I have found an interesting investigative report starting today in this local newspaper. They will publish an article everyday for a week.This should concern everybody who is still alive in the U.S.

Here is the link to the reports:

http://www.dcourier.com/main.asp?Sectio ... leID=54731

Text:

The question of who will take care of us doesn't always have an answer.

The number of primary care physicians - the front-line doctors adults visit for runny noses, itchy rashes and persistent pains - isn't keeping up with a growing population. Just look at some headlines from recent literature about the primary care shortage: "Marcus Welby is dead," screams one; "Primary care on verge of collapse," shouts another; "Doctor shortage projections dire," warns a third.

Making the shortage worse is the emergence of some disturbing trends in Prescott and Prescott Valley. Some primary care doctors are refusing to accept payment through insurance plans, even Medicare. Instead they want cash up front. Some are limiting the types of patients they'll see and the drugs they'll prescribe by making potential patients "apply" for a slot on their patient list and by "cherry-picking" the least troublesome ones. Some doctors are running "boutique" medical practices where they charge patients an annual retainer in return for increased access. Many doctors aren't accepting new patients at all.

From another article on same site:

The American College of Physicians - the nation's largest medical specialty society - says primary care in the United States is on the verge of collapse.

People looking for a primary care doctor in Prescott and Prescott Valley say the collapse already has begun. See a related story on 7A.

"The first two years I lived here, I had to return to the Valley when I needed to see a doctor," says Prescott resident Carol McBride. "No one accepted my insurance here and I found even though I was willing to change that, a new doctor would be difficult to find.... I had considered just switching to Medicare, but found many doctors here would not accept Medicare patients."

Nancy Sayer of Prescott Valley moved here in 2003. She's 72 and has had trouble finding and keeping a primary care doctor. Her first doctor changed careers and she's not happy with her current doctor.

"I'm about ready to move out of this town because I can't find a good doctor," Sayer said. Several doctors she's contacted all say the same thing: They don't take Medicare. "All they ever tell me is they don't get paid (enough) by Medicare. I've never lived anywhere like this."

Doctors here agree a shortage exists. At a recent board of trustees meeting at Yavapai Regional Medical Center, chief of staff Dr. H.G. Bowers said many doctors and their wives have trained in big cities and are unlikely to consider living in a small town.

"We're behind," Bowers said. "We need primary care in this town. They're the least paid and the most sought after."

Rowena Craighead of Prescott said that when she and her husband first arrived here, she called Yavapai Regional Medical Center's doctor help line for a list of doctors taking new patients. The woman who answered the phone didn't offer much hope.

"She hooted with laughter and said I'd have to go to Phoenix," Craighead said. She's finally found a doctor and so has her husband, but other friends of hers haven't. "This is a common, common problem."

The American College of Physicians - a national organization of 124,000 internists who specialize in the prevention, detection and treatment of illnesses in adults - issued its report on the collapse of primary care in the United States on Jan. 30, 2006.

In part, the report says:

• Very few young physicians are going into primary care and those already in practice are under such stress that they want out.

• Unless people act now, the country won't have enough primary care physicians to care for an aging population with growing incidences of chronic diseases. And without primary care, the U.S. health care system will become increasingly fragmented and inefficient with specialists having to tackle basic health care duties. That leads to poorer quality at greater cost.

• The preventive care that primary care physicians provide helps reduce hospitalization rates and save money. Such rates and costs are greater for everyone in areas with fewer primary care physicians and limited access to primary care. Areas with more primary care physicians have significantly lower overall health care costs.

The Association of American Medical Colleges says one-third of the nation's active physicians are more than 55 years old and likely to retire by 2020. And the newest generation of physicians is unlikely to work the long hours that prior generations of physicians worked.

Russell Coile Jr., a nationally recognized futurist specializing in health, has an even more dire prediction. He says by 2010 the rate of medical staff departures from active practice may reach "epic" proportions, far outstripping the ability of training programs to replace them.

