Doctors of VN

#301
#301
Just wanted to say kudos on a great thread and info. Thanks kiddiedoc for your quality input.

I have been married to a beautiful, kind hearted, loyal, god-loving woman for a couple of decades now, OH, and she has been chronically ill since day 1. I find myself looking at medical related stuff far too often as a result of her health issues. Anyway...thanks again.

Happy New Year everyone!
 
#302
#302
kiddiedoc said:
I'm hoping you aren't serious.

A recent example of how stupid this is: saw a kid with an earache this week who decided to start some leftover antibiotics at home (gasp). Your algorithm might have missed the deep neck space abscess that he is now being treated for with IV antibiotics and likely surgical intervention.
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Had a 10 year old kid come in about a month ago with a headache and some slight nausea for a month. Ended up finding two germinomas, one on his pineal gland and the other on the pituitary stalk.


In agreeing with you, I don’t think Germinoma would be the first think that popped up if you entered headache into that system. I think the rate of occurance for those is something like 0.7 in a million.
 
#303
#303
I’m no doctor, nurse or anything that prestigious, but I did spend a considerable amount of academic and clinical time training to be an ATC. You can’t take out the instinct factor. Sometimes you just know something isn’t right (based upon subjective and objective findings).

WebMD (which is basically what was being suggested earlier) can’t duplicate that.
 
#304
#304
kiddiedoc said:
That sounds like a bad experience -- I hope you have found a new provider that you trust.

Nothing, and I mean NOTHING, will convince me that expanding retail-based clinics is a good idea. I could fill a novel with crappy care stories I've witnessed over the past 14 years. I'm certain that every friend/colleague of mine will tell you the same, and the American Academy of Pediatrics has issued multiple policy statements opposing RBCs.
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Agreed. I am working to get into PA school currently and the thought of a corporation like Wal-Mart employing an army of clinicians scares the hell out of me. Yes they drove the cost of OD's down (as an 18 year old kid, this is what I wanted to be), but they also killed their salary. Thanks to corporate eye care, new grad OD's are starting out making 65-70K. Considering the amount of debt it takes to attend optometry school, that is absurd. I'm not going into healthcare for the money. But I need to be able to pay the $100,000 it will cost me to attend PA school. From what little data I have gathered in the east TN area, PA's are averaging anywhere between 95-115K (depending on specialty), which is sufficient for the amount of debt incurred. KiddieDoc, you may be able to confirm?

People just assume Physicians, NP's, and PA's are just over compensated health care providers. Most do not understand the debt absorbed in these schools and compared to the time, money, and sacrifices made, are more underpaid than overpaid.
 
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#305
#305
kiddiedoc said:
I'm hoping you aren't serious.

A recent example of how stupid this is: saw a kid with an earache this week who decided to start some leftover antibiotics at home (gasp). Your algorithm might have missed the deep neck space abscess that he is now being treated for with IV antibiotics and likely surgical intervention.
Click to expand...

I didn't say it should replace an exam. I used that as an example of how technology could make the process more efficient. I guess I'll always have to keep filling out the forms attached to the clipboard that the ladies at the counter hand me when I walk in.
 
#306
#306
kiddiedoc said:
TGO, one note on inefficiency:

Establishing a "medical home" or primary care provider should help immensely, if the practice is run well. New patients always have some paperwork/data entry, history taking, med history etc, but that's important information if handled correctly.

Once the up-front legwork is done, a good EMR should streamline the check in and history process. Example: my patients this morning have spent an average of 23.4 minutes in the office, from door to door.

If you are bouncing around from ERs to walk in clinics, etc, the time burden is your own fault.
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Nope. Same primary care group for well over a decade.
 
#307
#307
Thunder Good-Oil said:
I didn't say it should replace an exam. I used that as an example of how technology could make the process more efficient. I guess I'll always have to keep filling out the forms attached to the clipboard that the ladies at the counter hand me when I walk in.
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My GP actually sends me a login for an online portal. Days before my visit I can update any symptoms, prescriptions, family history, insurance info, etc. They have all of before I even walk in the door. Haven't filled out a paper form in 3 years.
 
#308
#308
wildnkrazykat said:
I’m no doctor, nurse or anything that prestigious, but I did spend a considerable amount of academic and clinical time training to be an ATC. You can’t take out the instinct factor. Sometimes you just know something isn’t right (based upon subjective and objective findings).

