This is personal...

[PCIntern]

Last edited Thu May 18, 2023, 06:44 PM - Edit history (1)

Those of you who know me here know that when I discuss personal issues, it’s to relate them to bigger things, and how the world is affected by certain impetus and the inertia felt therefrom. Today, I’m going to rail on about something which is extremely upsetting to me, and does have a bearing upon the body politic.

I wish to state from the outset that that I did not go to Provider School. I was not in college sweating for four years, taking pre-provider courses and swearing about organic chemistry, physics, and bio chemistry. The words we used to use back in the Paleolithic days were: premed, pre-dent, prelaw, and pre-vet. This was an indicator, for better or worse, tgatthe individual was attempting to go to a school of the healing arts. And those of you who know me know that I think we as practitioners of the healing arts are no better, nor are we worse than anybody else who does anything at all whatsoever for a living. This has nothing to do with that.

I am sick and tired of being called a provider. I do not have a diploma on my wall that says “provider“ on it, I do not have a license to be a provider, and in fact anyone who does anything for anyone at any time in this society provides a service. I respect all professions and for that matter of course , anyone who does any job of any type and believe that an engineer who designed the building should be called an engineer, someone who is a repairer of pipes, allowing flow of gas and liquid should be called a plumber, and well… You get it. All of a sudden, those who provide medical services are no longer called doctor, dentist, podiatrist, veterinarian, or whatever, they are lumped in with this word provider.

In my opinion, that is a way of diminishing the importance in education and experience of the individual who is the person who actually is responsible in every conceivable sense for the services rendered by anyone and everyone else in the office. it is a great deal of responsibility, ethical, legal, moral, and professional, and it is reprehensible that that has been diminished by insurance companies.

Because make no mistake, the insurance companies are now running the show. The hospitals and medical people, as well as all the other specialties mentioned above, are subservient to the whims and Vagaries of insurance companies and are constantly living under the threat of being unpaid, audited, banished from participation, being charged with all kinds of financial crimes, which they may or may not have even dreamt of committing, and generally living in absolute fear of these multinational, multibillion dollar companies.

Now, as many professionals are also finding, when they go to work for organizations which provide medical care, they are just another employee who is often treated much worse than many of the administrative staff, and even many of the people who ostensibly are employed to assist the trained, licensed, medical professional. I have seen doctors and dentists fired for getting into professional disputes with their underlings, who have taken it upon themselves to veto or override the doctors wishes or prerogative. Now, in some situations that may be acceptable in certain forms of business and arguably valid, but in a medical setting, the doctor is ultimately responsible for the result, and if anything goes wrong under the doctor’s care, whether he or she ordered it or not, the professional who has been schooled and licensed is the responsible party. This may lead to fines, loss of license, and other issues being brought against the person holding the doctorate.

On top of all of this, it is extraordinarily dehumanizing and degrading to minimize the level of education, Intellect, experience, and responsibility, which is why so many professionals dream of leaving their profession, and going into something which is more benign and reasonable. Yes, it’s true that often times the grass is always greener on the other side of the fence until you find out that it’s Astroturf, but if you only knew the number of “providers“ with whom I have spoken, who are longing to just get the fuck out of town, you wouldn’t believe it. It is ultimately going to be a very, very significant problem for people seeking care, and I believe we are in fact past the point of no return here. Yes, I know that’s cynical but things are not getting better to say the least.

I thank you for your time, patience, and understanding. And no, nothing in particular happened today, I’m just in a very disgruntled mood… As you can tell.

[drray23]

1. This trend started a few years ago.

For example, regarding doctors and nurses. There is a lot of youtube/tiktok and other social media content demeaning doctors as not knowing anything and that they should really listen to their nurses who know better.

I get the point than an experienced nurse is invaluable but at the end of the day, the doctor has to make the decision and will be blamed if something goes wrong.
I am not sure I understand the need to make the relationship adversarial when it reality it is (or should be) a collaboration.

[ForgedCrank]

61. "Provider" has

actually been a standardized term for a very long time on the inside. There are various titles and levels of skill in the field, so the term "provider" is meant to be generalized reference of those who provide a service. It's been on most of our documents for many years.

[Bernardo de La Paz]

2. I skimmed your post

I did not see you provide an alternative term. Did you and should I have read more carefully?

You didn't provide examples, with context, where "health care provider" is inappropriate and why. If you did I might find I agree with you.