Because it takes a minimum of seven years - and sometimes 13 - to train a doctor for primary care, the association says it is "imperative" that policymakers act immediately to avert the impending collapse of primary care.

Yes it is hard that the US medical system has declined so much, the government wants to regulate everytihng also being a problem I think with Physicians wanting to go into Primary care practioners.

I guess more patients do exist than physicians, then so many Physicians go into a specality other than Primary care.

I think it was better when we did not have all these specalities to go into.

Dr Spector was in that era of Physicians, which I belive to be more open to helping people than the following generations of Physicians.

Lets wish and hope for the best.

U.S. collapsing.

There, fixed it for ya.

A very good friend of mine has a pinched nerve, and the pain runs down her left leg. The pain was so bad she could not sleep and was taking 4 and 5 advils to just dull the pain. She finally got permission from Kaiser to go to the local emergency room were she waited from 11pm to 3am in a great deal of pain to see a Doctor. The Doctor would not look at it, and told her she was making it up. This morning she was able to see her normal doctor who gave her some meds, but would not give her any strong pain pills nor anything to help her sleep. She managed to get into see her dermatologist and he gave her a shot or medicine. I was at her house watching her 80 plus parents, and when she got home my friend got 20 minutes of sleep before the shot wore off. The only thing they told her was that it would take at least 3 weeks for the pinched nerve to help her.

The US medical system has collapsed unless you have money, and the said thing is the US is collapsing right behind it. A good example is - unless the next president pumps mega dollars in the space program China will leap ahead of us, and become the dominant force in space for the next century.

That is what happens to men who have testicular pain that can't be relieved. Dr's don't want to help unless you are at death's door from it. They don't want to remove one let alone both of them. I have a friend who almost died due to that. After losing the one that was the problem, the Dr. who removed it said he was within two days of being "gone". Thank God, I found one that would help me in my circumstances. BEing pain free is great.

It has been widely reported that there is already a shortage of nurses in this country. If it were not for nurses immigrating to the U.S. the retirement rate would leave almost no nursing staff in hospitals in a very few years. Worse, yet the nurses that would be training new nurses are the very ones that are retiring. Almost the same situation exists with doctors. The current recession may stave this off, temporarily, by making it more difficult for people to retire. (A whole other discussion.)

My doctor has started a boutique practice alongside his regular one. The patients who have paid the retainer get priority care. He did this because he has a rather affluent patient base who can afford this and will pay for it. (Many are in the entertainment industry and have a rather exaggerated opinion of their own importance...my opinion.) In reality, it helps subsidize (read, makes it possible to continue) his regular practice.

His objection to medical insurance is that the companies try to micro-manage the doctor's practice though the payments for each procedure or examination. The doctor's say that the insurance companies have forced "Eight-minute medicine" on the American people. Within the payments allowed, the doctor cannot spend enough time with a patient to make a proper diagnosis. They give the best W.A.G. diagnosis that their experience leads them to, prescribe and hope for the best. Usually this "When you hear hoof beats look for horses, not zebras." approach to diagnosis works, but not always.

I have personal experience of this with the diagnosis of my tumor. The insurance company did not want to pay for the diagnostic blood tests or the MRI to confirm the diagnosis because their medical procedure manuals (several years out of date) said that this was exclusively a woman's problem. Wrong! But, the payment was held up for months while the hospital sent me to collection.

Hospital care has also deteriorated to an unacceptable level. The nursing staff in most hospitals is overworked and inexperienced (Not to mention a certain lack of motivation among the younger ones.), so if you don't have a family member who will hang around the hospital all day to advocate for you as a patient you are in deep trouble.

Outsourcing is rampant in medicine. If you are taken to the hospital after normal business hours, between 6PM and 6AM, and have x-rays, CT scan or an MRI chances are the staff radiologist will not read the films. They will be scanned and transmitted over the Internet to India where a radiologist, in his normal business day, will read them and return the results. The, the hospitals say, is "maximizing resources". What happens if the doctor in India is puzzled by something, and as radiologists sometimes do, want to take a look at the patient? What recourse do you have if the doctor in India makes a mistake? Does he or she even care?