WebMD (which is basically what was being suggested earlier) can’t duplicate that.
Click to expand...

I did not suggest WebMD. It's far from a robust system.
 
#309
#309
TennVOLS93 said:
My GP actually sends me a login for an online portal. Days before my visit I can update any symptoms, prescriptions, family history, insurance info, etc. They have all of before I even walk in the door. Haven't filled out a paper form in 3 years.
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I think that an issue could be that the small, private practices aren't really well capitalized and aren't able to upgrade quickly. When they take a risk by investing in new technology, they have a difficult time abandoning what's maybe become obsolete.
 
#310
#310
Thunder Good-Oil said:
I think that an issue could be that the small, private practices aren't really well capitalized and aren't able to upgrade quickly. When they take a risk by investing in new technology, they have a difficult time abandoning what's maybe become obsolete.
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I think it's rare to see significant upgrades at family physician practices because most are severely underpaid.
 
#311
#311
Thunder Good-Oil said:
I think that an issue could be that the small, private practices aren't really well capitalized and aren't able to upgrade quickly. When they take a risk by investing in new technology, they have a difficult time abandoning what's maybe become obsolete.
Click to expand...

I have actually found that a small, private practice has a better chance to run efficiently. Hospital systems and large/multilocation groups tend to have cumbersome EMRs less tailored for their purpose and can be overmanaged to practice in a way to create revenue, rather than just taking care of the patient.
 
#313
#313
kiddiedoc said:
I have actually found that a small, private practice has a better chance to run efficiently. Hospital systems and large/multilocation groups tend to have cumbersome EMRs less tailored for their purpose and can be overmanaged to practice in a way to create revenue, rather than just taking care of the patient.
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I agree that hospitals aren't very efficient. They can't really control their costs when they're obligated to take care of anybody and everybody that wanders into their ERs. I hate to say it... but maybe that's an area for the government to take a bigger role.
 
#314
#314
kiddiedoc said:
I'm not sure about this, as our system is continually upgraded as part of the subscription pricing.
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Just speaking in general from the few PCP's in my area. You see some that are wayyyy behind the times in equipment and practice. I've just always equated that to being underpaid. But your medical groups seem to do well, such as Summit.
 
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#315
#315
My Dr is hot. And she has a nurse who is smoking hot. I don’t mind having to go to the doctor office.
 
#317
#317
The answer is NOT trying to let retailers like Walgreens and CVS take over health care. The majority of people working those clinics are NP's and not MD's. Sure there are things I'll settle for an NP for only because it was emergent and I couldn't get a slot with my GP. There are other things that I feel are more important to see my actual doctor over. In those cases I'll wait a few extra days to get an appointment with him. When it comes to health care there is often times no substitute for knowledge and decades of medical practice.
 
#318
#318
Thunder Good-Oil said:
I agree that hospitals aren't very efficient. They can't really control their costs when they're obligated to take care of anybody and everybody that wanders into their ERs. I hate to say it... but maybe that's an area for the government to take a bigger role.
Click to expand...

If hospitals were allowed to charge a $5 non refundable fee to everyone that walks into the door before they could ever get treatment it would make a world of difference in an emergency room setting. The homeless, the system manipulators, the people that use the ER like it's their own doctor's office would turn around and walk out.
 
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#319
#319
Coug said:
If hospitals were allowed to charge a $5 non refundable fee to everyone that walks into the door before they could ever get treatment it would make a world of difference in an emergency room setting. The homeless, the system manipulators, the people that use the ER like it's their own doctor's office would turn around and walk out.
Click to expand...


Exactly. When I worked at Children's hospital, I would often float and work down in the ER. Won't believe how many people would bring their kids into a packed ER with a simple cough or a temperature of 98.9. Of course they would be the ones complain about a wait time too.
 
#320
#320
TennVOLS93 said:
Agreed. I am working to get into PA school currently and the thought of a corporation like Wal-Mart employing an army of clinicians scares the hell out of me. Yes they drove the cost of OD's down (as an 18 year old kid, this is what I wanted to be), but they also killed their salary. Thanks to corporate eye care, new grad OD's are starting out making 65-70K. Considering the amount of debt it takes to attend optometry school, that is absurd. I'm not going into healthcare for the money. But I need to be able to pay the $100,000 it will cost me to attend PA school. From what little data I have gathered in the east TN area, PA's are averaging anywhere between 95-115K (depending on specialty), which is sufficient for the amount of debt incurred. KiddieDoc, you may be able to confirm?

