Eating Ramen Noodles may not be the healthy choice, but it is still possible to eat decent food on a budget without going out to restaurants multiple times a week.

However, if it costs extra to see a good doc and receive competent, timely care that the poor don't have access too, then we are talking about a different matter altogether. To answer your question, yes that is elitist. Oh, and by the way, you know those people who can afford the Lexus and that go out to eat the fancy dinners? They are elistist too. The difference is, buying an expensive car doesn't affect the quality of the Ford Focus.

[HERBIE1]

This is a ridiculous argument, and I think you know it. There is a difference between getting good health care and having luxuries in life. Health care is not a luxury, its a basic human right. If you're driving a Ford Focus you still get decent safety features, and have reliable transportation. Eating Ramen Noodles may not be the healthy choice, but it is still possible to eat decent food on a budget without going out to restaurants multiple times a week.

However, if it costs extra to see a good doc and receive competent, timely care that the poor don't have access too, then we are talking about a different matter altogether. To answer your question, yes that is elitist. Oh, and by the way, you know those people who can afford the Lexus and that go out to eat the fancy dinners? They are elistist too. The difference is, buying an expensive car doesn't affect the quality of the Ford Focus.

Does the fact that you are paying a "retainer" for your MD mean you will be getting better care? No, it simply means your doctor will be always available and you can call him/her in the middle of the night for an ear ache, you will not wait weeks for a visit, or he will always be the one visiting you in the ER and the hospital if you are admitted.

Look, this is no different than some well heeled person who donates millions to a hospital or is a celebrity who gets the royal treatment when admitted to a hospital. Many places do have special wings where they have top of the line rooms, silver water pitchers instead of plastic, special menus, nice furniture, art work, and nearly one on one treatment from nurses and aids. They get the VIP room, they see nothing but attendings (no students or residents). One hospital I deal with calls them their gold card patients. They actually have a special card that designates their priority status- quicker admissions, no wait in an ER, etc. Is this wrong- maybe, but like I said, there is always 2 sets of rules. Health care reform will NOT change this.

Bottom line- do these VIP's get better medical care? No, but they THINK they do, they pay for that perceived advantage, and that's what matters to them.

[CBEMT]

It is an odd and almost uniquely American idea that healthcare is not an essential service and that it should not be provided or at least regulated by the government. You (the collective you) continue to confuse me.

Our attitudes on what the federal government should or should not have control over stems from how and why our country was founded. I suggest some research.

"A government beig enough to give you everything you need is strong enough to take everything you have."

Edited November 25, 2009 by CBEMT

[HERBIE1]

Our attitudes on what the federal government should or should not have control over stems from how and why our country was founded. I suggest some research.

"A government big enough to give you everything you need is strong enough to take everything you have."

I like that quote, but I learned something today. I always thought it was from Thomas Jefferson, but was actually from Gerald Ford, of all people, back in the 70's. Still totally accurate.

Here's something Jefferson actually said, and is also appropriate in this context:

"The natural progress of things is for liberty to yield,^[1] and government to gain ground." - Thomas Jefferson to Edward Carrington, Paris, 27 May 1788^[2]

So, does that mean that our current march towards socialism is inevitable? I certainly hope not.

Edited November 25, 2009 by HERBIE1

[HellsBells]

Does the fact that you are paying a "retainer" for your MD mean you will be getting better care? ...you will not wait weeks for a visit, or he will always be the one visiting you in the ER and the hospital if you are admitted.

YES, that is an example of better care. Not waiting endless hours to see a doc, is better care than waiting hours to see a doc.

[CBEMT]

Oh, and I almost forgot- the 10th Amendment. Seems like it's been pretty well ignored in all this.

Edited November 26, 2009 by CBEMT