This country has been going down the tubes because of the knowledge drain since the late 1960's. The offshoring of the radiology readings is just another example of this. The ascendancy of China as the world leader in technology is another. The first thing we have to do, in all areas, is do more for ourselves in this country. In the medical area that starts with having the self discipline to take care of ourselves and not counting on doctors to fix us. (This is particularly painful to me because I have a fetish for plump women, but it has to be done.) Our young people need to realize that not everyone can be a rock star, sports hero, movie star or lawyer (Another entire other discussion.) We need more people becoming nurses, doctors, technicians, engineers, etc. and we need the jobs for them in this country.

Business, government and all the professions need to step back and take a look at what we are having done overseas and consider whether or not the quarterly bottom line is the most important factor in doing it. Yes, it's going to hurt someone financially, which is going to be very unpopular at the moment. We cannot turn back the clock to the pre-globalization era, but we need to get back a little America First attitude to keep from becoming an also ran.

I don't know of any doctor who would not agree that a cash patient beats an insurance patient any day. I feel that allowing these mega corporations we call insurance companies to control healthcare in this country is what the problem with our healthcare system is.

Today we rely completely on these corporations to pay for our healthcare. Have a cough and need to see the doctor for a simple $50 visit? Pull out that insurance card and let them pay for it. Never mind the fact that with them paying for it, they will say what happens with their money. They decide what treatment you will and will not get, what conditions you do and do not have, and how much or little time you will spend with the doctor they are paying for.

What puzzles me is that people are surprised when for profit corporations act like for profit corporations. They can't seem to understand that insurance companies are in business for the same reason as any other company - to make a profit. They get confused and angry when they are denied services. They seem to think that insurance companies are in business to pay for everything all of their clients ask for and run themselves out of business. They don't understand when insurance companies want to cut costs and increase profits. Perhaps a business 101 course is in order for these people.

I have done healthcare both ways - through insurance and paying for it myself. There is absolutely no question which one I have found to be the most beneficial. I would always take paying for it myself over having insurance.

When you pay for it yourself, you get to see the doctor for as long as you are willing to pay for. You get whatever medications and treatments you are willing to pay for. No third-party bureaucrats or corporate pigs making any choices for you.

This is why the doctor coinflipper mentioned is doing what he is doing. He knows that cash patients are more profitable for both himself and the patient. He can give more time and closer attention to each patient, and he can give them whatever treatment he and the patient feel is appropriate.

What further puzzles me is that many on this board discuss being fed up with the insurance companies, but they want to give control of the healthcare system to the govermnent. I don't understand how there would be any less third-party control or headaches and hassles with this method.

I have dealt with Medicaid, which is the current government healthcare system. There is no reason to believe a system to cover all would be any different from this one.

I was denied a bone scan after my castration by Medicaid because just like what coinflipper experienced, osteo is exclusively a women's condition according to them. As a result, I will never know what my baseline bone density was. The government refused to pay for a needed treatment, and I was screwed.

Yes, in an ideal world, we would all have free healthcare on demand. We would all see the best doctors, get the best treatments, and receive the best service. Furthermore, we would all be given our own private houses, all the food we could ever want, and anything else we might need or want. But unless you want to go communist, that just isn't going to happen. In the real world we don't have those things, and the government is not going to provide us all with top notch healthcare if we let them take control.

I used to believe that a government controlled system was the answer, until I realized that it isn't going to turn out like that ideal world. I would like to believe that everyone paying for their own healthcare is the answer, but realistically not everyone can afford to. So I will admit - I do not know what the answer to the healthcare problem is.

My friend found out that the Doctor she was sent to by Kaiser was fresh out of med school, and that if she had been to a more experienced doctor this incident with the severe pain would not have happened.

Can I quote you on the "horse vs. zebras" thing?!