Universal Health Care

[THE KOD]

Clinics serving uninsured strained
By ANDY MILLER

The Atlanta Journal-Constitution

Sunday, March 01, 2009

When Annette Washington lost her Circuit City job, she and husband Honore also lost their health insurance.

Since the 2007 layoff, the Powder Springs couple have received primary medical care at a community health center in Marietta. The center charges them $35 per visit. In addition, clinic staff members have helped sign them up for free prescription-drug programs.

Dr. Gabriel Onofre examines Cindy Villanueva of Grayson at Four Corners Primary Care Center in Norcross. Clinic leaders are seeking $300,000 in emergency funding to stay open. Enlarge this image

Villanueva holds her prescription written during her monthly visit to the clinic.

Villanueva (left) expresses her gratitude for the medical care. A widow, she is unemployed and uninsured. BY THE NUMBERS
Number of community health center organizations in Georgia: 26
Total number of clinic sites: 123
Number of Georgia counties with a clinic: 62
Percentage of Georgia patients with family incomes at or below federal poverty level: 50
Number of Georgia patients served per year: 285,000
Number of clinic sites nationally: 7,000
Sources: Georgia Association for Primary Health Care, National Association of Community Health Centers
To find a community health center near you, go to gaphc.org, and under ''About Us,'' click on ''CHCs'' and fill in the search information.

Clinics serving uninsured strained
? Metro and state news ?I couldn?t afford to go to a regular doctor or buy regular insurance,? said Honore Washington, 47, who has high blood pressure. Without this medical care, he said, ?I don?t know how I would have survived.?

Such community health centers have spread over the past decade in medically underserved urban and rural areas. The number of these clinics in Georgia has almost doubled since 2001, providing vital strands of the safety net for the uninsured and the poor with government Medicaid coverage. For people like the Washingtons, it?s a steady medical ?home,? offering the same physicians and open at least 40 hours per week, where patients with no insurance pay a fee based on their income.

A jump in federal funding under the Bush administration helped expand and create community health centers nationally. And the new economic stimulus package will add $2 billion more for the nonprofit organizations, where patients fill a majority of board seats.

Community health centers ?have done tremendous work,? said Ken Thorpe, an Emory University health policy expert, adding that the centers should be linked with hospitals and specialists.

Community health centers don?t make much, if any, money. And now they?re seeing an uptick in patients who have lost jobs ? and insurance ? during the recession. That translates into lower payments for medical visits.

The recession?s spurt of uninsured ?is a strain on our budget,? said Dr. David Williams, CEO of Southside Medical Center, which, with nine area clinics, is the biggest such organization in metro Atlanta.

One Gwinnett center, in fact, needs emergency funding to continue, or it may close in three months.

The Washingtons? Marietta clinic is part of West End Medical Centers, which in 1999 opened a new hub site, resembling a modern office building, in west Atlanta, aided by $2.5 million from Tenet Healthcare.

?We don?t turn anyone away,? said Daisy Harris, CEO of West End. ?If you can?t pay, you do not walk out of here without getting care.?

Harris and Williams call the clinics a great value for the health care dollar, saving money by preventing unnecessary emergency room visits and by managing patients? chronic diseases such as diabetes.

Dr. Michael Brooks, a West End internist and its medical director, says he could make a higher income in private practice. But he has worked at West End for more than 20 years. ?These are people who need you,? he said. ?This is a medical home. You see the same doctor every time.?

In Norcross, the Four Corners Primary Care Center sees a daily flood of patients without health insurance.

Skip Griffith of Lilburn, a Four Corners patient, lost his job as a warehouse manager a year ago. The $30 charge for a visit is sometimes difficult to cover, says Griffith, who has high blood pressure. ?We come here because we don?t have insurance and don?t have money,? Griffith said last week. Without the clinic, he said, he probably wouldn?t seek care at all.

