Physician quality and experience

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jacoavlu
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Re: Physician quality and experience

Post by jacoavlu » Sat Aug 24, 2019 9:05 am

Physician here. Years in private practice have made me a better doc no doubt, faster, more efficient, better at the “art” but I’m not sure I’m any better at the “science.” For the rare stuff, I (only half) joke that I get a little dumber every day since the board exam I studied months for and took at the end of training.

It’s also only a half joke that if you’re at some big academic center, you probably want the senior fellow operating on you, not the chairman of surgery.

I would advise you to give the new doc a try.

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dm200
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Re: Physician quality and experience

Post by dm200 » Sat Aug 24, 2019 1:39 pm

fasteddie911 wrote:
Sat Aug 24, 2019 7:31 am
dm200 wrote:
Fri Aug 23, 2019 12:06 pm
According to my PCP, dealing with Cardiologists, she noted that younger cardiologists tend to order and want more tests and more invasive types of theses - such as CT scans. In my case, I did not want to be unnecessarily bombarded with excess X-Rays from a CT scan. My PCP then made a referral for me to see an older cardiologist, who did not believe a CT scan of my heart was needed. :happy
Not sure of the details of your case, but this could also be an example of younger doctors being more up-to-date and/or older doc stuck in their ways. Something like a cardiac CT is relatively new (non-invasive btw) test, whereas old school method could be a cath, stress test, etc. Nevertheless, I haven't seen older docs practice any more or less aggressively than younger ones. In fact, I know a great veteran doc who started practicing more aggressively (ordering tests, etc.) after he lost a malpractice case. Every doc has their own style and it's about finding one that suits you.
OK - CT scan not "invasive", but potentially harmful from high exposure to X-Rays.

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dm200
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Re: Physician quality and experience

Post by dm200 » Sat Aug 24, 2019 1:47 pm

A part of the "quality" of a Physician, in my opinion and experience, is how well or how poorly he/she communicates (both directions) with patients. I believe (just my opinion and experience) this "communication" with patients is more important for Primary Care Physicians.

I believe female Physicians tend to be better with such patient communication - which is one reason I lean slightly towards Female Primary Care Physicians. This "leaning" works very well with my Kaiser plan, since about 2/3 of the Kaiser Primary care Physicians in this area are female.

Over time and experience, some Physicians get better at such patient communication, while others do not - and even become more set in their ways.

hmw
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Re: Physician quality and experience

Post by hmw » Sat Aug 24, 2019 1:57 pm

TheNightsToCome wrote:
Fri Aug 23, 2019 11:48 pm
A physician fresh out of training may be very good. How good depends on the individual and the training rec'd.

However, any physician who isn't better after 5-10 years of practice is doing something wrong.
Agree!

coffeeblack
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Re: Physician quality and experience

Post by coffeeblack » Sat Aug 24, 2019 2:23 pm

JPH wrote:
Fri Aug 23, 2019 2:43 pm
A complicated question, but most evidence suggests a slow decline in quality of care as years in clinical practice increase. However, I don't know of any study focusing on recent fellowship graduates. Medical information increases at a tremendous rate, and the half life of medical knowledge is relatively brief. A lot of continuing medical education is woeful. See for example the study summarized here: https://www.ncbi.nlm.nih.gov/pubmed/15710959
I would disagree that quality of care declines as years in practice increase. I would especially disagree in hospital and outpatient surgical care. It's like anything else. The more you do it, the better you get at it. In cognitive specialties it's really the same.

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dm200
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Re: Physician quality and experience

Post by dm200 » Sat Aug 24, 2019 2:32 pm

hmw wrote:
Sat Aug 24, 2019 1:57 pm
TheNightsToCome wrote:
Fri Aug 23, 2019 11:48 pm
A physician fresh out of training may be very good. How good depends on the individual and the training rec'd.
However, any physician who isn't better after 5-10 years of practice is doing something wrong.
Agree!
Makes sense to me as well.

How to "know" if he/she is "doing something wrong"?

I suppose that additional or ongoing "education" for Physicians costs money directly (paying for it - maybe including travel costs) and indirectly (no patient revenue/income while at such education/training)

TheNightsToCome
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Re: Physician quality and experience

Post by TheNightsToCome » Sat Aug 24, 2019 5:34 pm

dm200 wrote:
Sat Aug 24, 2019 2:32 pm
hmw wrote:
Sat Aug 24, 2019 1:57 pm
TheNightsToCome wrote:
Fri Aug 23, 2019 11:48 pm
A physician fresh out of training may be very good. How good depends on the individual and the training rec'd.
However, any physician who isn't better after 5-10 years of practice is doing something wrong.
Agree!
Makes sense to me as well.

How to "know" if he/she is "doing something wrong"?

I suppose that additional or ongoing "education" for Physicians costs money directly (paying for it - maybe including travel costs) and indirectly (no patient revenue/income while at such education/training)
"I suppose that additional or ongoing "education" for Physicians costs money directly (paying for it - maybe including travel costs) and indirectly (no patient revenue/income while at such education/training)"

That was more or less true not so many years ago, and physicians can still attend out-of-town CME meetings if desired. However, there are many more options now.

