One example of what's wrong with America

[Eos]

Originally posted by: moshquerade
Are you looking for or considering another job? You do know that rural areas would LOVE any family practitioners they can get their hands on, and you would be paid a lot better than you are now. Plus there are incentives to come here.

Why do you stay in the situation you are in when you obviously are being used poorly?

NHSC.

 

[Fingolfin269]

Originally posted by: colossus

Originally posted by: Cattlegod
Can you lower your rates? You may have a better chance of collecting if it isn't so expensive.

I guess I could. Haven't mentioned it to my biller. But it does say on the bill that partial payments would be accepted if patients truly have inability to pay. The one guy who did pay (the guy with the seizure who had $) only paid $250 of a $1100 charge. And he went on a cruise.

God this ticks me off (along with your other Vegas patient). People feel so entitled when it comes to being treated and a lot of them don't even give a second thought to worrying about whether the doc is paid when they're sipping margaritas on the deck of a cruise ship or reading a magazine while having their hair prettied up at the salon.

 

[IEC]

I can only hope I'm not in as bad a situation after I attend law school...

 

[0roo0roo]

http://www.cbsnews.com/stories...utes/main3889496.shtml

 

[Xavier434]

As much as it makes sense to blame the people since they are the ones making the choice to go in and not pay you, it's pretty useless doing so. Without getting into a gargantuan discussion about health care and how to solve it, let me just say that the loopholes in the system need to be fixed properly.

I do feel bad for you. However, try your best to maintain an open mind and treat all of your patients equally and with care. I realize that being a doctor is a profession, but it is also a responsibility that you should be very proud of.

As for that woman specifically, she sounds like a douche, but who knows? She might just end up paying.

Lastly, I agree with other posters that a large part of your problem is the location where you are choosing to practice. You are working in a hospital in a town that is full of illegal immigrants. I doubt that there are many other places in the US which are worse when it comes to patients like this than where you are now. Also, I live in South Florida so I am used to seeing this kind of thing a lot.

 

[fisheerman]

This is the exact way to fix the uninsured issue. Give people/companies huge tax deductions for sponsoring events such as this as well as incentives for doctors/nurses to volunteer and you would probably be able to provide, at least the basics to the majority of uninsured americans.


government run health care isn't the answer.

-fish

 

[911paramedic]

Originally posted by: Kntx
So does the girl have appendicities?

Is that a cross between appendicitis and ascites? 😉

 

[Stiganator]

Rural Minnesota would treat you well. I know for a fact there isn't a doctor at the hospital that makes less than 130,000 and a big house would cost 80,000, so 130,000 is a lot. I think I've even heard (unconfirmed) that some of the docs have their malpractice covered by the hospital.

Nurse 60-100k
Administration 60-120k
Nurse Anesthetist 90-120K
Anesthetist 150-260k
Family Practice 130-160k
Surgeons 175-280k

 

[Uppsala9496]

Originally posted by: Stiganator
Rural Minnesota would treat you well. I know for a fact there isn't a doctor at the hospital that makes less than 130,000 and a big house would cost 80,000, so 130,000 is a lot. I think I've even heard (unconfirmed) that some of the docs have their malpractice covered by the hospital.

Nurse 60-100k
Administration 60-120k
Nurse Anesthetist 90-120K
Anesthetist 150-260k
Family Practice 130-160k
Surgeons 175-280k

Malpractice is cheap in MN. Med Mal is the most expensive in southern CA and FL. Any other location will be cheaper.

 

[Stiganator]

Originally posted by: fisheerman
This is the exact way to fix the uninsured issue. Give people/companies huge tax deductions for sponsoring events such as this as well as incentives for doctors/nurses to volunteer and you would probably be able to provide, at least the basics to the majority of uninsured americans.


government run health care isn't the answer.

-fish

Setting up mobile triage is not the answer IMO. I think availability of free BASIC healthcare is a good idea. If you want some optional surgery then go to a private clinic.

Additionally, the medical system could allow more doctors into the market. I know plenty of capable and deserving students who have been denied medical school admission while dbags with rich dads who are doctors have gotten in. Let the market decide how many doctors we need. More doctors -->cheaper medical school --> cheaper healthcare.

In countries with universal healthcare, they are booked quite frequently. You could also look at it as a stepping stone. New MDs can work in the universal healthcare centers to get experience and then start their own practices if they are skilled or specialized enough.

 

[Slew Foot]

Yeah move out of the ghetto, screw those losers. They dont give a damn about you, I wouldnt give a damn about them.

We're hiring hospitalists for 180K yr in Sacramento, less for primary care, but thats great pay for CA.