Four Corners opened in 2007 to serve the growing number of uninsured in that section of Gwinnett County. It resembles a large doctor?s office, but without artwork and other decorative frills. Gwinnett?s board of health helps run the center.

Yet its leaders say that because it?s a new center, a quirk in state regulations prevents it from getting a healthy dose of Medicaid patients ? and thus higher payments for care. So instead of a typical 40 percent to 50 percent of its patients lacking coverage, Four Corners has a 95 percent uninsured load.

Clinic leaders are seeking $300,000 in emergency funding to stay open. ?We need capital to pay salaries and supplies,? said Dr. Lloyd Hofer, director of the Gwinnett Board of Health. With that money, and help from Medicaid, the clinic can sustain itself, Hofer said.

And it can keep serving the uninsured such as Terrie Gilbert of Loganville, a part-time Kmart cashier who praised the quality and cost of the medical care on her first visit there last week.

?I was made very comfortable,? Gilbert said. ?I?m going to continue to come here.?
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I dont understand why these clinics cannot be the stepping stone for providing society with reasonable medical care at reasonable cost.

 

[THE KOD]

we need alot more doctors that will work for this instead of money grubbing vultures.

 

[hedgehog]

we need alot more doctors that will work for this instead of money grubbing vultures.

So, you want doctors to go to school for 16 years and make a modest salary? How are they supposed to pay back their loans? We have the best health care in the world, why do we need to change it? I agree its ridiculous what they charge, but making it run by the government is not the right answer. The people who are going to school and are the brightest will now be lawyers instead of being doctors, because there will be no money incentive

 

[saint]

The problem starts with the insurance companies. You would be shocked to see what the physicians make after insurance gets done.

General surgeons literally, and i mean literally, make a mere 50 bucks for taking out a gall bladder in some cases. It's to the point where most med students don't even consider certain fields. Do you want a 2nd or 3rd rate doc operating on your loved ones? I wouldn't.

Scott if doctor's were doing as well as you paint it then why would 60% not recommend it to someone interested? Things are getting so bad they are having a hard time getting med students to consider general practice. How about 16 years of school and 300k in loans to come out seeing 100 patients a day and making 120k. It's just not worth it. Scott you are once again clueless.

http://medheadlines.com/2008/11/19/us-doctors-disillusioned-60-wouldnt-recommend-medical-profession/

The post above mine pretty much summarizes things well.

 

[THE KOD]

Scott you are once again clueless.

[

.................................................................

you are way off base calling me clueless.

I got to get some sleep.

I will address this tommorrow and show you facts that you dont know what your talking about.

as usual

 

[saint]

.................................................................

you are way off base calling me clueless.

I got to get some sleep.

I will address this tommorrow and show you facts that you dont know what your talking about.

as usual

Sure, I can't know what I'm talking about since the info regarding the gall bladders came from a friend who is a general surgeon and does it day in and day out. But feel free to post a link-

If 60% of physicians would not let their kid go into medicine something is very broken. Or maybe it's cause the parents made such a fortune their kids don't have to work

 

[saint]

NEW RESEARCH PROJECTS SHORTAGE OF GENERAL SURGEONS BY 2010

COLUMBUS, Ohio ? In less than two years, there may not be enough surgeons in U.S. hospitals to treat the critically injured or chronically ill.

A new study suggests that the number of available general surgeons, who often perform life-saving operations on patients in emergency rooms, will not keep up with public demand. As the population continues to grow, there will be a shortage of 1,300 general surgeons in 2010. That shortage will worsen each decade, reaching a deficit of 6,000 by 2050.

That means people will have to wait longer for emergency treatment and for elective general surgery, said Thomas E. Williams, co-author of the study and clinical associate professor of surgery at Ohio State University.

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The overwhelming costs of obtaining a medical degree are a large deterrent for many young students, despite scholarships and financial aid. The cost of obtaining a medical degree leaves many students with $125,000 to $150,000 in debt after completing medical school.

