Medical care over the years

Current wait time at my local hospital, 10 minutes away, is 163 minutes at 8:30AM. 5+ hours wait time after hours on weekends unless you arrive by ambulance. hospital blames it on uninsured people from neighboring county.

Remember the DuPont advertising slogan “Better Living Through Chemistry”? Or was it Dow Chemical? From my experience, that’s what really changed over the years. A “physical exam” is nothing more than a bunch of lab tests. Not saying that’s bad - just different from the old days. I moved a couple of years ago and I had no problem getting an appointment to see a doctor. And scheduling seems so much better today. Rarely do I have long waiting room times. 10 to 15 minutes. I can remember as a kid., literally waiting for hours. I recently needed a root canal and the dentist was 2 months out. Fortunately, antibiotics from my regular dentist calmed the infection and pain until I could see the endodontist. But that could have been rough if I really needed to get in

One thing that’s changed tremendously is how few solo practitioners there are left, it seems that most medical practices are consolidating into corporate practices, using multiple doctors who have become employees serving medical services according to the orders from the insurance companies, rather than acting in the interest of their individual patients.

Being near Boston I've always been fortunate to have access to great medical, primary or specialty, with extended wait times being rare (or knowing how to circumvent them). My network also has a great patient portal where I can get one-off medical questions answered in usually 24 hours or less. The problem have come from doctors too busy punching notes into their computer too talk to their patient, under mandates from their hospital or the insurers, both of whom have grown way the fuck out of line. Also a problem with prior authorizations for any kind of medication and a lot of procedures. A lot of these are outright denied by AI without a person not having looked at them. You have to advocate for yourself. Be a fucking Karen if you have to. The business model of insurance is to deny, deny, deny. You have to make it harder for them to deny than accept.

Well, as a rick my health is quite robust. And, frankly, I don’t really wanna be touched by damn dirty apes unless they are sexy females. However, I have discovered that your doctors have multiple different degrees. The three most common are M.D., D.O., and D.V.M. In my experience the smartest hairless ape doctors have a D.V.M. All of you should try to find a doctor with that degree. ROAR!!!

I have a new doctor (less than a year), an osteopath, instead of an M.D. My experience has been great. Prescriptions refilled in less than a day. My back gets fucked up skiing, I email a message that I need Flexeril and 12 hours later it's at the pharmacy, no appointment. Always on time. Appointments last 45 minutes with a full discussion on all issues. In the last 5 months my health has improved 50%.

Technology has certainly improved the overall medical experience immensely. Since I moved I had to establish new relationships with a primary care physician, a gastroenterologist for a colonoscopy, and optometrist, a dentist and a n endodontist. Filling out in those pre visit forms about medical history and prescriptions made it a breeze to do it beforehand on their portals. I can see lab results immediately and as skibum says, it makes prescription refills easy peasy.

Our NHS has its faults but it’s feee at point of use and I’m so thankful for it.

No one can seriously argue that general healthcare is better now than it has been in the past. Nor can anyone plausibly state that the federal government intervening in healthcare has improved it at all. Finally, it is the height of ignorance to blame the doctors for doing what it takes to survive. You should instead be damned grateful they are practicing at all. There is no single factor driving the increase in costs and the decrease. Remember that I manage a multi-specialty clinic which was grown from a solo practice, so I have a thorough understanding of many of the professional factors driving these changes. First and foremost is inflation. Wages for unskilled clerical, administrative, and 6-week degreed medical assistants are up. Operating expenses are up. Insurance costs are up. Medical school debt is up. Everything has increased EXCEPT for compensation from insurance payors. Insurance payors are fighting harder than ever to keep compensation down. How can you meet the increasing budget demands of operating expenses if your revenue per unti is not increasing? Sell more units (i.e. see more patients). Slash initial encounters from 45-60 minutes to 20-30. Slash follow-up visits from 20-30 minutes to 10-15. You can decrease your operating costs when you hire more PAs and APRNs than MDs and DOs. More patients are being seen by less educated and less experienced practitioners. It is not possible to do more with less and not have a decrease in optimal outcomes. Public hospitals have it even worse. They have to see patients who cannot or will not be seen anywhere else. It got so bad with Medicaid patients and their entitles behavior that we left the network. Now they have over an hour drive to the nearest hospital in our field, but they did it to themselves. With more schedule slots available for traditional payors, we saw a slight bump in our EBIT. Those hospitals over an hour away are not allowed to turn anyone away. If the patient has neither medicare nor medicaid, they get seen on some charity programs and the hospitals have to eat the cost. The public hospitals have even fewer physicians than we do and rely very heavily on the advanced-practice nurses for these patients. There is no other way to stay afloat. These hospitals have the same problems with rising operating expenses and other costs. As the population in those areas of Florida grows, they still need to build more facilities and add more beds which will be decades before it pays for itself. A lot of the upfront costs will come out of their traditional operating budget for the current fiscal year, including patient care. I mentioned that we stopped seeing medicaid patients because of their behavior. I mean I paid a bonus to certain employees to obtain a CCW and Sheriff's Office civilian firearm training and carry a pistol to work. I began wearing sport coats and blazers to carry my CCW all the time. We've had to implement a buddy system when certain employees were threatened by certain patients. This is happening EVERYWHERE- the violent threats, not the armed response. It's like the airlines after the pandemic, people have forgotten how to behave in the public square, how to have professional interactions, and how to deal with disappointment like an adult. Why would you go $750,000 in debt to have people try to bully you and walk all over you all day? That's why we need more doctors. That's why family medicine and general practice are facing the most dire staffing shortages. The headwinds facing the healthcare profession are very, very damaging. I would blame profiteering by insurance payors, politicians, and lawyers in that order. People, the degeneration of acceptable behavior and treatment, is easily fourth. Tort reform is the most important thing to be done to ease the pressure. I would love to see the insurance payors punished with increased government regulation, but that would be cutting off my nose to spite my face, I don't have the answer on this one. I don't know what can or should be done without making things worse or causing new problems.