"Doctor" or "dentist" is not sufficient, as in many contexts those terms exclude numerous highly educated professionals, including nurses. When there is the opportunity to be specific to an individual they are appropriate.

I understand not wanting to be lumped in with hygienists and nutritionists, but what is your general term for professional (university educated) people who dispense health care? "Health care dispensers"? A term is necessary for forms and discussion. Are you talking about some specific form from an insurance company?

If you are talking about the Doctor of Dental Surgery (or equivalent) at the center of a practice, then doctor or dentist is satisfactory and fine. But if someone wants to talk about all the professionals in the office or the practice or the organization, then "doctor" or "dentist" is inappropriate. You can be called a dentist in one context and a provider in the other, appropriately.

So what is appropriate is dependent on context.

Without contextual examples, I'm not sure what problem exactly you are railing against. I understand the importance of respect for training, education, and experience.

[Kali]

7. I understand the OPs rant but this post is good too.

it used to be you went to the Doctor. now it could be any of several levels of education/degrees/formal titles. I never know how to address some of these people any more. IF they even give a credential when you meet them. yes, I can ask but that isn't the point.

[Bernardo de La Paz]

8. Call them all "Doctor"? They'll correct it. Pros usually don't accept greater certification than the

Professionals are generally reluctant to accept greater certification than they actually have achieved.

[Ms. Toad]

22. My reaction, as well.

When I'm referring to a specific person, I use their title (Dr., Nurse Practitioner, etc.). When I'm discussing rights under an insurance plan I use the term provider or health care provider, since that right to care often pertains to people with a broad range of training.

[mike_c]

27. "doctor" is an academic rank and a personal title....

I think the better terms are the names of specialties, e.g. oncologist, neurologist, orthopedist, etc, or the general term "physician." So while PCIntern and mike_c are both doctors, PCIntern is a physician and I'm a different kind of doc altogether.

In my profession the honorific "Dr" is usually reserved for formal settings among colleagues, like introductions and carpet calls, and strictly speaking but often disregarded among students, for whom "Professor" might be preferable anyway, so while I don't usually refer to colleagues as "Dr," I do usually refer to my physicians that way, even in informal conversations.

[Bernardo de La Paz]

28. Thanks for that discussion of protocol. Accords with my understanding of things

I'm all for naming and identifying with specialties, but I think there are general contexts where general terminology is the thing.

Like how we might refer to "academics" when meaning not only Profs but Teaching Assistants, Lecturers, Research Assistants, etc. Or soldiers / troops for grunts, admirals, GIs, pfcs, pilots, and NCOs.

Anyway, I sympathize with the OPs plea for more respect and recognition, but also the administrator's needs and not neglecting recognition of other staff.

[RobinA]

62. What's Wrong

with "doctor," "nurse," "occupational therapist," or "lab technician?" What was everyone together called before the horrific "provider" reared its ugly head? I have no horse in this race. Provider gives the receiver of the information no guidance at all concerning what is being discussed. "I went to my provider today..." I know nothing except that the person talking went to see somebody who wasn't a friend. To me, "provider" is a meaningless weasel word. A way to say something without really saying anything. Of which there is way too much these days.

[Bernardo de La Paz]

66. Nothing is wrong!

The words all have different uses!

Doctors, nurses, therapists and lab techs are all health care providers. "Provider" is a generic term for when an inclusive term is needed. We can say things like "the health care providers went on strike, all except the lab techs who have a separate union".

We would not say many times "the doctors, surgeons, occupational therapists, rehabilitation therapists, psychologists, OR nurses, ICU nurses, ward nurses, CAT scan operators, X-ray techs, radiologists, osteopaths, and phlebotomists went on strike".

Nobody is asking you to say "I went to my provider today"!


Nobody.

[pwb]

3. What your patients call you is what counts.

Administration and management are a problem for most of us today. Family, friends and who you know are running the place. None of them know anything about the job. Some promoted because they suck so bad. Move them up not out. Yep.

[Stargazer99]

5. I see what this person is talking about

the insurance companies are too powerful....wake up!