For example, I purchased an online CME series from Mayo recently. It contains every lecture from their last echo board review meeting, and I can view it online (at home, nights and weekends) and then take an online test for CME credit. It saves me the time and expense of airline tickets, rental cars, and hotels -- and it's better than being there because I can stop the video and rewind if I miss something or lose my concentration.

In fact, I recently went back to one of the lectures to review material germane to the care of a patient with an uncommon problem. It's terrific.

The American College of Cardiology has many similar CME offerings, as well as daily updates on the latest literature in bite-sized nuggets, albeit without CME credit.

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southerndoc
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Re: Physician quality and experience

Post by southerndoc » Sat Aug 24, 2019 5:39 pm

The credentialing process for a new provider at my health system takes 3-6 months.

It can be painfully slow even for someone with no criminal record, clean financial history, etc.

jayk238
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Re: Physician quality and experience

Post by jayk238 » Sat Aug 24, 2019 7:37 pm

DesertDiva wrote:
Fri Aug 23, 2019 6:48 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
DesertDiva wrote:
Fri Aug 23, 2019 5:35 pm
newdoc wrote:
Fri Aug 23, 2019 2:10 pm
I'm a new doc and I have to say, personally I generally advise my family members to seek someone with around 15 years experience, particularly if it's in a procedure based specialty. At 15 yrs a doc is young enough to be familiar with newer technologies but experienced enough to, well, know what they're doing, frankly.
I'm not a doctor, but I've had plenty of experience on the consumer side of things. And I have stayed at a Holiday Inn Express a few times.

I like NewDoc's approach to find someone who isn't fresh out of med school. Even with 5 years experience, I would be happier (> 10,000 hours of real world experience). I would even be more content with a Physician's Assistant who had some years under his/her belt.

Personal experience: our family practice clinic (in another state) hired a new grad. My husband had some odd symptoms and Dr Youngster dismissed them as a side-effect of medications. About 5 months later we moved across the country, and the symptoms never changed but steadily worsened. Our new family practice doctor, probably in her mid-40's, followed up with some tests. As a result, my husband learned he had a rare and aggressive form of lymphoma and was given days to live. Thankfully he did survive, but the journey was traumatic and difficult. I often wonder if his treatment would have been less severe if either 1) Dr Youngster had been a bit more experienced, or 2) if my husband had seen an older, more seasoned doc.

My $0.02 worth. Peace.
I find it almost absurd to recommend a pa w few years experience over a new doctor.

Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Not trying to be insulting - I have respect for anyone who makes it out of med school - but what good is recommending the latest therapies/treatments if you don't have the acumen to properly diagnose a problem in the first place? That's the crux of the matter.

Personally, I believe that a doctor should have "critical thinking" abilities to get to the root cause of a matter. Experience would enable a doctor to develop this skill more effectively.
This is indicative of how little is understood about what doctors do in training. There is no residency for PA. All of what they learn is largely at the behest of volunteer hospitals and private clinics that offer to teach pas while in school during their clinicals. Thats it. No guarantee that the one pa student at the local va surgical rotation is learning the same as a pa at an ambulatory surgical rotation (hint neither is enough). Most of what they learn is during employment with a provider who teaches them not what helps them diagnose best but whats best for that offices bottom line including asking the specific questions that doctor wants them to.

A physician has 3 years or more of residency where they are closely monitored with the express idea to help them practice independently.

I have learned through my residency what questions and what physical exams are highest value because when i was the sole doctor on call in the hospital in the middle of the night at a community rural hospital you can bet the only thing keeping that crashing patient alive was my physical skills acumen.

Tell me, what you want in your provider now?

This is the problem with healthcare today. So little is understood what goes on behind the scenes.

Much of it is because hospitals are terrified of letting the media see this chaos and are content to not advertise but if society could see what we cannot adequately ever describe well enough the respect for our profession would be even higher.

jayk238
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Re: Physician quality and experience

Post by jayk238 » Sat Aug 24, 2019 7:40 pm

dm200 wrote:
Sat Aug 24, 2019 1:47 pm
A part of the "quality" of a Physician, in my opinion and experience, is how well or how poorly he/she communicates (both directions) with patients. I believe (just my opinion and experience) this "communication" with patients is more important for Primary Care Physicians.

I believe female Physicians tend to be better with such patient communication - which is one reason I lean slightly towards Female Primary Care Physicians. This "leaning" works very well with my Kaiser plan, since about 2/3 of the Kaiser Primary care Physicians in this area are female.

Over time and experience, some Physicians get better at such patient communication, while others do not - and even become more set in their ways.
Does it matter that more female providers are part time than their male counter parts or have to take more time off after birth ? Does this delay the 5-10 year rule? Is there no meaningful connection? Just asking.

jayk238
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Re: Physician quality and experience

Post by jayk238 » Sat Aug 24, 2019 7:47 pm

sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.

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BolderBoy
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Re: Physician quality and experience

Post by BolderBoy » Sat Aug 24, 2019 9:03 pm

sawhorse wrote:
Thu Aug 22, 2019 11:19 pm
My condition is rare.
Define "rare".