?People may wait hours in an emergency room if there is a shortage of surgeons. But the problem is that if you?re not operated on within a few hours, your disease progresses and that can create more serious problems in other areas of the body. These are problems that you would not have had with prompt surgical attention,? said Williams, who is also a retired thoracic and cardiac surgeon.

In emergency rooms, general surgeons are called upon to determine whether or not to operate on a patient. But an increasing number of medical professionals choose to specialize in other fields such as cardiac or orthopedic surgery. So the shortage of general surgeons will directly impact emergency rooms around the country, which rely on general surgeons.

The projections were made based on data from the U.S. Census Bureau and The American Board of Surgery. The data included population statistics and projections, medical school graduation rates, and information on the number of surgeons currently practicing.

The study was published in a recent issue of the journal Surgery. Williams conducted the study with E. Christopher Ellison, professor and chair for the department of surgery at Ohio State. The pair has co-authored a book with fellow Ohio State professor Bhagwan Satiani, entitled ?The Coming Surgeon Shortage: Who will fix our hearts, your hip, and deliver our grandchildren?? The book is expected to be released late next year.

The shortage was calculated by taking the difference between the number of retiring surgeons and those entering the workforce. This number is then compared to the expected need for general surgeons. Previous research has shown that 7.53 general surgeons are needed for every 100,000 people to keep the current level of care. The current study shows this number will not be met as early as 2010.

There are about 21,500 general surgeons practicing in the United States today. Each surgeon practices for an estimated 30 years and about 705 surgeons die or leave the workforce every year for personal reasons or retirement.

Meanwhile, nearly 1,000 new surgeons enter the workforce each year. But of that number, only 850 will practice general surgery. After accounting for retiring surgeons, that means only 145 new general surgeons will enter the workforce annually, far less than is needed given the continuous rise in the population.

But some authorities have suggested that as many as 600 of these 1000 surgeons are entering other surgical specialties each year, creating an even larger shortage of general surgeons than the current study projects.

?Many doctors today want to specialize in areas such as vascular, colon, or thoracic surgery. They?ll train for one or two more years beyond general surgical residency so they have more professional expertise, and probably won?t take the general surgery calls in emergency rooms,? Williams said.

?But if even more surgeons are getting these specialized certificates, the problem will just get worse. We?ll see fewer available doctors for patients in the emergency rooms who depend on these general surgical procedures for their care.?

Williams estimates that it will cost $62.5 million per year ($750 million total) to train the additional 1,875 general surgeons needed by 2020. Because training is 5 years in duration, each year of training costs approximately $80,000, including salary, benefits, and other direct and indirect costs.

Despite recent attempts to increase the number of medical students and establish new medical schools, there are several barriers standing in the way.

Attracting students to the medical field is a growing problem, Williams said. The overwhelming costs of obtaining a medical degree are a large deterrent for many young students, despite scholarships and financial aid. The cost of obtaining a medical degree leaves many students with $125,000 to $150,000 in debt after completing medical school.

In addition, students required to train as residents are often underpaid for their work, Williams said. The average resident earns between $40,000 and $45,000 per year for three to seven years before they are board-certified. Compare that to the average salary of a first-year associate at a New York law firm, who will earn $150,000 to $200,000 per year.

The lawyer will typically work on weekdays, with some evening and weekend work when needed. The resident, on the other hand, will work nights, weekends, and uneven hours for up to seven years for lesser pay.

?This lifestyle can serve as a deterrent for many who might otherwise choose surgery. When you are married and have children you need a more predictable schedule. Someone has to take the kids to music lessons or football practice. One of the problems in surgery is that it?s often unpredictable and that makes it hard to lead a scheduled lifestyle,? he said.

?What we need to do is make this profession more attractive through programs to help reduce costs and arranging the 80 hour work weeks to more manageable schedules. Without these changes, we simply won?t keep up with the increasing demand.?