[jaxexpat]

6. Absolutely "feel you", PCIntern.

I am fortunate to be a client of a very good physician, though my insurance carrier prefers to refer to him as PCP (primary care provider). My wife and I talk frankly with him, and all our various physicians, about the current trends and general climate within his profession, office and his sponsoring/parent organization. We agree that the current unsatisfactory situation is unlikely to improve. The distractions he wrestles through would be unthinkable 30 years ago even as science and the array of medicines and techniques have extended lives. He has had to learn to tolerate insubordination and even overt racism from his staff (he's a darkish guy of Puerto Rican heritage) until he can have them replaced. My wife and I have both seen it play out in the petty drama of their incompetence and willful childishness. I've seen no difference within hospitals. They seem ever more likely to be the cause instead of merely the place of death. I can see in my doctor's eyes, more so lately than before, that he is losing an ongoing battle to retain positivity about the future of his career.

When we become too frail to care for ourselves, I'm in no way certain but that we won't simply expire of well-funded institutional neglect by some staff of barbarians, our bodies lying cold and decayed, in situ, until the building's demolition in an AI managed renovation of the property at some future time. By then the heroes may have all given up the fight for civilization.

In the end our opposable thumbs just may not suffice to make a difference.

[PatrickforB]

9. Well, you all know how I feel...Medicare for ALL Americans!

Seriously - the profit motive of insurance companies is in direct conflict with our interests as patients and YOUR interest as a healthcare professional - I believe you're a dentist, is that right?

[PCIntern]

10. Yes and I agree wholeheartedly.

[live love laugh]

14. Even Medicare doesn't address the diminished care of "providers".

Medical facilities still routinely offer doctor substitutes like physician assistants and nurse practitioners first.

[Ms. Toad]

23. Medicare for all would be fantastic -

but it doesn't address the use of the term provider. Medicare also uses provider as a general term to refer to people with a range of medical training who provide care.

[womanofthehills]

11. What's happened now - it's hard to actually see a dr

Who is an actual dr -many of us just see providers. People call nurses running clinics out where I live - doctors.

Town people tell me the Dr at the clinic gave them some drug -(they don’t put drs in the clinics they anymore) They all have some initials after their name, but not Dr.

[woodsprite]

15. I go to a 'nurse managed care' group and I never know what to call them.

They have one Dr who is an advisor to their group, but not part of their group.

[3catwoman3]

58. Just ask them how they would like to be addressed.

I started my 45 year nurse practitioner career in the Air Force nurse corps, where everyone was addressed by rank - I was Lieutenant X, then Captain X, and finally (while in the reserves), Major X.

When I left the AF after 4 years of active duty and got my first civilian job, I had to decide how I wanted people to address me. My predecessor in that job, also an NP, had let people call her "Dr. Anne." I wasn't comfortable with that, as I thought it was a misrepresentation. After being addressed by rank for 4 years, going by my first name felt too familiar and too casual, so I chose to be "Mrs. X."

It worked fine. I reasoned that children didn't call their teachers or their doctors by their first names, and it set a tone of equal professionalism. When meeting a family for the first time, I would simply say, "Hello. I'm Mrs. X, the nurse practitioner." No room for misinterpretation.

[live love laugh]

12. "Provider" language allows nurse practitioners to replace MDs.

It’s BS.

[Ms. Toad]

24. Not really.

It is the licensing laws which govern what care nurse practitioners (physician assistants, etc.) are able to provide - not what they are called by insurance companies.

[live love laugh]

38. Their capabilities and licensure is not what I referred to.

I’m talking about the companies that they work for—or the insurance companies that they or the companies they work for—associate with. It’s those companies that prioritize care assignment to the cheapest “providers” and minimizing usage of full-page MDs and the most expensive healthcare pros.

[Ms. Toad]

40. My point is that licensure is a prerequisite to being covered by insurance.

If the state limits the prescribing ability of a nurse practitioner, for example, the insurance companies can't decide that s/he can fill that role. So the limits of care are imposed by state law.

I have never personally been limited, by any of the dozen or so insurance companies I've used - and now Medicare, to seeing someone with training less than an MD. I often have that option. It is often faster than seeing an MD. And, to be honest, the doctors I see often push it. One of those doctors pushing NP visits, rather than seeing him, also pushes seeing a NP for bloodwork so they can charge an office visit (at the time I was having daily blood draws). Since my insurance at the time didn't require it I have gone to a separate lab to have bloodwork drawn without paying for an office visit.

[live love laugh]

41. I'm talking about the companies / hospitals etc. that they work for offering

the lower-paid providers first — often without notice that an actual doctor is not being scheduled unless, in my case, I ask before scheduling to ensure that I see a doctor.

[Ms. Toad]

43. Again, it isn't the language "provider" that allows them to do that.

It is what the state licensing laws permit.

