Don’t simply look for a surgeon who is board certified. Make sure they are trained to do the procedure you are having. Yes, board certification is important, but the training is more so (in my humble opinion).
If you are having a breast augmentation, you don’t want a board certified maxillofacial surgeon or Ob-Gyn or neurosurgeon. You want someone trained in plastic surgery. It is a bonus if they are board certified. By the same token, if you need brain surgery you don’t want a board certified plastic surgeon you want someone trained in neurosurgery.
This rant was prompted by Read more »
*This blog post was originally published at Suture for a Living*
An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.
The essay caught my attention because I do think it’s true that we need more well-trained specialists, as much as we need capable general physicians. Ultimately both are essential for delivery of high-quality care, and both are essential for reducing health care errors and costs.
Primary care physicians are invaluable. It’s these doctors who most-often establish rapport with patients over long periods of time, who earn their trust and, in case they should become very ill, hold their confidence on important decisions — like when and where to see a specialist and whether or not to seek more, or less, aggressive care. A well-educated, thoughtful family doctor or internist typically handles most common conditions: prophylactic care including vaccinations, weight management, high blood pressure, diabetes, straightforward infections – like bacterial pneumonia or UTIs, gout and other routine sorts of problems. Read more »
*This blog post was originally published at Medical Lessons*
While public opposition to healthcare reform has diminished since its passage, physician opinions are still negative, especially among specialists who see their value to the healthcare system decreasing as reform emphasizes primary care.
A survey reports that 65 percent of nearly 3,000 physicians in all specialties said the quality of healthcare in the country will deteriorate in the next five years. Seventeen percent of respondents believe the quality of healthcare will stay the same and 18 percent believe it will improve. Meanwhile, 30 percent of healthcare consumers believe that the quality of healthcare will improve.
Physicians cited as reasons for their pessimism personal political beliefs, anger at insurance companies and a lack of accurate planning in the reform act. Other reasons include that primary care physicians won’t have the time to keep up with the extra workload, forcing more patients to depend upon nurse practitioners for primary care. When asked who will likely handle the 32 million Americans expected to receive healthcare following passage of the reform, 44 percent said primary care physicians will handle the load and 44 percent said that nurse practitioners will see them. (Physicians could vote for more than one category; options include physicians assistants and specialists, for example.) Read more »
*This blog post was originally published at ACP Internist*
Regular readers have heard me rant about the fragmentation of medical care in this country. Each body part not only has its own medical specialist, but in some cases its own allied health profession. Such is the case with the feet.
Doctors of podiatric medicine have to complete a four-year course of study after college, followed by a three-year podiatry residency. At the end of all that, I grant, they are expert in the care and management of complex disorders and conditions of the foot, ankle, and lower leg. I refer to them regularly, especially for stubborn ingrown toenails. (I did indeed learn how to remove offending portions of nail bed, but over the years I’ve gotten away from it.) They fail, though, when they try to extend their reach beyond their grasp, which is the case of the podiatrist above the knees. Read more »
*This blog post was originally published at Musings of a Dinosaur*
Some states are finding it tough to retain physicians. Take Virginia for instance:
A recent study found Virginia retains only 35 percent of its medical school graduates and ranks 31st among other states in retaining doctors.
In 2008, Virginia spent more than $50 million from the general fund to support medical education and had nearly 600 new physicians graduate from Virginia’s four medical schools.
Despite this, Virginia still struggles to retain medical graduates, with less than 25 percent of Virginia’s physicians graduating from medical schools in the Commonwealth.
Some feel incentives might work:
Dr. Greenawald says other states including North Carolina have incentives to keep medical students in state. He hopes Virginia considers following suit. Dr. Greenawald also said the over burden of paperwork and insurance company oversight have taken doctors away from what they love doing which is providing care to patients. He said that’s prompted many doctors to retire early.
I’m not so sure. Until more medical students feel primary care is worth the effort, the mass exodus to specialties (and the out-of-state training that is often required) will continue.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*