Importing Doctors
NPR is now trying to make the point that doctors from other countries do basically what we do, so why not import more of them into the US? Check out the article here. Wow, can we be marginalized any more? First it is midlevels and now it is foreign docs. Why do some people keep trying to get rid of us? For this NPR writer, our job, as doctors, is very simple. “First, do no harm. Second, take a look at this weird bump and tell me if I should get worried. The job is basically the same in many countries around the world.” He figures that since we import other products to save money, let’s important doctors too. In other words, we are just a “product” now. His big beef is that there are too many regulations stopping this process. And here is my favorite part. They use the good old “rural area” routine . You know that one. In this case, the author uses it to insinuate that these new foreign docs would clamor over each other to work in North Dakota or rural Alabama.
And the benefit, he argues, isn’t just for foreign doctors, or rural areas where they might work.
This same excuse is being used, and always has been, by LELTs to get them to go to the rural areas. Funny thing, it is just that….an excuse. It never works. They always come back to live in the better areas. It’s an age old distraction technique to get others to open the door for them and give them more power. And now the same idiots want to do the same thing for foreign docs. Can’t we just find a way to incentivize medical students to go into primary care? Close the pay gap with specialists. It’s that simple.
Don’t want to sound ethnocentric, but the first time an employer told me what tests to order and how often because of profit, I looked around and all my coworkers had accents. Since then I have noticed getting an MD to get a Visa seems to correlate with a lack of interest in using taxpayer dollars fairly. US trained docs are no saints, but at least until a few years ago we were people who had other choices and choose medicine with some sense of idealism. I never prejudge without allowing a person to prove me wrong, but when a Chinese doc asked me with my credentials why I was working in a rural area I had a really hard time explaining how rural areas are places where real family practice can be done, and then I remembered he really thought of himself as a cardiologist stuck doing primary care, and probably also stuck in the country. I somehow doubt he spends much time worrying about how his orders affect the American taxpayer either, and would probably love to do what the “cardiologist” down the road was doing- just like my previous employer – echos q 6 months on stable patients. This was a “doctor shortage area”, where plenty of FMG’s and NP’s treated colds with antibiotics and any reported q 3 week acute pain with Vicodin, but no one was doing the complex multiple chronic disease coordination. So in light of the first comment here I’d also like to add- we don’t need primary care to pay better, we need complex visits to pay better and better ways (?pay by the minute, or the number of conditions something is done about) to keep people from claiming simple visits are complex.
Sorry, Nothing is going to change in this country until patients are held accountable to their bad habits. 25 years ago when I started, I implored people to change their ways. They didn’t do it, I did my best to take care of them even with their self inflicted complications. Take for instance diabetes. Used to be a death sentence. Now people think you take a pill or a shot and you’ll be fine. Can even keep eating shit and take more insulin.
With the elderly, there are not enough assisted living joints or nursing home to deal with the population now. They have trouble with keeping track of their meds even with written instructions with 40 point type from me. Again one has to take the philosophy of “Doing the best you can with what you got” attitude to survive insanity.
Hell, no provider wants to pay for diabetic instruction. I can’t do miracles in 15 minutes. They don’t want medical care they want magic.
Primary care physician = Nursemaid who gets to take the blame for
lousy outcomes due to individual noncompliance.
EMR = Device that generates more volumes of uncompensateable paperwork.
Where I’m at, a physician has to “supervise” a nurse practitioner.
This means the physician has to “piss” on everything they do.
I say let them operate without MD supervision and they will realize they are getting paid shit to do MD work and will stop going into
FNP and gravitate more towards specialty nurse practitioner work.
(I wouldn’t blame them.)
I get paid less than a congressman yet the only thing they need to
worry about is getting re-elected. Primary care docs have to worry
about getting their asses sued off and losing everything they have.
Rats! I guess that means bacon is off limits, too….
ugh,, correction.. We either HANG together or we all HANG separately..
Doug,
Love your posts. But have to take exception with your “cure” for keeping or increasing Docs in Primary care. As a surgeon, with two board certifications and 9 years of post med school training, I don’t think the answer is to set doctors on doctors, ie specialists vs generalist. Then, “divided” we can easily be “conquered” Specialists have been getting hammered by the decreases in medicare, medicaid and commercial insurance just as much as the PCPs.. And, I can’t hire another person, like a PA, to do more surgeries, so I’m limited.. I watched as one primary care doc after another served on my surgical service as residents, and then left to open practice, while I had to continue multiple years of residency, starving. They made their choice, just like I made mine.. ALL specialities have taken a hit, and all specialties need to be paid better. Otherwise, this year it’s me who closes, next year it will be you. I don’t want to hear about “cognitive” medicine vs “procedural”
medicine. The top ten people in my med school class went into surgical disciplines, so that doesn’t fly. If we weren’t ALL bright,we wouldn’t (presumably) been in medical school We either hand together, or we will definitely hand separately…
You make some great points but for a dermatologist to get paid 3x a family doc is insane. And there are plenty of other examples of ridiculous disparities. Hey, a neurosurgeon should make more than me. That’s a given. An anesthesiologist making three times more than me with 12 weeks vacation? C’mon. When I came out of med school, Brigham and Woman’s couldn’t even fill their anesthesiology spots. They were taking anyone. So they weren’t just taking the top ten in med school classes…at least then. But I do agree with your point of hanging together. Too bad we have no one solid organization to do that.
When you use the term “better areas” alluding to metropolitan areas, those of us that live and practice in rural areas ought to be offended,but since we know we actually do live in “better areas”, we are not.
I have worked in rural Maine for 18 years. It’s all perception but you understand my point.
Exactly, and I think you have already commented on the disproportionate percentage of “LELT’s” that live in urban area.
I predicted this when Obamacare was first conceived. The imported docs will be 95% muslim.
“The imported docs will be 95% muslim.”
…and?
That means hospitals will start banning pork BBQ. Dammit!!
I didnt realize that medical qualifications were based on religion?
Or is your point that Obama is a muslim? And if he was – so what?
Or he wasnt born in america?
Pathetic comment.
Yup