I have great, private medical insurance. Leave things as is and fuck y'all lol.

Care isn't as good as it had been, with fewer MDd and more PAs. Our local hospital no longer has an MD on grounds 24/7. The electronic system means 1/2 the visit is checking boxes on the laptop. Many doctors are good, but quite a few have no interest in figuring out root causes. They prescribed something for the symptoms and call it good. I had a cancer scare and without me asking for the tests, they would have just ignored it. Same for checkups, colonoscopy etc. There is no proactive care at all.

When I tested positive for Covid in December I emailed my doctor at 9:30 am. I received a call from him at noon to discuss options. My level of care, and I have always had fabulous care/insurance is as good, if not better than at any time in history. Having said that emergency rooms are a nightmare and if conscious I would choose to die in my car than go into one.

I recently had a 6 month appointment. I noticed it was coded to Medicare as a “long visit”. WTF It may have been 15 minutes. What’s a “short” visit?

Where I live there are two hospitals. One is private, the other is under the university. Most people in the entire state come to one of these two hospitals if they need medical attention. They are both constantly competing, even expanding into neighboring states (both of them). They’ve both bought many doctors offices and small medical centers within a 100+ mile radius. My wife’s doctor retired and she’s (my wife) been through (I think) 5 different doctors in under 2 years. They keep quitting because the hospital they’re associated with wants them the turn and burn patients all day which I’d imagine has worn out those doctors pretty quick. Over the past 4 years or so - insurance premiums have gone up (I think it was somewhere between $50-$100 a month for 2 adults) and co-pays for visits went from $25-$50. Coverage didn’t change, just the costs, which have gone up just as everything else in my life has too. As for appointments it can take up to a month to get one, if I’m sick and need a Rx I go to this clinic and they always see me quickly, and a pharmacy is attached so I get my script quick. This has been helpful as I’ve lost count how many times I’ve gone in the past 2 years and they come in and say “guess what you have COVID again!”

We have a lot of medical facilities near where I live and one is the size of the VA complex in Tampa, which looks like a small city.

“people have forgotten how to behave in the public square.” Amen…

Obamacare is great. Don't have to worry about being denied health insurance for pre-existing conditions any more. (Unless the orange bozo and his party succeed in duping enough voters again and repeal it; their dire predictions about Obamacare have all proven to be absurd.) Insurance marketplaces make it much easier to compare plans. You can also research doctors online now before selecting one to check their credentials and patient ratings. Online research has helped me pick pcp's who are patient focused. My pcp's are all very responsive to emails--and it's great to be able to communicate with them like that. In the old days, you'd have to make another appt just to ask a question. However, insurance companies are getting trickier about evading the law though about what they are supposed to cover and making people pay out of pocket for preventive care; should be able to clamp down on them if the democrats get back in control of congress.

If the democrats get control of congress only illegals will be getting benefits. Obamacare has been a massive failure and raised costs. If you are a leech sucking the life out of this country, you love democrats. If you love America, you hate them.

One thing I’ve found to be true is that I didn’t care about healthcare when I was younger because thankfully I never needed. Then I got older and had kids and all of us needed it, and suddenly I cared about healthcare. Has it gotten better or worse when adjusting for my own biases of not needing it and now needing it? Like most things, it’s a mix. It’s more expensive, but so is everything. I hated the old HMO systems. The current high deductible plans also suck for the initial cash outlays, but at least I can go right to a specialist if I need one and not labor through all the various levels of care, starting with cheapest and going to the more expensive, that the HMO would put you through before you could see the specialist you needed. It took me 20 months to eventually get to the orthopedist I knew I needed when I need to get arthroscopic surgery. That was 20 months of pain I didn’t need and wouldn’t have to go through today. I don’t like the factory like approaches to many offices. I’ve found that it’s more about office choice and we’ve settled on good practitioners and get good bedside manner. On the insurance side, the removal of the preexisting condition prohibition is huge. Same for covering dependents up until their 26th birthday. If your kids go to grad school, that coverage is a huge comfort.