If the state licensing laws permit certain care to be provided by someone other than a doctor, the entity you go to can use a person with that training to provide it. It has nothing to do with the term "provider" (the claim in the post to which I initially responded). It has to do with practice area as defined by the state licensing laws, and choices made by the hospital, doctor's office, etc. you go to.

If you don't like their practices, go to a different hospital or doctor's office which strictly employs MDs.

I receive care from individuals with a variety of licensing. An MD with a specialty for radiation follow-up, two nurse practitioners for breast cancer follow-up (surgical and oncological), a physician's assistant for some of my sarcoma care, a DO for my primary care. That's just off the top of my head. In each case, the level of training is appropriate for the care they are providing. One of the nurse practitioners is one of my current favorite health care practitioners. Both of the nurse practicioners spend far more time with me than the doctors, and have all of the knowledge necessary to provide the care they are providing.

I haven't yet seen the nurse practitioner in my primary care doctor's office - but if I had suspected flu, COVID, or something similar I would be quite happy to see her rather than wait a couple of days to see the doctor.

[live love laugh]

45. I didn't say the "language" "allowed" it. I said they assign the lower paid providers.

[Ms. Toad]

47. From the first post I responded to:

"Provider" language allows nurse practitioners to replace MDs.

[live love laugh]

52. Language encompasses a broad range of meanings.

Last edited Fri May 19, 2023, 05:37 AM - Edit history (1)

It can mean the reference to a set of established procedures.

So that: A facility or hospital adheres to language from their own body of written procedures that guides them to make decisions such as offering lower paid professionals first.

This is not something I have experienced alone. It’s also happened to friends and family at different medical facilities. It is not an isolated practice.

[Ms. Toad]

53. I didn't suggest it was an isolated practice.

Just that it is licensing, not the term provider, that allows them to do this.

[Bev54]

13. Thank you for opening our eyes to the word "Provider" as we mindlessly listen to it

all the time and never thinking about what they are doing. Anyone you know, looking to get out, Canada is always looking for Medical Professionals.

[MOMFUDSKI]

16. I have asked every doctor

How they like the insurance companies running their biz. They will carefully answer “not so much”. SOMEONE has to say it out loud.

[Warpy]

17. You've touched on two things: being dehumanized and burnout

Being dehumanized started shortly after WWII ended, when we stopped being customers and started being consumers. It's an important distinction, the former had agency and if they didn't like what you were selling, they didn't buy it. The latter were braindead morons to be manipulated and totally zombified into buying your crap, whether they needed it or not.

It has since metastasized into dehumanizing most of us in one way or another, all cogs in a giant machine dedicated to making some remote asshole richer.

And now the whole thing has gotten even nastier. Once we've been dehumanized and turned into mere things, it becomes easier to threaten our livelihoods with retribution if we do our jobs properly, as we were educated to do them, because it violates some arbitrary and often shifting rule laid down by the morality police. The DEA leaning on doctors is one example. The new and idiotic antiabortion laws are another. Both violate standards of care.

And that is leading to massive burnout and not only among "providers." Dehumanized people under constant external threat burn out very quickly, become angry or apathetic toward the whole system, and lash out.

And yeah, we've all wanted to get out of Dodge somehow. We called it earning a GOON* degree.

(Get Out Of Nursing)

[raging moderate]

18. Those who want to dictate medical practice to doctors should go to medical school first.

In order to become a speech/language therapist, I had to take a couple of beginner-level courses at the local medical school, with dissection of a few small body parts. In order to pass these courses, I had to memorize the course textbooks and a few chapters of Grey's Anatomy. I kept Grey's Anatomy and the course textbook propped open in my dining area and memorized a page or two every time I passed that counter. Grey's Anatomy is HUGE AND HIGHLY TECHNICAL, WITH MANY CHAPTERS. And medical school requires a person to MEMORIZE the whole book. Plus the relevant texbooks, plus supervised dissection of MANY body parts and whole corpses, plus supervised practice, etc., etc., etc. And medical school students are supposed to win bachelor"s degrees with high grades in very technical undergraduate majors BEFORE entering medical school. And then they are required to do an internship and a residency and a special fellowship training program, too! I will NEVER understand how ANYBODY else can pretend to know enough to tell doctors how to practice medicine.

[Scottie Mom]

19. Well, I have a Juris Doctorate, but...

...have never been called "doctor" or "provider."