1:1000, 1:10000, 1:billion?
"Never underestimate one's capacity to overestimate one's abilities" - The Dunning-Kruger Effect

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sawhorse
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Re: Physician quality and experience

Post by sawhorse » Sat Aug 24, 2019 9:37 pm

BolderBoy wrote:
Sat Aug 24, 2019 9:03 pm
sawhorse wrote:
Thu Aug 22, 2019 11:19 pm
My condition is rare.
Define "rare".

1:1000, 1:10000, 1:billion?
I saw two figures that were far apart, and neither cited a source, so I don't know if I can trust them.

It's on the National Organization for Rare Diseases page (www.rarediseases.org), but the website doesn't list a figure.

toofache32
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Re: Physician quality and experience

Post by toofache32 » Sat Aug 24, 2019 10:04 pm

Swansea wrote:
Fri Aug 23, 2019 8:29 am
I rely heavily on where the doc did residency for my choices.
How do you find out which are the good residencies for a particular specialty? For example, in my surgical specialty, Harvard is the laughing stock of the USA, although everyone has heard the name Harvard.

Swansea
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Re: Physician quality and experience

Post by Swansea » Sun Aug 25, 2019 6:49 am

toofache32 wrote:
Sat Aug 24, 2019 10:04 pm
Swansea wrote:
Fri Aug 23, 2019 8:29 am
I rely heavily on where the doc did residency for my choices.
How do you find out which are the good residencies for a particular specialty? For example, in my surgical specialty, Harvard is the laughing stock of the USA, although everyone has heard the name Harvard.
That is a good point that I had not considered. Is there a way for lay people to discern this?

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JPH
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Re: Physician quality and experience

Post by JPH » Sun Aug 25, 2019 7:08 am

jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
This is very important. The physician must develop the skills needed to quickly answer a clinical question when the need arises. You can't rely on being spoon fed the right information at some for-profit CME course at a golf resort or by answering one or two easy questions on an internet site.
While the moments do summersaults into eternity | Cling to their coattails and beg them to stay - Townes Van Zandt

jayk238
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Re: Physician quality and experience

Post by jayk238 » Sun Aug 25, 2019 7:41 am

JPH wrote:
Sun Aug 25, 2019 7:08 am
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
This is very important. The physician must develop the skills needed to quickly answer a clinical question when the need arises. You can't rely on being spoon fed the right information at some for-profit CME course at a golf resort or by answering one or two easy questions on an internet site.
Internet site questions? Which ones are you referring to out of curiosity. Id like to check them out ;)

Ophiuchus
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Re: Physician quality and experience

Post by Ophiuchus » Sun Aug 25, 2019 8:50 am

sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I believe that it depends on how a physician trained or previous experiences. Working in a clinic for the uninsured. We were forced to use older medications first since they were cheaper or on the walmart 4 dollar list.

toofache32
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Re: Physician quality and experience

Post by toofache32 » Sun Aug 25, 2019 9:10 am

Swansea wrote:
Sun Aug 25, 2019 6:49 am
toofache32 wrote:
Sat Aug 24, 2019 10:04 pm
Swansea wrote:
Fri Aug 23, 2019 8:29 am
I rely heavily on where the doc did residency for my choices.
How do you find out which are the good residencies for a particular specialty? For example, in my surgical specialty, Harvard is the laughing stock of the USA, although everyone has heard the name Harvard.
That is a good point that I had not considered. Is there a way for lay people to discern this?
I doubt it.

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JPH
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Re: Physician quality and experience

Post by JPH » Sun Aug 25, 2019 9:38 am

jayk238 wrote:
Sun Aug 25, 2019 7:41 am
JPH wrote:
Sun Aug 25, 2019 7:08 am
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
This is very important. The physician must develop the skills needed to quickly answer a clinical question when the need arises. You can't rely on being spoon fed the right information at some for-profit CME course at a golf resort or by answering one or two easy questions on an internet site.
Internet site questions? Which ones are you referring to out of curiosity. Id like to check them out ;)
I have not taken this course but it is one that I can find quickly. It may be one of the good ones.
http://learn.elseviercme.com/801c
While the moments do summersaults into eternity | Cling to their coattails and beg them to stay - Townes Van Zandt

jayk238
Posts: 612
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Re: Physician quality and experience

Post by jayk238 » Sun Aug 25, 2019 9:49 am

JPH wrote:
Sun Aug 25, 2019 9:38 am
jayk238 wrote:
Sun Aug 25, 2019 7:41 am
JPH wrote:
Sun Aug 25, 2019 7:08 am
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm

Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
This is very important. The physician must develop the skills needed to quickly answer a clinical question when the need arises. You can't rely on being spoon fed the right information at some for-profit CME course at a golf resort or by answering one or two easy questions on an internet site.
Internet site questions? Which ones are you referring to out of curiosity. Id like to check them out ;)
I have not taken this course but it is one that I can find quickly. It may be one of the good ones.
http://learn.elseviercme.com/801c
Interesting. Ive never seen these before. I cant imagine busy providers stick w these. Instead i follow what the abim or acp provide -mksap 17 etc.

