How old a feller are ya?

I agree. But Managed Care was the result not the cause of the deterioration of care.

Come with me on a trip down memory lane. Back when HC was all fee-for-service. When some doctors mainly specialists discovered the principle of ‘more’.

Like the monkey in a cage who accidentally bumps the button and drops a banana. Many doctors learned that if the purchased (leased) that diagnostic equipment they could generate a six-figure plus revenue stream.

Add hospitals to that doctor equation. Add the American patient psyche back then where they demanded unfettered care on-demand and woe to you if you didn’t jump.

Over utilization, litigation, explosion in tech and procedures, caused the Fed to explore ways to slow the bleeding by reducing Medicare reimbursements every year until the payers figured out risk and that they could shift it to providers.

And here we are today w risk based contracts.

That’s a 35-40 year over simplified summary.
I will take that a step further (and maybe this is implied in your post) payers followed Medicare's lead and cut reimbursements by 2/3. So the docs and hospitals had to triple prices so they could get reimbursed for the cost of the tests/procedures/visits. It's a vicious circle.
 
I will take that a step further (and maybe this is implied in your post) payers followed Medicare's lead and cut reimbursements by 2/3. So the docs and hospitals had to triple prices so they could get reimbursed for the cost of the tests/procedures/visits. It's a vicious circle.

What's affectionately known as the Cost to Charge Ratio.
 
I swore I wasn't going to comment once this thread went from "how old are you guys" to...whatever it is now! But, as an old school, dedicated doctor, I find the biggest problem today is twofold:

1. Patients barely ask or have time to ask pertinent, common sense questions of their doctors
2. Doctors are not really interested in spending time talking with and "working" with their patients..in other words, call in a prescription and move on to the next $10 copay.

Guys, THIS IS WHAT MANAGED CARE HAS DONE TO OUR ONCE NOBLE, DEDICATED AND TRUSTWORTHY PROFESSION!! If each of you re-read your anecdotal stories about your doctor this or that or they tried to give me an NP blah blah blah........... you now have an answer.
My Dad was a Gastroenterologist and hated the idea of HMOs, He had a private practice but was forced to join a local medical group in order to see patients in the local hospitals. The group had to hire a manager who then put in place protocols that forced the docs to order standard batteries of tests whether the patient needed them or not. He hated the idea but it was the way the medical system was evolving. Mid to late 80's. He died when he was 50 so was spared what the medical system had in store for him but I am sure he would probably have left the profession.
 
Wow great thread!! 46 years old here! been married for 20 years and have two wonderful boys 19 and 16. Been on the water most of my life, my kids are fourth generation on the water. I obsess about it most days can’t imagine not being on the water all year long even in the cold climate that I live in.
Here’s a fun fact my user name “joeyleggz” came about back in high school it’s a nickname i’ve had ever since, I guess it has to do with the fact that I’m 6 5” and 240 and have pretty long legs!
 
61 in August this year. Married 37 years ago -wife is 2 years younger and have 1 girl, 1 boy, a daughter in law and Corgi's. Have my Mo @ 87 home with us. I bought my first boat when I turned 16 before I bought a car. (Had lots of friends willing to tow it to the ramp). After 5 boats, finally got our 340. Have lived in Beautiful St Mary's County, MD on Breton Bay since we were married.
 
I agree. But Managed Care was the result not the cause of the deterioration of care.

Come with me on a trip down memory lane. Back when HC was all fee-for-service. When some doctors mainly specialists discovered the principle of ‘more’.

Like the monkey in a cage who accidentally bumps the button and drops a banana. Many doctors learned that if the purchased (leased) that diagnostic equipment they could generate a six-figure plus revenue stream.

Add hospitals to that doctor equation. Add the American patient psyche back then where they demanded unfettered care on-demand and woe to you if you didn’t jump.

Over utilization, litigation, explosion in tech and procedures, caused the Fed to explore ways to slow the bleeding by reducing Medicare reimbursements every year until the payers figured out risk and that they could shift it to providers.

And here we are today w risk based contracts.

That’s a 35-40 year over simplified summary.
I cant argue with this! But given what the whole system has become I won't be pushing my kids into medicine unless they go in with their eyes wide open.

CERTAINLY the return on investment is not there! No joke...my residents are coming out with 300K to 400K of debt!
 