People just assume Physicians, NP's, and PA's are just over compensated health care providers. Most do not understand the debt absorbed in these schools and compared to the time, money, and sacrifices made, are more underpaid than overpaid.
Click to expand...

When you get your credentials, please check out the VA.

We love all our providers, including physicians, NP’s, PA’s,
clinical psychologists, LCSW’s, and erebody else. We emphasize proper patient care, without regard to possible insurance payments. (What with one thing and another, less than 10% of our inpatient and outpatient care is billable.) Work on a salary, which is a pretty decent salary for the responsibilities, btw. Excellent benefits.

Yes, you will often go barking mad. How is that different from any other job??

There are EXCELLENT VA facilities, which go unnoticed in the scandal du jour updates. No one hates the bad VA’s more than those of us who work at the good ones.

But mainly we love our veterans, and we are always looking for the best people to care for them. Please check us out when the time comes.

God luck to you in your PA career!
 
#321
#321
Coug said:
The answer is NOT trying to let retailers like Walgreens and CVS take over health care. The majority of people working those clinics are NP's and not MD's. Sure there are things I'll settle for an NP for only because it was emergent and I couldn't get a slot with my GP. There are other things that I feel are more important to see my actual doctor over. In those cases I'll wait a few extra days to get an appointment with him. When it comes to health care there is often times no substitute for knowledge and decades of medical practice.
Click to expand...

Why can't well capitalized companies like Walmart hire MDs? Or Amazon? Or Alphabet? In a well managed, well financed operation with economies of scale the MDs could see more patients. Right now serious cases and not so serious cases are herded though the same facilities and systems.
 
#322
#322
VolNExile said:
When you get your credentials, please check out the VA.

We love all our providers, including physicians, NP’s, PA’s,
clinical psychologists, LCSW’s, and erebody else. We emphasize proper patient care, without regard to possible insurance payments. (What with one thing and another, less than 10% of our inpatient and outpatient care is billable.) Work on a salary, which is a pretty decent salary for the responsibilities, btw. Excellent benefits.

Yes, you will often go barking mad. How is that different from any other job??

There are EXCELLENT VA facilities, which go unnoticed in the scandal du jour updates. No one hates the bad VA’s more than those of us who work at the good ones.

But mainly we love our veterans, and we are always looking for the best people to care for them. Please check us out when the time comes.

God luck to you in your PA career!
Click to expand...

If you’re in Tennessee, how is the reputation of the Johnson City facility?
 
#323
#323
Tri-CitiesVol said:
If you’re in Tennessee, how is the reputation of the Johnson City facility?
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To show how complex life is these days, I’m in North Carolina, until recently an employee of the Asheville VA. Now I work from my home office in West Asheville for the San Francisco VA.

I don’t have direct knowledge of Mountain Home (the name of the JC VA, along with “James Quillen.”) My understanding is that it’s one of the “good guys”, especially according to its SAIL scores, a VA quality measure.

But when you get down to the level of your day-to-day what-do-you-want-and-need stuff, every VA (and “normal” hospital) will vary by service and provider. Are you looking for primary care? mental health services? medical specialties? surgical specialties? housing support? legal aid? —we do it all, but you’re going to find great, ok, and oh yikes quality, depending on where you go and who you get. I’m being honest here. You probably won’t get this level of honesty in the outside world.

Your best bet may be to check in with the local Vet Center, which are generally independent and refreshingly ornery non-VA resources, for info on what you need. Do keep in mind that lots of folks like to b!tch and moan, just like back in the service, so you might want to keep that in mind.
 
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#324
#324
volsarelife1 said:
Exactly. When I worked at Children's hospital, I would often float and work down in the ER. Won't believe how many people would bring their kids into a packed ER with a simple cough or a temperature of 98.9. Of course they would be the ones complain about a wait time too.
Click to expand...


I work in the ER now, I had a guy come in at 2-3 in the morning once because he got bit by a mosquito
 
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