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: Physician quality and experience

Post by coffeeblack » Sun Aug 25, 2019 12:01 pm

jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
"Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost. "

Is it the doctors job to check all the insurance companies rules? Those new drugs you mention are very expensive. If physicians had more time and patients took more responsibility for their health perhaps we would not need so many new diabetes drugs. It is so obvious that the first rule of medicine is prevention. Especially in a disease that can be mostly prevented in the majority of the world. Yet it continues to grow.

arsenalfan
Posts: 774
Joined: Mon Dec 09, 2013 12:26 am

Re: Physician quality and experience

Post by arsenalfan » Sun Aug 25, 2019 12:16 pm

BionicBillWalsh wrote:
Thu Aug 22, 2019 11:24 pm
Meet with her. See what she has to say. Coming out of fellowship, she'll be competent. You just have to determine if she's a good fit for you.

If not, you're not married to her. Move on.
+1

I see a different HVAC/oil change mechanic/plumber/refrigerator/computer repair person every visit. Many in their 20s.

With the corporatization/venture capital groups buying medical practices, truth is that doctors are just another laborer as above.

Regarding medicines, depends on their employment. If they are an employee of a cost-containment system like Kaiser, they will have to try generics first/lower cost meds. Some hospitals don't even have the expensive stuff on formulary (IV Tylenol, ropivicaine) as they will not absorb the cost.

As a physician, I would not hesitate to see a younger MD. Training in the 2000s, we were taught "pain is the 5th vital sign" and it should always be assessed/minimized. 15 years later, voila: opioid crisis, and "a little pain is ok".

txbabe
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Re: Physician quality and experience

Post by txbabe » Sun Aug 25, 2019 12:27 pm

A physician coming out of fellowship is not inexperienced. They have gone to 4 years of medical school, 3 -7 years of residency and then probably another two years of fellowship. They are probably up-to-date on the newest research and treatment. They have probably just studied like crazy and passed their specialty boards. I would have no problem seeing a newly graduated fellow and then making my mind up if I liked them as my doctor or not.

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ram
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Re: Physician quality and experience

Post by ram » Sun Aug 25, 2019 1:05 pm

In most professions 10 years after college would be considered 'experienced'
Specialist physicians have that much experience on day 1 of the job. ( 4 years of med school, 3 yrs residency and usually 3 yrs fellowship)

For primary care it would be 4 years on medical school and 3 years of 80 hours/ week of residency . This would be the equivalent of 6 yrs of 40hrs/week work.

A brand new MD has (college +7 years) at least 5 more years of patient contact time than a brand new PA. (college +2 years).
Ram

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dm200
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Re: Physician quality and experience

Post by dm200 » Sun Aug 25, 2019 1:59 pm

ram wrote:
Sun Aug 25, 2019 1:05 pm
In most professions 10 years after college would be considered 'experienced'
Specialist physicians have that much experience on day 1 of the job. ( 4 years of med school, 3 yrs residency and usually 3 yrs fellowship)
For primary care it would be 4 years on medical school and 3 years of 80 hours/ week of residency . This would be the equivalent of 6 yrs of 40hrs/week work.
A brand new MD has (college +7 years) at least 5 more years of patient contact time than a brand new PA. (college +2 years).
Thanks.

Interesting way to look at the issue. I now feel better about past, present and future dealing with young Physicians. :happy

jayk238
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Re: Physician quality and experience

Post by jayk238 » Sun Aug 25, 2019 3:47 pm

coffeeblack wrote:
Sun Aug 25, 2019 12:01 pm
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
"Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost. "

Is it the doctors job to check all the insurance companies rules? Those new drugs you mention are very expensive. If physicians had more time and patients took more responsibility for their health perhaps we would not need so many new diabetes drugs. It is so obvious that the first rule of medicine is prevention. Especially in a disease that can be mostly prevented in the majority of the world. Yet it continues to grow.
If i prescribe something and pt wont take it becauae they cant afford it then its no different than not prescribing it. So yes. Knowledge about diabetes drugs and insurance is unfortunately part of my job

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Re: Physician quality and experience

Post by DesertDiva » Sun Aug 25, 2019 5:33 pm

jayk238 wrote:
Sat Aug 24, 2019 7:37 pm
There is no residency for PA. All of what they learn is largely at the behest of volunteer hospitals and private clinics that offer to teach pas while in school during their clinicals. Thats it... Most of what they learn is during employment with a provider who teaches them not what helps them diagnose best but whats best for that offices bottom line including asking the specific questions that doctor wants them to.
Two PAs I've worked with have been exceptional. One worked at a practice I used to go to (before my insurance changed) and had at least 15 years experience. He listened attentively, made appropriate recommendations and didn't jump into any area outside of his realm of expertise. He graduated from a major medical school in Michigan. If I still had my previous insurance plan, I wouldn't hesitate to see him again if a doctor in the office wasn't available.

