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  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    wHY INTERNAL MEDICINE IS GETTING SO HARD?

    wHY INTERNAL MEDICINE IS GETTING SO HARD?

    Now days everybody wants to do internal medicine, in the past the positions for this area was allways abailabel for IMG.

    Now the thing nobody wants is Family practice, and it has a lot of open and even unfilld positions

    What about General Surgery, I remember in the past it was very dificult to get inn, now is more easy.

    Last but not least when is the LATEST to aplly for residency?
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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  2. #11
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    Quote Originally Posted by popozao View Post
    why do we need fp's anyway? What can they do that an IM doc can't?

    last time i visited a doc, it was at an internist's office.
    This is an articule related to the problem
    The new face of family practice
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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  3. #12
    popozao is offline Permanently Banned 510 points
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    is IM getting hard? it says there's a shortage of docs too.

    increasing the pay by $50000 can help solve the exodus out of the primary care fields.

  4. #13
    ********* | DM erutuF's Avatar
    ********* | DM erutuF is offline Senior Member 512 points
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    Quote Originally Posted by popozao View Post
    is IM getting hard? it says there's a shortage of docs too.

    increasing the pay by $50000 can help solve the exodus out of the primary care fields.
    I don't that would help...

    FP is relatively low-paying for physicians. If FP's want to be paid more, the insurance industry has to foot the bill, which in turn gets translated to higher insurance costs to the patient, giving the patient even more reason to go to the ER. When there's no patients for FP, FP positions close, and then there's NO pay for FP's.

    I can't think of any other way to bring back physicians to the primary care field, except for maybe a vast cultural shift from materialism to selflessness in the US within the next decade??

  5. #14
    IMG2006 is offline Member 510 points
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    Quote Originally Posted by ********* | DM erutuF View Post
    I can't think of any other way to bring back physicians to the primary care field, except for maybe a vast cultural shift from materialism to selflessness in the US within the next decade??

    Selflessness? Have you lost your mind?


    Anyway... this is not only a problem for FP. General Surgeons, and IM are having the same problems. The answer to the crunch is simple. The body of knowledge, which is to say the knowledge of the body, has out paced the capacity of training. Medicine is the one field that does not reward generality of skills. If you were a carpenter, and you only built stairs, the guy who could build whole houses would put you out of business. In medicine, it's the guy who only builds the 3rd step who takes home the big checks. Why? Because there is actually enough information available in healthcare now to support that kind of focus. There is probably more written about the hand now than there was about the whole body 50 years ago. Being all things to all patients in a competent manner is no longer a realistic goal.

    That having been said, over specialization has also created a good deal of this problem. FP doctors are trained and capable of doing much MUCH more than they are typically able to do in practice. We are trained to do colonoscopy and EGDs, but have great difficulty in getting credentialed to do these in hospitals. What does the data say? That there is no statistical benefit to having a GI do your routine scopes, and the benefit of continuity may actually support the idea of returning this to FP. The same can be said for EM and stress testing... Imagine if you went to the ED and actually followed up with the same doctor in 3 days in the office. Wouldn't that be nice?

    FM has burried itself in continuing to relinquish procedures and upper level care to others... the mindset was that there would always be plenty left if they played it politically. Well, the well just ran dry. Honestly, FM should be a 5 year residency and SHOULD be one of the most competitive. The training should ALL be implemented- you'd be one hell of a doctor. Until malpractice and 3rd party insurers get on board though, the field is in a real mess.

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    ERMD5 is offline Member 510 points
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    Interesting ...its tru how overspecialization have vreated problems. I was just talking to a physician a few days ago and he mentioned how when a pt has cardiac problem and lets say he also has Renal artery athrosclerosis. The cardiologist would be able to perform an angiogram on the coronary arteries, but the renal artery becomes an issue becuz vascular surgons believe its their teritory and interventional radiologist think its theirs. One hte other hand the cardiologist say I'm going up to the heart I can check out the renal artery too.
    So who's job is it?

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    Dr.Azimi is offline Permanently Banned 510 points
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  8. #17
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    I go to an IM doc in the US and all he does is write drugs with no invasive procedures. In return for limiting his scope of practice, his malpractice insurance is greatly lowered. Just depends on what one wants to do.

  9. #18
    IMG SURVIVOR's Avatar
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    So:
    1- why they dont put a cap limit to malpractice insures?
    2- Give more insentive to go to that area?
    3- What the US goverment will do?


    long story short why do you think ER all over the country are over crouded and lets not imagen a disaster like an earthwake, or hurracain.
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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  10. #19
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    Quote Originally Posted by IMG SURVIVOR View Post
    So:
    1- why they dont put a cap limit to malpractice insures?
    2- Give more insentive to go to that area?
    3- What the US goverment will do?


    long story short why do you think ER all over the country are over crouded and lets not imagen a disaster like an earthwake, or hurracain.
    I actually dont agree with a cap on malpractice suits.....we all get emotional bc we always assume a doctor doesnt screw up....what about the ones that do. What about the one who disables a kid during delivery or kills his patient bc he doesnt transfuse quick enough? What about a doctor that causes a problem that requires far more than 250,000 in medical bills
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  11. #20
    MushieCookie is offline Senior Member
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    ...

    To 'combat' the first issue with less pay for the 'un-specialized' physicians...it's partly due to our predecessors who would charge anything and everything to insurance companies (back in the day), and the insurance companies would pay ANYTHING a doctor asked. Before, a OB/GYN doc could ask for $5000 for a bilateral tubal ligation, and would get it. Now, they get $25 reimbursed by medicaid/medicare. Private insurance (and non-privatized) cought onto the game a LONG time ago, which is why THEY are now bringing in $500 million plus in profits every year...which means the less for everyone else.

    As for malpractice suits and payments...do y'all realize that we are TERRIBLE at policing our own kind? Meaning, if someone makes a mistake, we don't say anything, but try to 'look away' and not incriminate someone else. What does that lead to? These 'bad' doctors keep making mistakes. It is less than 10% of doctors who get sued for the LARGE malpractice settlements. These doctors get sued over and over, and raise the cost of malpractice for everyone else. I could go on and on...but seriously, look it up. I'm not joking.

    Oh, and as for an internist doing scopes, or performing chest x-rays and reading them in your own office...sure, you will create a significant amount of revenue for yourself...especially if you own the machines! But...your malpractice insurance will be through the roof!!!! Why? Because your not 'certified' to perform these procedures and competently read the results in an acceptably accurate manner...because you haven't been trained to do so. Also...are you willing to take the chance that you take an CXR of your patient, read it as normal, and miss the fact that there is a small nodule 'obscured' within vasculature markings? You miss it, the symptoms worsen, pt. gets another CXR, it gets caught by a board certified radiologist...and your SOL. Sure, people make mistakes, but the general internist will make a LOT more (relatively speaking) than a 'board certified' specialist in their field.

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