Letters to the Editor
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@dlmk1950
Businesses, including but limited to WalMart, don't operate on the concept of doing good for others. I agree.
But often businesses--and other enterprises--wind up doing good for others even though that was not their primary motivation.
Are the for-profit sickness enterprises, otherwise know as hospitals, private clinics, free-standing ER's, etc. motivated by doing good for others? Are quickie oil changes? No, but almost inadvertently they do (good for others.)
One change I would like to see made is for the media to stop calling the medical industry the "Health Care" industry and call it what it actually is: the "Sickness Care" industry.
Virtually any innovation that impinges on the physician-monopoly is sickness care is a positive development.
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Dear Old Timer
I saw your post and was not surprised at all. In October I was ill, I walked into my GP's office at 9 am. I waited 30 minutes. I paid 65$ and even got 40$ worth of antibiotics free in the form of samples.
When asked why I don't purchase insurance, this is what I say. I imagine I would need to go to the doc 5 times or more per year just to make paying the deductible worth it.
Will I buy insurance when I have a family? Sure. Will I buy it when I'm 30? Sure. Does it make financial sense to buy it now? I guess my choice not to buy it says no.
Long live Denmark!
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The market incentives need to be examined
A good primary care doctor or pediatrician will take the time to determine, for example, if the sore throat they're seeing is due to a virus and defer the request for an antibiotic. That's good medicine for the patient, sparing them side effects from a medicine they don't need, and good for the community, reducing the rates of antibiotic resistance. But patients often are dissatisfied when they aren't given the antibiotic they feel they need. Will a drop-in clinic practictioner take the time to do the right thing, even at the risk of alienating a paying customer? Or will they do the easy quick "solution" of writing that prescription for Augmentin and keeping the customer satisfied?
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Treeple
My first point refers to both insured and uninsured people. I think you illustrate the point well when you mention your personal experience with friends being surprised that you didn't consult a physician when you had the flu. My personal belief is that the "public" has been conditioned to seek medical care nowadays for ailments that people a generation or two ago (30 years?) considered trifling.
It might even make sense for the sickness industry to charge more for a visit for someone with a cold than someone with a broken arm!
I did not read the article in The Atlantic, but arguing that having fewer MD's would lower sickness care costs is ridiculous on its face. Think of a world with only Shell and Exxon gas stations.
Increase the supply of providers and prices for the service will fall...look at attorneys, for example.
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To Momanddoctor
The antibiotic issue (or any other unnecessary medication) is important, but I think public education (that is, education of the public rather than public schools) is already making a difference there. There is a persistent desire for people to FEEL something happening, even if that feeling is a pill going down the hatch, in order to believe a treatment is working. I'm reading a book about medical treatment from the 60s and damn, did they used to overmedicate. I'm not sure my entire generation wasn't born high, with the drugs they regularly gave women during the course of normal deliveries. So I see the antibiotic thing as a passing problem, if providers stick to their guns and educate patients.
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Will you really see a doctor?
Many of these retail clinics will not be staffed by physicians; instead they will be run by nurse practitioners or physicians' assistants. The vast majority of the time, this will be fine. However, there will be times when decision-making isn't so straightforward. Someone who looks like a textbook case of X will turn out to have Y instead. I recently saw some data comparing physicians' and nurse practitioners' responses to patients coming in with elevated cholesterol. The physicians changed medication doses more frequently than the nurse practitioners. While the study did not attempt to determine which groups' decisions were more appropriate, the fact remains that physicians and nurse practitioners aren't trained the same way. I personally would rather err on the side of caution by seeing a physician.
In an ideal world, such walk-in clinics would be part of already-existing medical practices. (I think a previous poster said this was already happening in some pediatric groups.) That way, a mid-level provider could see and treat the patient, and could provide immediate follow-up to the patient's regular provider. Faxes and telephone calls are nice, but nothing beats having collaborators on-site.
I think retail clinics are okay as supplements to medical homes and primary care providers, but should not replace them. My parents get all of their medical care from retail clinics, and I've been trying to change their minds. (But who the hell listens to me, anyway...)
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Refills
I'm sure I'm not the only one who objects to seeing a doctor whenever I need a refill on a prescription, like my asthma inhaler and my kid's acne lotion. It's $100 (I have that high-ded insurance) just to get into my doc, and he'll only do one refill, so every few months, I have to get an appt just to get a refill of perfectly safe medications. This is really stupid and wasteful of time and money.
Much better to make a quick trip to a clinic for $40. Even that's ridiculously expensive, considering I just need that little piece of paper, but as long as doctors insists on being gatekeepers to the pharmacy, I guess I'll have to pay that.
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@Fredrick Bernancke
If there were more Medical Schools in the United States, graduating, say, two or three times the current number of MD's, the price value of each MD would naturally decline...not something the AMA would be thrilled about.
The AMA isn't the one who regulates the doctor supply. Organizations like the AMA and the Council on Graduate Medical Education make recommendations, but it is really Congress who does the regulating. How does it do that? By setting reimbursements for graduate medical education. We could have 50 new medical schools opening up tomorrow, but it wouldn't change the number of residency training slots. That's the real rate limiting step.