I dealt with another PA at Mayo Clinic. He worked on my husband's oncology team, and I had daily communication with him at the onset. Also, the doctor who led the initial care team was a bit younger; however, I knew that Mayo's approach to patient care meant that my husband's case was getting a collaborative approach and both the new doctor and the PA were working in unison with top-notch professionals.
Tell me, what you want in your provider now?
Glad you asked. Here's what I look for in a provider:
  • Experience - "I've seen this before and I know what direction this may be heading. I know what tests/labs to order, and I'm comfortable knowing I can provide appropriate treatment/meds/etc. I know other doctors who may need to get involved."
  • Critical thinking skills - "There may not be a issue, yet there could be a problem larger than the symptoms indicate. I need to investigate further."
  • Humility + willingness to collaborate - "This is out of my league - I need to consult a mentor/specialist/etc. or check articles on NIH's website, etc."

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Munir
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Re: Physician quality and experience

Post by Munir » Sun Aug 25, 2019 6:55 pm

txbabe wrote:
Sun Aug 25, 2019 12:27 pm
A physician coming out of fellowship is not inexperienced. They have gone to 4 years of medical school, 3 -7 years of residency and then probably another two years of fellowship. They are probably up-to-date on the newest research and treatment. They have probably just studied like crazy and passed their specialty boards. I would have no problem seeing a newly graduated fellow and then making my mind up if I liked them as my doctor or not.
When health professionals comment in this forum about "experience" they usually are referring to the years in clinical practice spent treating patients AFTER completing all your training and not the years IN training in your specialty or medical school. Yes, they are long years and cannot be compared to other careers when you may be counting years after high school or college as experience.

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sawhorse
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Re: Physician quality and experience

Post by sawhorse » Sun Aug 25, 2019 10:08 pm

Munir wrote:
Sun Aug 25, 2019 6:55 pm
txbabe wrote:
Sun Aug 25, 2019 12:27 pm
A physician coming out of fellowship is not inexperienced. They have gone to 4 years of medical school, 3 -7 years of residency and then probably another two years of fellowship. They are probably up-to-date on the newest research and treatment. They have probably just studied like crazy and passed their specialty boards. I would have no problem seeing a newly graduated fellow and then making my mind up if I liked them as my doctor or not.
When health professionals comment in this forum about "experience" they usually are referring to the years in clinical practice spent treating patients AFTER completing all your training and not the years IN training in your specialty or medical school. Yes, they are long years and cannot be compared to other careers when you may be counting years after high school or college as experience.
Yes, the only experience I would consider really relevant to my decision is the fellowship. She was probably exposed to little if any cases of my type in medical school. Internal medicine residencies are usually a lot more general. The fellowship is probably the only time she would have seen patients like me, and I don't know how many she would have seen.

coffeeblack
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Re: Physician quality and experience

Post by coffeeblack » Mon Aug 26, 2019 12:52 am

jayk238 wrote:
Sun Aug 25, 2019 3:47 pm
coffeeblack wrote:
Sun Aug 25, 2019 12:01 pm
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm
jayk238 wrote:
Fri Aug 23, 2019 6:43 pm
Im an internist and most often the comment i receive from patients is that i am more up to date and aware of recent therapies than experienced docs.
Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
"Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost. "

Is it the doctors job to check all the insurance companies rules? Those new drugs you mention are very expensive. If physicians had more time and patients took more responsibility for their health perhaps we would not need so many new diabetes drugs. It is so obvious that the first rule of medicine is prevention. Especially in a disease that can be mostly prevented in the majority of the world. Yet it continues to grow.
If i prescribe something and pt wont take it becauae they cant afford it then its no different than not prescribing it. So yes. Knowledge about diabetes drugs and insurance is unfortunately part of my job
See that's where I see it differently. It's part of your job to give medical advice, do medical procedures and/or write for medications etc. That's medicine. Anything beyond that is not medicine. It's the burden the system has placed on you and you have chosen to accept it. No just you personally. The entire medical profession. There is little to no representation, so you get to carry the burden. That's not your job. I know physicians want to be altruistic. But what is it costing the healthcare system?

Topic Author
sawhorse
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Re: Physician quality and experience

Post by sawhorse » Mon Aug 26, 2019 1:08 am

coffeeblack wrote:
Mon Aug 26, 2019 12:52 am
jayk238 wrote:
Sun Aug 25, 2019 3:47 pm
If i prescribe something and pt wont take it becauae they cant afford it then its no different than not prescribing it. So yes. Knowledge about diabetes drugs and insurance is unfortunately part of my job
See that's where I see it differently. It's part of your job to give medical advice, do medical procedures and/or write for medications etc. That's medicine. Anything beyond that is not medicine. It's the burden the system has placed on you and you have chosen to accept it. No just you personally. The entire medical profession. There is little to no representation, so you get to carry the burden. That's not your job. I know physicians want to be altruistic. But what is it costing the healthcare system?
Depending on the specialty and the problem, increasing prescription compliance can be a major part of improving outcomes. I would certainly want my doctor to take cost into consideration when it might be impossible to comply due to the cost. The most promising drug for one of my conditions costs over $4k a month, and insurance won't cover it. So it's obviously not an option. I would consider it bad medicine if the doctor said, "It's only my job to tell you what's most effective and give you a prescription for it. Can't afford it? That's not my problem." Thankfully she didn't.

In terms of what it's costing the health system, it's costing a lot less if doctors choose less expensive treatments if there is evidence they are just as good, and it costs a lot less if patients are compliant with the prescriptions.