 

[rpanic]

Parents and I were born at that hospital and it?s also where two of my grandparents died. I moved away from that area long ago its way to ghetto now you also have the same problem if you get into a car accident in that area with people who have no insurance. It?s pretty much the Mexican Beverly Hills compared to the surrounding areas. Its very sad I use to like that hospital.

You need to go elsewhere I think your luck would be a lot better.

 

[JS80]

Damn when I went to the emergency room this year the hospital basically ran a background check, took my Social, Driver's license, insurance card before they treated me. This is probably because I spoke English and looked like a professional.

It's funny you say this is what's wrong with America - but it's exactly what's right with it - we treat everyone and anyone no matter if we go bankrupt because of it. In Mexico the hospital would kick your ass out and you bleed on the street if you didn't pay up front for medical services.

 

[imported_Baloo]

When you only make $1200 a month before taxes, $380 dollars a month is a lot to pay for insurance.


I agree, national health is overdue.

 

[Auryg]

Originally posted by: Uppsala9496

Originally posted by: Stiganator
Rural Minnesota would treat you well. I know for a fact there isn't a doctor at the hospital that makes less than 130,000 and a big house would cost 80,000, so 130,000 is a lot. I think I've even heard (unconfirmed) that some of the docs have their malpractice covered by the hospital.

Nurse 60-100k
Administration 60-120k
Nurse Anesthetist 90-120K
Anesthetist 150-260k
Family Practice 130-160k
Surgeons 175-280k

Malpractice is cheap in MN. Med Mal is the most expensive in southern CA and FL. Any other location will be cheaper.

Just stay away from Willmar or you'll have the same problems.

Another plus is MN has some of the best hospitals around.

 

[Slew Foot]

Originally posted by: Baloo
When you only make $1200 a month before taxes, $380 dollars a month is a lot to pay for insurance.


I agree, national health is overdue.

Its not the system that's the problem, its the douchebags that think paying 250 of a 1100 bill is OK, or not paying anything at all is OK. I say send em all to collections.

OP, you made your biggest mistake when you signed at up at a ghetto hospital without a pay guarantee. I work at a county hospital in Sac so I see my fair share of medicare/cal/illegals/uninsured, but the hospital guarantees my salary so if the illegal immigrants dont pay, the taxpayers pick up the balance.

 

[Analog]

Originally posted by: colossus
So anybody who comes into the ER and needs to be admitted and doesn't have an insurance plan that has a specified doctor I end up admitting. If they have no insurance I end up admitting. I do this in the hopes of finding patients who like me and end up switching to me as their doc.

Your problem seems to be your own making.


My family practitioner has turned away new patients for years. We signed up with her back in 1988 when she was finishing her residence. You've got to get out of that specific situation with dealing with non-insured patients. What do you expect?????? 😕

You need to find an older family practitioner that may want to retire in the next few years. Partner with that doctor, then end up taking over the practice. Or find a different hospital situation.

Here in the midwest, we are chomping at the bit for family practitioners. You could practically print your own money at it, so I'm not sure where you're coming from in your situation. I feel that you have this entirely in your own hands, you just need to decide to change.

 

[colossus]

Don't have much time to reply to everything. Interesting discussion so far. Seems like a lot of anger in here - as there should be.

Prevailing sentiment is I should move out of the ghetto. If you look at the Downey's history you'll see it's anything but ghetto. Suburbia yes, ghetto no. Rockwell had it's huge plant there that maintained the Space Shuttles until it got move to Palmdale/Lawndale. Coca Cola has a plant there. North Downey has ridiculously large home (multimillion).

I did my training at this hospital so that's why I choose to practice there. When I entered as a medical student there were always good patients. Hell, I would work without complaint if ½ my patients off ER call had insurance. The total from last night is 8 admits, 1 insured and 7 without. So I'm making $120 before taxes on about 8 hours of work. Fortunately there's a nephrologist that's letting me do the IM for him and he has good Medi/Medi patients. Haha - that's funny. 20 years ago no physician would touch Medi/Medi cause they reimbursed horribly. Now they're gold mines here in CA.

My parent's house (where I live) is 8 miles away in Cerritos, CA. Cerritos is pretty well to do, I would say the top 15% if not 10% of national incomes (of course everybody in CA is in the top ½ usually). 8 miles from Downey in the other direction is what you would call the ghetto - Compton, North Long Beach, Bell, Lynwood, Watts. I volunteered at MLK when I was in high school during a summer. Learned a lot but did get scared shitless a few times.

With the hospital closing (MLK) the 11 hospitals in the area are now impacted. Even Kasier was forced by our Nazi state/county to take some of the MLK flow. A private company forced to handle uninsured patients by our government. That's what nationalized health care would be.