However: The terms reserved for attorneys are usually less kind and more vulgar than either of the above!

[kooth]

20. Thanks

I hear you, and I appreciate today's post (and all of your posts in general.) There are a lot of us who understand, to a degree, what you're going through.

As a patient, I see the crap that insurance "providers" pull with me and other acquaintances; I have spoken with nurses, technicians, and other people who assist in the various practices I visit, and they say the same things as you said in your post. I for one am amazed at what doctors are able to do, and I respect them and root for them to have better control and a lot less oppression from insurance companies.

Hang in there!

Sincerely,

Keith E. Cooper

[Delmette2.0]

21. I understand.

I get phone calls sometimes from "Healthcare."
Really which one? Perhaps they are trying to sell me something. Perhaps it is the administration assistant calling me. To bad, I really hate answering the phone that appears to be a local number only to had
someone telling me about my "car warranty". Leave a message.

[mwooldri]

25. Kinda understand (not totally tho) where you're coming from.

Wifey is per her doc (well our family doc as we all see the same guy) "pre diabetic" but borderline being Type 2. Sugars up and down all over the place. Metformin wasn't helping. Doc wanted her to try something with semaglutide in it (picked Mounjaro to use). Yes she got a few of those to lose too. Doc and wifey think it's a good medication and she's seeing good results from it. Sugar isn't so up and down and yes it is helping with kick-starting some weight loss. Yet what does the medical plan people say? Nope! Not covering that! She isn't officially Type 2. Wifey is getting by with a coupon from the manufacturer for now... And Doc is equally frustrated. After all... He's been through how many years of med school? How many years of residency? How many years of service in the Navy? How many years of service in private practice? Isn't it darned well possible that he knows a thing or two? Given his experience he probably knows a thing or two about a thing or two. Yet some "health insurance" company thinks they know better than he does when it comes to patient care? The same private healthcare business that probably collectively made in profit the same amount of money the UK government uses to fund the entirety of NHS England... ?? I think the health insurance companies if they're gonna use a better word than healthcare providers for doctors, nurses etc, then how about sugar daddies and sugar mommas? After all without healthcare professionals the insurance companies and the for profit healthcare companies couldn't rake in the obscene profits that they do.

No, PCIntern, you aren't a "provider". Neither is our family doctor (Stephen Fry - same name as a certain English "Entertainment Provider&quot . And yes it's OK to be grumpy. But now I'm rambling.

[BeckyDem]

26. I'm not sure you're cynical at all.

Realistic and safely circumspect actually....that is what horrifies me about our nationwide issues.



K&R

[Joinfortmill]

29. I hear you.Timely too. Doctors are getting scarce.

[Rhiannon12866]

30. I had no idea what that term even meant

During the pandemic lockdown I became very sick. I called my doctor's office, but they wouldn't see me when I said I was congested because - Covid! So they sent me to a walk in clinic who said they couldn't do anything for me(!) and sent me to the ER at the hospital - which turned out to be a nightmare.

They did do a chest X-Ray, but then after a long wait, this very young woman led me to an exam room somewhere in the hospital and gave me a Covid test and an inhaler. And that's where I sat, waiting, for what seemed like an eternity, struggling to breathe and watching the clock. Every half hour or so, I ventured out and this same girl, without even looking at me, said I needed to wait for "the provider." WTF was that? Was it a religious thing??

After a few hours, a woman came in, and finally took action. She informed me that I had the flu, "Type A" specifically (though I'd had a flu shot as well as the Moderna vaccine), and someone else arrived with a nebulizer to help me breathe which was what I had originally hoped they would do at my doctor's office. And they couldn't have been nicer - apparently this woman who I think was a PA was my "provider." I will never, ever go there again.

[RainCaster]

31. I understand completely

My daughter works in a clinic where they call them "providers" and the whole culture seems rather demeaning to me. For everyone.

[Haggis 4 Breakfast]

32. Dear PCIntern

Thank you for your spirited post. I always know that when you post, I will learn something. Today is no exception.

I think that as a nation, we are too concerned with appropriately "labeling" people with whatever cutesy fad vernacular is currently popular. I find much of it dehumanizing and degrading and disrespectful. You raise many valid points. But please allow me to take a different tack on the word "provider."

When I was a child (of Welsh and Scottish immigrants), "provider" meant Dad, as in who provided the roof over our heads, the food on the table and the direction of our young lives. It was Dad who provided moral clarity and guidance toward building character. Dad provided us with the means to grow and mature our minds and further our education. He also provided us with unconditional love and grace to grow into confident, mature, productive members of society.