That said, I don't expect doctors to keep up with all the prices. Some medications have surged 55x overnight. There was a proposed law in a state, Louisiana I think, where doctors would get a printout each month of how much each of their prescribed drugs cost the patient and the insurer. I don't think it passed. I think it would have been a good idea.

Anyway, that's another topic. I still have to decide which doctor to ask for. I would still prefer a more experienced doctor, but it sounds like the newbie will probably be fine too.

How much longer would you be willing to wait to see an experienced doctor vs a newbie?

coffeeblack
Posts: 122
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Re: Physician quality and experience

Post by coffeeblack » Mon Aug 26, 2019 1:43 am

sawhorse wrote:
Mon Aug 26, 2019 1:08 am
coffeeblack wrote:
Mon Aug 26, 2019 12:52 am
jayk238 wrote:
Sun Aug 25, 2019 3:47 pm
If i prescribe something and pt wont take it becauae they cant afford it then its no different than not prescribing it. So yes. Knowledge about diabetes drugs and insurance is unfortunately part of my job
See that's where I see it differently. It's part of your job to give medical advice, do medical procedures and/or write for medications etc. That's medicine. Anything beyond that is not medicine. It's the burden the system has placed on you and you have chosen to accept it. No just you personally. The entire medical profession. There is little to no representation, so you get to carry the burden. That's not your job. I know physicians want to be altruistic. But what is it costing the healthcare system?
Depending on the specialty and the problem, increasing prescription compliance can be a major part of improving outcomes. I would certainly want my doctor to take cost into consideration when it might be impossible to comply due to the cost. The most promising drug for one of my conditions costs over $4k a month, and insurance won't cover it. So it's obviously not an option. I would consider it bad medicine if the doctor said, "It's only my job to tell you what's most effective and give you a prescription for it. Can't afford it? That's not my problem." Thankfully she didn't.

In terms of what it's costing the health system, it's costing a lot less if doctors choose less expensive treatments if there is evidence they are just as good, and it costs a lot less if patients are compliant with the prescriptions.

That said, I don't expect doctors to keep up with all the prices. Some medications have surged 55x overnight. There was a proposed law in a state, Louisiana I think, where doctors would get a printout each month of how much each of their prescribed drugs cost the patient and the insurer. I don't think it passed. I think it would have been a good idea.

Anyway, that's another topic. I still have to decide which doctor to ask for. I would still prefer a more experienced doctor, but it sounds like the newbie will probably be fine too.

How much longer would you be willing to wait to see an experienced doctor vs a newbie?
IMHO, you are making your problem the doctors problem. If a drug cost too much then perhaps you can call and ask the doctor for an alternative and then see if it cost less (assuming there is an alternative). A doctors job is to advise the best route or routes to achieve the best possible outcome. There may be more than one way to get there and he/she should discuss that with their patients. The cost of medicines, labs, diagnostic tests and procedures are excessive in some cases because we have allowed it to get there. Physicians (I am a physician) shouldn't have to be responsible for those things. It's the people who choose to buy things including healthcare. It's the people who sometimes have to pay for things they don't want. Do you think if millions of people had to pay 50k per year for a drug they would just sit there and take it. People would be out in the street and courts. Just like the recent insulin issue. People spoke up. So it's not doctors that are going to save healthcare. It's the people. That will happen when enough people get fed up. They will get fed up when those who are ripping them off have to face them. The way it is now people get angry at the doctor or the poor insurance company rep/employee who can't make any meaningful changes. They vent and then nothing happens. Meaningful change take place via a collective effort by the people who want the change.

Topic Author
sawhorse
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Re: Physician quality and experience

Post by sawhorse » Mon Aug 26, 2019 2:54 am

coffeeblack wrote:
Mon Aug 26, 2019 1:43 am
IMHO, you are making your problem the doctors problem. If a drug cost too much then perhaps you can call and ask the doctor for an alternative and then see if it cost less (assuming there is an alternative). A doctors job is to advise the best route or routes to achieve the best possible outcome. There may be more than one way to get there and he/she should discuss that with their patients. The cost of medicines, labs, diagnostic tests and procedures are excessive in some cases because we have allowed it to get there. Physicians (I am a physician) shouldn't have to be responsible for those things. It's the people who choose to buy things including healthcare. It's the people who sometimes have to pay for things they don't want. Do you think if millions of people had to pay 50k per year for a drug they would just sit there and take it. People would be out in the street and courts. Just like the recent insulin issue. People spoke up. So it's not doctors that are going to save healthcare. It's the people. That will happen when enough people get fed up. They will get fed up when those who are ripping them off have to face them. The way it is now people get angry at the doctor or the poor insurance company rep/employee who can't make any meaningful changes. They vent and then nothing happens. Meaningful change take place via a collective effort by the people who want the change.
The insulin issue hasn't changed. The prices are still sky high. Luckily I have doctors that are unlike you in that they try to work within the patients' limitations when possible.

I'm not sure what you're trying to accomplish by derailing the topic.