The problem is everybody who has good insurance in enrolled in HMOs. I refuse to deal with that BS. I either want cash/Medi-Medi/PPO in my outpatient office. People are stuck with their busy docs who are quagmired under HMO BS and they don't know I exist. I guess you could call me boutique medicine w/o the crazy rates. I'll see patients in office for an hour and would be happy with $60 cash (I say to hell with the government, they're not seeing this money - afterall they're not paying me their MediCal bill). What plumber do you know will work for $60/hr.

There honestly is no place to move. Downey had nice patients coming the hospital. When the bad MLK patients came in, the Downey patients went to another hospital which is closed to outside physicians. The money trail moved away kind of like animals migrating. After all, why would you pay for insurance and sit in an ER and get behind sicker people who aren't paying anything. Hello, fee for service people. You pay insurance - you get your treatment. None of this triage bullshit.

Unfortunately my wife to be is Tiawanese and I'm Indian. I want to be close to home to take care of my parents and in SoCal - well I just love being here - as does everybody else. I'm willing to pay $600K for a house that's $60K in the rest of the country. I'm not willing to work for free and not be able to afford the house though. Since my wife will make more than enough money I'll be OK.

I'm upset at the fact I'm willing to go out on a limb and help people and be an awesome doc. I give all my patients (all 5 of them my pager #). 3AM they have questions they talk to me - not some answering service. True I don't want to get busy. But with just 200 patients I could get by easily. With everybody in the country enrolled in a crappy HMO plan, I can't find any unattached patients.

And the rest of the country will only become like it is becoming here in SoCal. I don't want to blame a certain race or group for it. The nephrologist I work for is hispanic and I'm fluent in Spanish. I speak Spanish with 90% of the people I see - that's just the reality here in SoCal. That's fine - Downey has a lot of rich Spanish speaking patients. Problem is the ones from south of the border who choose not to pay for whatever reason. Yes they do make up fake address and SSN in the ER so there's no way they'll get billed. Of the 8 I'm seeing from last night, 3 are from Mexico and 1 is from El Salvador. The rest are locals. Unless you run to Beverly Hills you can't escape the wave of ininsured.

What really irks me are the locals who choose not to pay insurance. Obviously illegals shouldn't be signing up with Blue Cross - um, they're not supposed to be here - that's another issue I won't debate. This 23 year old twit (I've yet to see) is a local turnip.

If I want $, I can sell my sole and just go into vanity medicine and do Botox. Sadly, I can't see myself doing that. I turned away from engineering because it paid badly in the 80s when I dad did it out here in CA. Now it pays pretty well to be a nerd. If I feel like using my brain I'll probably go work for GE medical or assist with EMR programming. If I feel real angry I'll probably sell my soul and sell real estate or BMWs. Shit, if I convine a witness to get a blood transfusion I sure as hell can sell a 3 series to some 23 year old going to Vegas. The hell with morals - I'll have kids and a wife to feed.

Yes, I'm stubborn in choosing not to move. But the LA Basin has about 20 million people. As the primary docs get more and more fed up they'll quit and no young docs like me will choose FP. Everybody will go to the ER for care and ERs will shut down. Just look at how many trauma centers there are in LA compared to 20 years ago. The Healthcare system will collapse. States will mandate hospitals to keep their ERs open at the risk of losing their license (As mentioned above) but sooner or later the burden will fall.

If we have a socialized health care system it would help in that the useless sacks of shit who don't pay for anything would be paying. Problem I see is that nobody would use it (As mentioned above) and the goverment would not actually pay the physicians and providers. How many times has the goverment put in a tax for one thing and stolen the funds for something else. You pay taxes for Social Services that are supposed to fund things like MediCal/Medicaid but the government doesn't pay the physician. I have been paid by MediCal in over 1.5 years. They even issued a memo from the state saying the hospitals won't be paid unless money is found in CA messed up budget.

I honestly don't have a full solution to this problem or I would have written a dissertation. I think it would take a team of people including MPH/physicians/nurses/hospital administrators to actually write a plan. Problem is Congress is too busy rooting for John and Barrack to get any work done. If I had some ricin I know where I would put it :evil:

 

[Pastore]

Originally posted by: Stiganator

Originally posted by: fisheerman
This is the exact way to fix the uninsured issue. Give people/companies huge tax deductions for sponsoring events such as this as well as incentives for doctors/nurses to volunteer and you would probably be able to provide, at least the basics to the majority of uninsured americans.


government run health care isn't the answer.

-fish

Setting up mobile triage is not the answer IMO. I think availability of free BASIC healthcare is a good idea. If you want some optional surgery then go to a private clinic.