My father provided me with all the tools I needed to become the person I am today. We lost him recently. But he provided us with everything a loving father could.

[Martin68]

33. Since Obamacare started, health insurers are concentrating far more on preventive care. That's a big

improvement, along with the end of the pre-existing condition excuse for cancelling or denying health care. As for the term "provider" I don't really understand your objection. Are you not a health care provider? Is that demeaning in some way that I don't understand?

[malaise]

34. The takeover by business school graduates

Last edited Fri May 19, 2023, 05:57 AM - Edit history (1)

is so vulgar that it hurts. It's everywhere - their sense of self importance is mind blowing but they also eat up (and i mean that literally) way more resources than they deserve.

To be kind they have fucked up lots of systems that worked way better before this neo-liberal bullshit.

[Iris]

51. This. And now higher Ed has cannibalized itself by creating Higher Ed professionals

Creating degrees in higher Ed admin to teach people to “run it like a business”

[malaise]

56. You nailed it

[grantcart]

36. You have provided an excellent take.

😂

[Hekate]

37. I hear you. Thanks as always for an informative & interesting post, Dr PC.

[BlueLucy]

39. I always call my primary care "Doctor."

even though she is actually a nurse practitioner. It's just habit. Nurse practitioner doesn't roll off the tongue easy. What should I call her? I had no idea it was an issue. I certainly meant no disrespect to anyone.

[3catwoman3]

59. Just ask her what she would like you to call her.

Most nurse practitioners go by their first names. I did not. Below is a copy and paste of something I posted earlier in this thread:

I started my 45 year nurse practitioner career in the Air Force nurse corps, where everyone was addressed by rank - I was Lieutenant X, then Captain X, and finally (while in the reserves), Major X.

When I left the AF after 4 years of active duty and got my first civilian job, I had to decide how I wanted people to address me. My predecessor in that job, also an NP, had let people call her "Dr. Anne." I wasn't comfortable with that, as I thought it was a misrepresentation. After being addressed by rank for 4 years, going by my first name felt too familiar and too casual, so I chose to be "Mrs. X."

It worked fine. I reasoned that children didn't call their teachers or their doctors by their first names, and it set a tone of equal professionalism. When meeting a family for the first time, I would simply say, "Hello. I'm Mrs. X, the nurse practitioner." No room for misinterpretation.

[llmart]

42. If we're talking about words and the health care field...

you should really take umbrage to them calling your business a "practice", as in "dental practice". Whenever I hear that or "medical practice" I want to say, "I hope to god they're not just practicing on me."

As an aside, my daughter is a writer for the largest medical insurance "provider" in the country and she always tells me that she is in the department that writes only for the "providers". I believe it's called "provider communications". She said she despises how they come up with terminology for various things and she is forced to use those terms.

[eppur_se_muova]

44. "Provider" reduces your role to a purely economic one.

There are "consumers" and "providers" who exchange money and services. All humanity traditionally associated with the terms "doctor" and "patient" are bleached out.

"Provider" is a term used in contracts and advertising. I have never heard it used by patients.

[halfulglas]

46. It was back in the 1990s that I first heard that term used for patients - consumers.

It came during Clinton's health care initiative. That was the term used right from the start by the insurance industry. They were acting like we had a lot of say over which health plan we could purchase, and we had to be informed consumers, when the reality was if your job provided health care there was very little choice to be an "informed consumer." They never said they were going to low ball everyone or that they would increase the grip on health care that had already started.

I don't blame you, PCIntern, for resenting the control that they have not only over patient care, but the nomenclature that we have to use because the billing codes control the payments.

But that reminds me of a story I heard from my DIL. She was part of a neighborhood group taking turns babysitting the newborn of one of her book club members. The baby was delivered by cesarean section and mother and baby were discharged I forget whether it was the next day or the day after that. Anyway, the mother developed an infection in the incision and had to be readmitted to the hospital. She first went to the emergency room and that's another story because they didn't want to admit her. She ended up in the ICU for about a week with sepsis. My DIL was upset about the surgeon. I told her that's not the real culprit. A certain amount of incisions do develop redness and infections, but if you are monitored for days before you are discharged, this is caught before there are serious problems. The problem was the insurance companies usually only allow a limited number of days after the delivery. When I had a cesarean back in the 1970s I was in the hospital for 7 days. Every day they felt my belly for tenderness, and the bandage was removed and reapplied before discharge. (I had irritation from the clips so a few were removed.) The point I tried to make to her was that it might be the surgeon (and I know many surgeons are A-holes, I know, I used to work for one), but if the infection was his fault, it would have been discovered sooner if it weren't for the mess the insurance companies have made of our health care system.