 

[BobbyBlueChip]

.................................................................

you are way off base calling me clueless.

I got to get some sleep.

I will address this tommorrow and show you facts that you dont know what your talking about.

as usual

It sounds like saint's blaming DTB, who's just going to blame Eddie, who's going to blame Saint (or probably a real doctor) and this thread isn't gonna go anywhere. But the truth . . . it's the insurance companies

 

[saint]

In response to an article in the WSJ:

http://blogs.wsj.com/health/2008/05/19/as-general-surgery-ranks-dwindle-patients-may-suffer/

"I have read the above and agree that the practice of surgery is in dire straights. The last two appendectomies I did in the middle of the night, I was paid by PPO A and PPO B about $385 (before taxes and all overhead costs for about a total of 8-10 physical hours of work per case, pre-, intra-, and post-op.) After 15 years in practice and around 10,000 major operations, I?m also looking toward throwing in the towel in the next year or so. The ?supply and demand? phenomenon won?t happen in time for me??..burned out and signing off?..
Comment by yet another burned out surgeon - June 1, 2008 at 11:42 pm "

 

[saint]

Excellent article

Excellent article

This about sums it up

Are Doctors Underpaid?

Phillip Miller, for HealthLeaders Media, July 17, 2008

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go to complete list

For the last 15 years, Merritt, Hawkins & Associates has been reporting on the salaries offered to recruit physicians, and our most recent Review of Physician and CRNA Recruiting Incentives reveals an interesting new development. In the last year, salaries offered to recruit certified registered nurses anesthetists (CRNAs) were higher than salaries offered to recruit primary care physicians. On average, CRNAs were offered $185,000 a year, compared to $172,000 for family practitioners. CRNAs also were offered more income, on average, than general internists, pediatricians and hospitalists.

The fact that nurses (albeit it those with advanced training) are paid more than some physicians is eyebrow raising and has sparked a good deal of heated online discussion. Some physicians argue that CRNA salaries demonstrate how relatively poorly doctors are paid, while non-physicians maintain that the six-figure salaries doctors earn are nothing to complain about regardless of what CRNAs make.

Do physicians who maintain that they are underpaid have a case? Or should doctors be happy with their current earnings?

First, consider average salaries being offered to physicians in various specialties as reported in Merritt, Hawkins' 2008 Review:

* Orthopedic surgeons: $439,000
* Radiologists: $401,000
* Cardiologists: $392,000
* Urologists: $387,000
* OB/GYNs: $255,000
* Psychiatrists: $189,000
* Hospitalists: $181,000
* General internists: $176,000
* Family practitioners: $172,000
* Pediatricians: $159,000

One point brought home by these numbers is the striking disparity between the pay of primary care physicians and surgical and diagnostic specialists. Current payment systems reward physicians who perform procedures at a higher rate than physicians who employ cognitive and consultative skills. This is one reason why fewer medical school graduates are choosing primary care, fueling a shortage of primary care doctors that some observers feel could soon reach crisis proportions.

Independent of disparities between specialists, most physicians earn upper middle class incomes, while a few doctors are outright millionaires. Apparently, some people are not happy with this state of affairs, since the pressure to cut physician reimbursement is unremitting. The government and private payers wouldn't find cuts quite so easy to impose if the public at large objected. There is little demonstrable outrage, however, over declines in physician reimbursement.

Maybe there should be.

Many doctors can argue with some justification that they are underpaid. Eleven or more years of collegiate and post-collegiate training set a high bar to professional entry, particularly when they result in $150,000 or more in debt, as often is the case. Once in practice, physicians shoulder an extremely high level of professional responsibility, are highly scrutinized and regulated, and are frequently sued by patients expecting results that cannot reasonably be achieved.

While some might question the value to society of stock brokers, lawyers, or even public relations executives like me, the benefits physicians bring to society are beyond dispute. By delivering, enhancing, and prolonging life, and by easing its passage, physicians provide a service worthy of considerable reward.