I won't be pushing my kids into medicine unless they go in with their eyes wide open
I have a friend that’s a urologist.. he says exactly the same thing about his kids. He says if he knew then what he knows now he never would have gone into medicine. Not a good situation for the profession.
 
Here is my take
I have a friend that’s a urologist.. he says exactly the same thing about his kids. He says if he knew then what he knows now he never would have gone into medicine. Not a good situation for the profession.
Look, it's always noble work when you choose to help those who need help especially when it comes to their health. We're on the very front lines working with sick people. But, if you're personality is like mine (and I suspect it is) you don't want to be jerked around by big corporate insurance companies telling you how to practice your craft....then forcing you to jump through THEIR hoops and hurdles to justify your professional decisions! And aside from that we are forced to hire way too administrators and staff to help jump through those hoops. It's become an administrative nightmare/hostage situation!
 
Here is my take
I have a friend that’s a urologist.. he says exactly the same thing about his kids. He says if he knew then what he knows now he never would have gone into medicine. Not a good situation for the profession.
Look, it's always noble work when you choose to help those who need help especially when it comes to their health. We're on the very front lines working with sick people. But, if you're personality is like mine (and I suspect it is) you don't want to be jerked around by big corporate insurance companies telling you how to practice your craft....then forcing you to jump through THEIR hoops and hurdles to justify your professional decisions! And aside from that we are forced to hire way too administrators and staff to help jump through those hoops. It's become an administrative nightmare/hostage situation!

I guess I'm so pissed off I had to say it twice!!! :D
 
Last edited:
I cant argue with this! But given what the whole system has become I won't be pushing my kids into medicine unless they go in with their eyes wide open.

CERTAINLY the return on investment is not there! No joke...my residents are coming out with 300K to 400K of debt!

I’m one of those Grey beards that they refer to about career change in the Great Exit.

It had nothing to do w the “pandemic “. After 35 years in healthcare. People ask me why I left. I tell them healthcare left me.
 
I’m one of those Grey beards that they refer to about career change in the Great Exit.

It had nothing to do w the “pandemic “. After 35 years in healthcare. People ask me why I left. I tell them healthcare left me.
Hmmmmmm!.....you know El Capitan, I knew there was a reason I liked you.
 
My Dr does a pretty good job spending time with me. He asks me how I'm doing, about my job, etc. He is probably in his 70's and from the Phillipines. He ended up joining a group and quit doing surgeries because the local hospital no longer allowed him in there. No idea the details behind that but after reading some of the stuff above maybe he refused to play their games?
But I had hernia surgery 2 weeks ago through a different Dr. While everything went well it was much less personable. He did come in to the prep room and ask if I had any questions but I never saw him again until yesterday at my 2 week follow-up.
 
52 years old, like others, cancer (Renal) survivor (1.3 years and counting), Married for 26.5 years and just bought my eighth Sea Ray from a dear friend who unfortunately has to hang up his captain's cap due to health. It is bitter sweet, as I am thrilled to be back into cruiser boating, but sad for my friends Don and Judy who are entrusting their baby with me.
 
I have a friend that’s a urologist.. he says exactly the same thing about his kids. He says if he knew then what he knows now he never would have gone into medicine. Not a good situation for the profession.
My old man as well as being a Physician was a gentlemen farmer and raised us on the farm. He pushed us to do the best we could in school with a path to going to college but beyond that he specifically discouraged us from medical careers. He encouraged our Entreprenurial endeavors in aviation even though there was no easy path to wealth in that direction. I remember him telling us that the true meaning of success was being in control of the first 8 hours of your day.
 
565E736D-0FC7-422F-A9E9-5EA9F5353EFE.png
I’m 50 my wife is 48. We’re a blended family with 4 kids. Ranging from 20-13. We been married now for 8 years.
 
52 years old, like others, cancer (Renal) survivor (1.3 years and counting), Married for 26.5 years and just bought my eighth Sea Ray from a dear friend who unfortunately has to hang up his captain's cap due to health. It is bitter sweet, as I am thrilled to be back into cruiser boating, but sad for my friends Don and Judy who are entrusting their baby with me.
Scott, sorry about your friends. But happy to see you "back in the saddle" again. Boating is in your blood.
 

Forum statistics

Threads
113,196
Messages
1,428,319
Members
61,103
Latest member
Navymustng
Back
Top