I have a good friend who used to work for an OB-GYN practice that refused to take insurance because they would not turn care control over to the insurance company. It was up to the patient to work out the payment and get reimbursed. Of course, I never asked her if there were any patients in the lower middle class who could afford this.

[lostnfound]

48. Dr Glaucomflecken

The Middlemen of Healthcare—this one is so good it hurts.

[Bluethroughu]

49. It's the Walmart model.

Diminish the value of everything, and offer a cheaper version. Pretend to live large, although the cost may be priceless.

The education and skill set, no longer have value to any entity that can afford to make big mistakes, but still make money.

This is not only happening in the medical field, but engineering, education, and many other critical jobs that shouldn't be done with flippant under educated skills or decisions.

It really does keep me up at night.

[Ilsa]

50. I can empathize, but not from a professional point of view.

I get put ouf by Human Resources calling men "men" and calling women "females" on a constant basis. Female is an adjective, not a noun. Other things are called female, including the connecting ends of cords, hoses, etc . It's dehumanizing to refer to women as "females " when men are referred to as "men."

[PCIntern]

54. Agreed...

It is for many a subtle form of degrading women and is an element of the Orwelllian mind-fuck of the jargon of today.

[SWBTATTReg]

55. Thank you for allowing us a brief snapshot into your life and what you deal w/, and

what the true cost of being a medical professional is really all about, the almighty dollar and the profit motive. It's a sad picsture and disturbing.

Thanks again.

[area51]

57. k&r n/t

[ismnotwasm]

60. Do you visit r/residency on Reddit?

Cause those folks spent an inordinate amount of time complaining about mid levels.—whether it is a NP with a doctorate or a PA running an ED somewhere

You are not wrong, of course. Insurance companies literally do not want to pay Doctors what they are worth (the other issue is rural and other challenging areas not having enough providers available, still, if it paid enough they would come)

[leftyladyfrommo]

63. Doctor is one of the top 10 jobs people think are great but

which really are horrible.

I can't remember all of the others but veterinarians and police and journalists are on there, too

[Caliman73]

64. Understand, however...

Provider is a more generic term because of the increases in Physician's Assistants and Nurse Practitioners who are being assigned as primary care providers.

When we use the term we are simply using the widest possible term for those who are sanctioned to provide primary medical care. We can't say, "Who is your doctor?" when we know that most of the people providing care in a clinic are RNPs or PAs.

I respect the work and education that Doctors, Physician Assistants, Nurse Practitioners, Nurses, etc... put in. I think it is a separate issue from the denigration of expertise which seems to be coming primarily from the Right.

[PCIntern]

65. I understand your post, and in large part agree

With much of what you were saying. However, and there is always a however, nothing can substitute for competent experienced clinical care by someone who’s been trained academically, medically, and experientially. I am not saying that they are not extraordinarily competent ancillary staff who do a magnificent job for the most part in all phases of medicine. All that being said, I cannot tell you how many times I have been having a reasonable discussion with support personnel, medical and dental, and when a subject or opinion is posited, I respond with some information from my academic, clinical, and research background which changes the complexion of the discussion in its entirety.

I’ll make an example: many dental offices are what they call, amalgam free, that means that the mixture of silver, tin, and mercury, which most people know as “silver fillings“ is not used. I understand this, although I disagree with it in extremis. There are some instances in which amalgam is a vastly superior material to composite, particularly to keep things simple, when placed where moisture cannot be avoided. There are in fact many instances where this is the case in dentistry. People who manage offices which are amalgam free, when faced with the need for amalgam placement or failure often will choose the course of failure, because they will not accede to the fact that on occasion, you have to use the material in order to attain success. I myself work in such an office and have supervised and placed myself in positions where and I know that this is just to put it simply, “not going to work over time”. As an employee, I have virtually no say in this matter, although I do in fact, know better . Yes, I can stand my ground, and it will be just one more nail in my coffin for when they eventually fire me, and I have chosen not to enter into that argument at this time. This is but a microcosm of how it “works in the medical and dental field”.