Of course, money itself is not the only, or even the primary, sticking point for many doctors?empowerment is. Unlike just about everyone else trying to earn a living, most of you reading this cannot raise yours fees when your cost of doing business rises. Unlike the rest of us, you cannot even submit a bill with any expectation that it will be paid. Perhaps most frustrating of all, you cannot suggest a course of treatment for your patients with the assurance that it will be approved by someone with far less medical training. Little wonder that many doctors feel powerless and marginalized.

The upshot is that a growing number of physicians are looking for a way out, either by retiring, finding non-clinical jobs, limiting access to their practices, working part-time, working as temps or circumventing third parties through direct-to-patient contracting.

Despite prevailing notions, medical practice today often is inequitable to doctors, and many physicians are not as well off as the public may perceive. For every plastic surgeon making millions from elective cosmetic procedures, there are dozens of primary care doctors unable to afford the cost of implementing electronic medical records or even raises for their staffs.

This is not a good prescription for attracting the best and brightest people society has to offer to a profession that eventually affects all of us in a profound way.

These reimbursement woes are one of the drivers of a looming nationwide physician shortage, and payment disparities have already made primary care physicians scarce in many areas.

If you believe physicians are overpaid now, wait until no one wants to be one. That is the point at which we will all be paying a high price, not only with our wallets, but with our health.

 

[saint]

So Scott- what professions are you okay with making a lot of money? It seems to me you think everyone should be paid the same amount regardless of what type of work they do and the training required. I guess it's okay for professional athletes to make 5 million a year but physicians who are the backbone of our (failing) healthcare system don't have the right to reap the rewards of years of hardship. Seems to me you just aren't in the best position in your own life and so like many americans you just piss and moan about people who have it better than you.

 

[hedgehog]

So Scott- what professions are you okay with making a lot of money? It seems to me you think everyone should be paid the same amount regardless of what type of work they do and the training required. I guess it's okay for professional athletes to make 5 million a year but physicians who are the backbone of our (failing) healthcare system don't have the right to reap the rewards of years of hardship. Seems to me you just aren't in the best position in your own life and so like many americans you just piss and moan about people who have it better than you.

you hit the nail on the head there, great post

He likes socialism/communism, change we can believe in

 

[The Sponge]

The problem starts with the insurance companies. You would be shocked to see what the physicians make after insurance gets done.

General surgeons literally, and i mean literally, make a mere 50 bucks for taking out a gall bladder in some cases. It's to the point where most med students don't even consider certain fields. Do you want a 2nd or 3rd rate doc operating on your loved ones? I wouldn't.

Scott if doctor's were doing as well as you paint it then why would 60% not recommend it to someone interested? Things are getting so bad they are having a hard time getting med students to consider general practice. How about 16 years of school and 300k in loans to come out seeing 100 patients a day and making 120k. It's just not worth it. Scott you are once again clueless.

http://medheadlines.com/2008/11/19/us-doctors-disillusioned-60-wouldnt-recommend-medical-profession/

The post above mine pretty much summarizes things well.

Dam i almost agree with ur post Saint. Almost 9 tenths of it. Watching a girl in nursing school and a guy studying in med school we still will have bright doctors and nurses. Im just talking about two prestigious schools now so i could be wrong but what they put these kids thru to shake out the weak hands will still bring bright people in the med field. I think 7 out of ten kids ultimately quit or run crying out of the room. Its stunning the amount of work they get piled on them and with computers now it makes it easier for teachers to pile it on. Doctors make way less today then say 20 years ago. They still make good coin but percentage wise it isnt even in the same ball park. sop i will throw my hat in and be the third person to agree its insurance companies who have been getting the free ride and shoving it up our ass as their percentages rise like Scottys temper when u lash out at him. Im sure the Insurance guy will say its lawyers and that .000023 percent they cause. Maybe we do need tort refoorm so the insurance companies can make more.