Additionally, the medical system could allow more doctors into the market. I know plenty of capable and deserving students who have been denied medical school admission while dbags with rich dads who are doctors have gotten in. Let the market decide how many doctors we need. More doctors -->cheaper medical school --> cheaper healthcare.

--> Lower doctor wages --> Lower quality of service

In countries with universal healthcare, they are booked quite frequently. You could also look at it as a stepping stone. New MDs can work in the universal healthcare centers to get experience and then start their own practices if they are skilled or specialized enough.

 

[waffleironhead]

Originally posted by: colossus


Now when I was 23 I had insurance under my dad. Sure he paid for it, but I owed him in the form of chores around the house (I'm 32 and still live at home until I get married in 3 weeks - sad, I know). I have yet to see a patient under 25 who I have admitted who had insurance. I guess it's not cool to have insurance - must put a damper on the sex life or something. Maybe it cuts into the number of beers you can buy.

There you go, you had insurance because of your father. I am 30 now and have not had insurance since I moved out at 18. Why? Either it was not offered by my employers or my expected share was so high it would cut my pay by 25% or more. I cant afford it. If i can barely make ends meet with my current salary, the is no way that I can live after paying my share of the insurance costs.
This country is headed in the wrong direction but is it fair to blame the uninsured?

 

[Stiganator]

I don't know about that, presumably doctors become doctors because they want to help people. In the US, it gets more complicated because of malpractice, but still. Its not really a situation where you can do poorly unless you're pure evil. I mean say you're a surgeon, a guys chest is open on the table in front of you. Would you think, man if I were making $40 more an hour, I'd make sure this guy made it, but as it stands I'm just gonna say I did all I could??

 

[colossus]

Originally posted by: waffleironhead

Originally posted by: colossus


Now when I was 23 I had insurance under my dad. Sure he paid for it, but I owed him in the form of chores around the house (I'm 32 and still live at home until I get married in 3 weeks - sad, I know). I have yet to see a patient under 25 who I have admitted who had insurance. I guess it's not cool to have insurance - must put a damper on the sex life or something. Maybe it cuts into the number of beers you can buy.

There you go, you had insurance because of your father. I am 30 now and have not had insurance since I moved out at 18. Why? Either it was not offered by my employers or my expected share was so high it would cut my pay by 25% or more. I cant afford it. If i can barely make ends meet with my current salary, the is no way that I can live after paying my share of the insurance costs.
This country is headed in the wrong direction but is it fair to blame the uninsured?

I wasn't insured at 23 because I was in medical school (which is like working 2-3 jobs). If I could have supported myself I would have (I had perfect attendance from K-12 - not even a tardy - I'm a snooty poster child). If everybody who could afford insurance did pay for it then the costs would be much lower since those who pay (my entire family) subsidize those who don't.

Now, the question then becomes how to lower the cost. Well - there a lot fo good solutions Congress would need to do since it's a nationally regulated industry just like airlines. I want to see an national standard EMR passed. I think that would cut down a lot of redundancy testing (some people get 12+ head CTs in a year because of bad headaches - that would have paid for 5 people to see a neurologist every month for a year). There's a lot of fraud in the system. MLK was leeching $8k per day from MediCal and letting people die on the floor in the ER (everybody heard about this national story). Downey can keep people alive if not healing them for $2-3k because the hospital isn't filled with crooks. Yes there are crooked physicians. I work side by side with them and have already reported 3 to CMS (yeah, I'm an ass and I'm getting on people bad sides - what are they going to do - put a hit on me).

If you can afford to have a car in CA you can easily afford to have basic health insurance (I'm talking high deductible of say $5k). Nobody chooses this - instead they shell $400 to see the Lakers or spend $110 every 2 months on their hair.:disgust:

 

[Chiropteran]

Non-paying patients should be used as organ doners.

 

[ShinmenTakezo]

Have you considered working in the VA system? I'm a medical student and I've done a few of my rotations at the local VA hospital. While the doctors who work there complain about how inefficient and backwards the system can be, they also say that it has it's advantages. As I understand, the physicians are paid a predetermined salary for the year, regardless of how many patients they see, and are guaranteed to get paid. Although the pay isn't as high as it could be for a private practice physician, it's competitive enough that it might be worth taking a hit in pay to avoid dealing with insurance companies. Also, since you're not scrambling to see as many patients as possible to keep your earnings up, you can afford to spend more time with patients, increasing quality of care.

 

[DrPizza]

Originally posted by: eits

Originally posted by: moshquerade
Are you looking for or considering another job? You do know that rural areas would LOVE any family practitioners they can get their hands on, and you would be paid a lot better than you are now. Plus there are incentives to come here.

Why do you stay in the situation you are in when you obviously are being used poorly?

this.

Agreed. Get out of the inner city.