As a physician, you would in theory have something to contribute with regard to the decision I have to make. Would you care to do that?

newdoc
Posts: 80
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Re: Physician quality and experience

Post by newdoc » Mon Aug 26, 2019 8:11 am

sawhorse wrote:
Sun Aug 25, 2019 10:08 pm
Munir wrote:
Sun Aug 25, 2019 6:55 pm
txbabe wrote:
Sun Aug 25, 2019 12:27 pm
A physician coming out of fellowship is not inexperienced. They have gone to 4 years of medical school, 3 -7 years of residency and then probably another two years of fellowship. They are probably up-to-date on the newest research and treatment. They have probably just studied like crazy and passed their specialty boards. I would have no problem seeing a newly graduated fellow and then making my mind up if I liked them as my doctor or not.
When health professionals comment in this forum about "experience" they usually are referring to the years in clinical practice spent treating patients AFTER completing all your training and not the years IN training in your specialty or medical school. Yes, they are long years and cannot be compared to other careers when you may be counting years after high school or college as experience.
Yes, the only experience I would consider really relevant to my decision is the fellowship. She was probably exposed to little if any cases of my type in medical school. Internal medicine residencies are usually a lot more general. The fellowship is probably the only time she would have seen patients like me, and I don't know how many she would have seen.
Actually, there is absolutely no way of knowing what exactly the doc was exposed to and when unless and until you ask him/her. Experiences are too varied for you to be able to say what this doc probably did and didn't do in med school vs residency vs fellowship. As an example, I worked with the world expert on Whipple surgeries (a relatively uncommon procedure) in med school for 2 months and assisted on more whipples than most general surgeons see in their entire careers. I'm not even a general surgeon but I know I've seen more than my general surgeon colleagues did in their residencies or their fellowships. Likewise, the geographic area I did my residency in had a very large sickle cell population, I saw almost none in fellowship, so I have a lot of particular knowledge dealing with that just as a function of geography and not level of training. See it's all very nuanced and I'll say again that the public has no simple way of being able to tell. Instead of filling this void with assumptions, just ask the doc.

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dm200
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Re: Physician quality and experience

Post by dm200 » Mon Aug 26, 2019 9:58 am

I often chat with various Physicians about their experience/training.

I think this helps me better communicate with the Physician.

On several occasions, I learned that the Physician had another, different, specialty from previous training. In one case, an Ophthalmologist I saw had previously functioned as a Neurologist.

I also know several Physicians that had a very different career before going into medicine. I currently know an Ophthalmologist who was a Dietitian/Nutritionist before going to Medical School. In most cases, I believe, the better "connection" you have with a Physician - the better will be your treatment.

Broken Man 1999
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Re: Physician quality and experience

Post by Broken Man 1999 » Mon Aug 26, 2019 10:54 am

I am curious, for a doctor coming from a foreign country, how is he/she credentialed in the US?

As well, what about a specialist? Additional credentials?

Just idle questions...

I kinda know my doctor's route somewhat.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: Physician quality and experience

Post by coffeeblack » Mon Aug 26, 2019 11:04 am

sawhorse wrote:
Mon Aug 26, 2019 2:54 am
coffeeblack wrote:
Mon Aug 26, 2019 1:43 am
IMHO, you are making your problem the doctors problem. If a drug cost too much then perhaps you can call and ask the doctor for an alternative and then see if it cost less (assuming there is an alternative). A doctors job is to advise the best route or routes to achieve the best possible outcome. There may be more than one way to get there and he/she should discuss that with their patients. The cost of medicines, labs, diagnostic tests and procedures are excessive in some cases because we have allowed it to get there. Physicians (I am a physician) shouldn't have to be responsible for those things. It's the people who choose to buy things including healthcare. It's the people who sometimes have to pay for things they don't want. Do you think if millions of people had to pay 50k per year for a drug they would just sit there and take it. People would be out in the street and courts. Just like the recent insulin issue. People spoke up. So it's not doctors that are going to save healthcare. It's the people. That will happen when enough people get fed up. They will get fed up when those who are ripping them off have to face them. The way it is now people get angry at the doctor or the poor insurance company rep/employee who can't make any meaningful changes. They vent and then nothing happens. Meaningful change take place via a collective effort by the people who want the change.
The insulin issue hasn't changed. The prices are still sky high. Luckily I have doctors that are unlike you in that they try to work within the patients' limitations when possible.

I'm not sure what you're trying to accomplish by derailing the topic.

As a physician, you would in theory have something to contribute with regard to the decision I have to make. Would you care to do that?
Your decision is a simple one. Set up an appointment with 2 or 3 doctors. See if you like them. As in can you communicate with them and do they communicate well with you. As far as skill go if they have finished residency and fellowship they are up to date. Board certification after the initial certification is useless. Most keep up with it only because they are forced to do it. Most doctor keep up in their area of expertise. The rare condition may not be seen buy any doctor new or old. It's rare. Some physicians specialize in certain rare conditions. They do research in it. Mostly at a university level. I doubt you will find that. Most doctor will research topics they don't see regularly. Your condition is no different. If your new physician has access to your old records it will be a good start. Communication is the key.

