tag:blogger.com,1999:blog-20056539.post2086334253182396168..comments2017-01-21T06:19:17.045-08:00Comments on Movin' Meat: Accountabilityshadowfaxhttp://www.blogger.com/profile/11648279307230813762noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-20056539.post-10518727916288045012015-03-10T22:32:35.242-07:002015-03-10T22:32:35.242-07:00Interesting and informative post! You&#39;ve put r...Interesting and informative post! You&#39;ve put really a lot of effort into all this. Thank you for that and keep on doing this fantastic job!!! <a href="http://www.vitalsmartsindia.com/crucial-accountability" rel="nofollow">Accountability</a> Training programsAnonymoushttps://www.blogger.com/profile/09479787954832440077noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-42211824509706597342009-06-23T13:33:47.127-07:002009-06-23T13:33:47.127-07:00i posted the below comment on Ian&#39;s blog but t...i posted the below comment on Ian&#39;s blog but thought it would also fit here. i agree that doctors&#39; compensation must be a major part of the reform. the us medical education is probably the most expensive one in the world and the debt acquired after leaving the training is tantamount. this problem somehow should go away if we want great people to be drawn to medicine. however, i hope the financial compensation is not the primary reason for anyone committing to this eminent profession.<br /><br /><br />&quot;yeah, eternal ethical dilemma: fix an expensive disease regardless of its cost to the society or consider the impact to the society at large but let a valuable member of the society pass.<br /><br />this quandary has been keeping medical ethicists busy for ages. i believe the best solution is to let the society decide for themselves. for example the canadians voted for their kind of health care system referendum after referendum regardless of the consequences - such as waiting for treatment of elective problems, not having the option to use the most advanced technology lavishly hence letting their aging or 20 week newborn family member go. in some others, the well-to-do members of the society can enjoy the most advanced medical interventions while others have to settle with sub-standard services.<br /><br />yes, we have the best medicine that money can buy but at what cost? when and what is enough? is the health care system our greatest national priority so we can continue jacking up the cost to our detriment?<br /><br />everything has an opportunity cost. when we let the health care spending continue at its current expansion, we have to give up some other priorities, which might be the investments for technological advancement that made us the world leader (which currently keeps slipping from our reach).<br /><br />hard choices, not enough time and mental stamina to sort it all out...&quot;Ayse Tezcanhttps://www.blogger.com/profile/03514291953426076855noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-59387050619246067652009-06-22T21:18:29.413-07:002009-06-22T21:18:29.413-07:00I am not sure how effectively decreasing the numbe...I am not sure how effectively decreasing the number of procedural specialists and increasing primary care would hold down cost, unless as a by-product of that event, access to care was limited by fiat. The cost of a product is usually determined the cost of production and delivery as well as demand. As an example, producing, delivering and implanting a knee joint replacement is a very expensive process, from the cost of R&amp;D and skilled manufacturing, to the hospital OR where high tech equipment, anesthesia and drugs are used, to the post-op recovery unit and rehab unit, to the operating surgeon&#39;s (the installer&#39;s) fee, the surgical nurses and medical consultants, physical therapy and rehab devices such as crutches and walkers. Of all of these costs, the surgeons fee is a small but crucial fraction. Without the surgeon taking risk, paying high malpractice and working, there is no joint replacement. Without arbitrarily limiting access, I don&#39;t see that any decrease in patient demand for such a proven, life changing procedure is going to happen. How is simply decreasing the joint replacement surgeons fees and increasing the primary care doctors fees going to decrease societal demand for knee replacements, a high tech and expensive procedure?Scotthttps://www.blogger.com/profile/06632573096467696895noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-21555521897288909372009-06-22T19:50:16.346-07:002009-06-22T19:50:16.346-07:00I appreciate your clarifications and elaborations,...I appreciate your clarifications and elaborations, many of which directly concern my earlier comments on the NYT site and here on your blog. <br /><br />Of course I don&#39;t agree with every (or even most!) of the counter-arguments you&#39;re making, but I feel as if I&#39;ve said my piece, and any further discussion would be counter-productive. Plus, I&#39;ve taken some time to read your blog and the other things you&#39;ve written, and frankly you seem like a really great guy and now I feel bad about being somewhat hostile in my comments. So, sorry about that. I just feel very strongly that many of the problems highlighted in Gawande&#39;s article stem from physicians trying to eke out a better living in a climate of constricting reimbursements--that, basically, reduced physician pay has created this atmosphere of overspending. Further, I believe that physicians are about to get completely and totally screwed in this health care reform business, and the last thing we need is for anyone--particularly anyone in the medical community, which for its own good desperately needs to show solidarity right now--to suggest that there is a problem with physician/surgeon overcompensation, and that the solution is to take money away from anyone, even if it should ostensibly be given to some other group of physicians. Unfortunately, history has shown that this is never how it happens--physicians don&#39;t make more from Medicare/insurance; they only make less, and have more and more carved out of their livelihood. If anyone in government latches onto the idea that a group of physicians is growing fat in the current system, then you can bet that the next iteration will redress that boon, and probably many others, but most assuredly without any compensatory increase in another sector. <br /><br />Bottom line is I don&#39;t want to go through all of this training and debt-accruing, only to find myself in a new health care system in which I make the same type of money I made before medical school as a computer consultant. And I know that thousands of others feel the same, including pre-medical aged folks who will say &quot;screw it&quot; and go into law or business or some other field where the remuneration is commensurate with the effort. <br /><br />Anyhow, sorry for another long-winded post, and sorry again for any acrimony. I assure you that none remains on my end. You clearly have some great thoughts on the issue of health care reform, and you clearly care. I feel the same way myself. If you ever want to compare notes with somebody in another specialty, in (I promise!) a friendly and collaborative spirit, feel free to track me down at jocoserious at gmail dot com. <br /><br />Sorry, too, to hear about your cat. I wish you and your family the best. <br /><br />Best regards, <br /><br />Ian D.Ianhttps://www.blogger.com/profile/06185428739495676922noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-992393337655226402009-06-22T18:05:08.092-07:002009-06-22T18:05:08.092-07:00Although compensation in EM is quite good, it is s...Although compensation in EM is quite good, it is somewhat insensitive to what the govt or insurance companies actually pay. I have seen net collections as a % of billings go from 70% in the early &#39;80s to ~30%<br />for the past 6-8 yrs. With these results, it is no wonder that many contracts require a hospital subsidy to be viable. Unless such subsidies are prohibited, EM pay is not likely to change much. There are a few hospitals where fee for service works well but even these are under pressure.schnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-3901206585390907302009-06-21T18:45:57.961-07:002009-06-21T18:45:57.961-07:00I think you published piece did a good job explain...I think you published piece did a good job explaining the cognitive vs. procedure point well, especially to the non-medical reader.ladyk73noreply@blogger.com