 

[ryson]

Don't forget about the malpractice insurance doctors have to carry, that helps drive up the rates too. Seems like the lawyers and insurance companies make a good amount of coin from health care as well.

 

[ImFeklhr]

The people who are going to school and are the brightest will now be lawyers instead of being doctors, because there will be no money incentive

I am a pessimistic SOB, but I still find this to be bullshit. EVERYONE isn't motivated exclusively by money. There are lots of smart folks who are called into a variety of professions. Some people actually want to be doctors to HELP people.


I am not trying to be overly sentimental, but don't you have ANY faith in people?

 

[THE KOD]

saint - I will answer but let me throw this one out there.


Is it true that Doctors receive kickbacks, cash, trips, etc from the drug companys to dispense new drugs and drugs that they want doctors to push hard.

 

[Chadman]

Sounds like to me, the main concern of fewer doctors lies with the high costs of education, and the tough work schedules. Plus, later on, the high insurance premiums. Of course, many doctors, from what I have read, have other ways of making money or benefiting in other ways from pharmaceutical and medical component companies and reps for using their products.

So, perhaps, a completely new way of conducting healthcare in this country and making it easier financially for people to get an education could possibly make it better for doctors and patients, and certainly less expensive for both? And perhaps less profits for pharma companies, and insurance companies?

Perhaps, instead of blanketly trashing some new ideas about an overall healthcare plan to change the way things are done now, that maybe some new ideas should be on the table?

 

[jer-z jock]

Perhaps, instead of blanketly trashing some new ideas about an overall healthcare plan to change the way things are done now, that maybe some new ideas should be on the table?

Thats whats wrong, the ones at the top getting the billions and billions from this industry wont go for CHANGE. I always wonder If a country that has half the resources that we do can grow their citizens older, live longer along with having less health care problems through out life why cant we? Its not about smart doctors and prices of education, there are 3rd world countries have doctors that use this national or universal health care system..and are dispensing the same medicines and treatments damn near free that we are using here for hundreds and thousands of dollars.

 

[saint]

saint - I will answer but let me throw this one out there.


Is it true that Doctors receive kickbacks, cash, trips, etc from the drug companys to dispense new drugs and drugs that they want doctors to push hard.

They used to. Not anymore. No more dinners for no reason....the only dinners they can go to are speaker-dinners on disease states. More on that in a second. No more trips, no more alcohol, no more sporting events, strip clubs, nada. They aren't even given pens and paper anymore advertising pharma companies as of Jan 1 this year. There have been some major changes. The only thing they still get are lunches. Big fucking deal, here's some Chic Fil A. In fact most doctor's are no see-meaning they won't see reps anymore.

The only thing that they can do is be a speaker for the company at the previously mentioned dinner. They maybe get 1k-1500 bucks to be a speaker. Now Scott this is just proof that they aren't making huge big bucks. Do you think if they are bringing home boatloads of money they are going to go to a dinner to pump a product after a long day's work instead of being with their kids? They go because as general practitioners insurance is bleeding them dry and they need to supplement their income.

I do believe that Pharma companies are evil and a big part of the problem. So I'm glad to see they can't do the things they used to do. But again, for them to invest millions and millions into developing meds (many of which don't pan out), they need to recoup their money at some point.

 

[saint]

I am a pessimistic SOB, but I still find this to be bullshit. EVERYONE isn't motivated exclusively by money. There are lots of smart folks who are called into a variety of professions. Some people actually want to be doctors to HELP people.


I am not trying to be overly sentimental, but don't you have ANY faith in people?

I think most people go into medicine with a desire to help people. But let's be honest, if they only made 75k those same people would look to contribute elsewhere. I mean, you can't expect someone to sacrifice income from the age of 22-26 during med school, then work 80+ hours a week in residency making 40k from 26-30+, then do a fellowship and specialty training. I mean these people sacrifice a huge part of their life. For them to do they there has got to be financial reward for it.