As far as what I was accomplishing. I was responding to another physicians post and what he said in it.

jayk238
Posts: 612
Joined: Tue Jan 31, 2017 1:02 pm

Re: Physician quality and experience

Post by jayk238 » Mon Aug 26, 2019 11:21 am

coffeeblack wrote:
Mon Aug 26, 2019 12:52 am
jayk238 wrote:
Sun Aug 25, 2019 3:47 pm
coffeeblack wrote:
Sun Aug 25, 2019 12:01 pm
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm
sawhorse wrote:
Fri Aug 23, 2019 8:36 pm

Do you think there's a tendency for new physicians to gravitate toward the newer therapies as the first choice rather than trying an old medication first? There have been plenty of instances in which a new drug has later been shown to not be any more effective than an old drug, but the newer drugs cost far more and might be difficult for patients to afford.

Do you find one group to be more cost conscious than another?
I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
"Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost. "

Is it the doctors job to check all the insurance companies rules? Those new drugs you mention are very expensive. If physicians had more time and patients took more responsibility for their health perhaps we would not need so many new diabetes drugs. It is so obvious that the first rule of medicine is prevention. Especially in a disease that can be mostly prevented in the majority of the world. Yet it continues to grow.
If i prescribe something and pt wont take it becauae they cant afford it then its no different than not prescribing it. So yes. Knowledge about diabetes drugs and insurance is unfortunately part of my job
See that's where I see it differently. It's part of your job to give medical advice, do medical procedures and/or write for medications etc. That's medicine. Anything beyond that is not medicine. It's the burden the system has placed on you and you have chosen to accept it. No just you personally. The entire medical profession. There is little to no representation, so you get to carry the burden. That's not your job. I know physicians want to be altruistic. But what is it costing the healthcare system?
It may be extra but my pt like my extra effort and as a result they keep coming back to me instead of another provider! It puts food on my table. Not just altruism

coffeeblack
Posts: 122
Joined: Wed Jun 19, 2019 10:20 am

Re: Physician quality and experience

Post by coffeeblack » Mon Aug 26, 2019 11:53 am

jayk238 wrote:
Mon Aug 26, 2019 11:21 am
coffeeblack wrote:
Mon Aug 26, 2019 12:52 am
jayk238 wrote:
Sun Aug 25, 2019 3:47 pm
coffeeblack wrote:
Sun Aug 25, 2019 12:01 pm
jayk238 wrote:
Sat Aug 24, 2019 7:47 pm


I find the cost conundrum a bigger consideration for my (younger) generation. Its more important to us because we hear about it so often. I dont know that this was ever harped on the older doctors. My partner orders vit d routinely yet shows no concern for the fact that its an 80-200 dollar test. I rarely order it.

I also inform my patients thoroughly about the cost of testing.

This stems from my perusing forums like this and reddit and reading articles about the cost of healthcare. Most older docs are not as involved online so maybe they dont relate to these posts/forums as much and are not as exposed/concerned about these topics as a result.

Many of us young and old will use sources like up to date which helps us find the correct therapy regardless of cost.

There are exceptions.

Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost.

However, with some understanding of insurance and rebates one can easily get the costs down or find the right drug covered by the particular insurance so that some mix works.

This takes a lot of active and continuous learning. Its something ive dedicated myself to and have had success.
"Im a big believer in the new diabetes drugs. A lot of older docs have thrown up their hands and stick to the cheaper generics. Personally the data is so clear on the value of newer drugs like glp1 and sglt that i comfortably prescribe these. Interestingly many of the guidelines from the diabetes and endocrinology associations do not explicitly advocate for the newer drugs due to cost. "

Is it the doctors job to check all the insurance companies rules? Those new drugs you mention are very expensive. If physicians had more time and patients took more responsibility for their health perhaps we would not need so many new diabetes drugs. It is so obvious that the first rule of medicine is prevention. Especially in a disease that can be mostly prevented in the majority of the world. Yet it continues to grow.
If i prescribe something and pt wont take it becauae they cant afford it then its no different than not prescribing it. So yes. Knowledge about diabetes drugs and insurance is unfortunately part of my job
See that's where I see it differently. It's part of your job to give medical advice, do medical procedures and/or write for medications etc. That's medicine. Anything beyond that is not medicine. It's the burden the system has placed on you and you have chosen to accept it. No just you personally. The entire medical profession. There is little to no representation, so you get to carry the burden. That's not your job. I know physicians want to be altruistic. But what is it costing the healthcare system?
It may be extra but my pt like my extra effort and as a result they keep coming back to me instead of another provider! It puts food on my table. Not just altruism
Yeah I know. I do the same. I just don't think we should be put in the position to have to do it. Not in that way.

rjbraun
Posts: 1476
Joined: Sun Sep 09, 2012 8:22 pm

Re: Physician quality and experience

Post by rjbraun » Mon Aug 26, 2019 1:15 pm

toofache32 wrote:
Sun Aug 25, 2019 9:10 am
Swansea wrote:
Sun Aug 25, 2019 6:49 am
toofache32 wrote:
Sat Aug 24, 2019 10:04 pm
Swansea wrote:
Fri Aug 23, 2019 8:29 am
I rely heavily on where the doc did residency for my choices.
How do you find out which are the good residencies for a particular specialty? For example, in my surgical specialty, Harvard is the laughing stock of the USA, although everyone has heard the name Harvard.
That is a good point that I had not considered. Is there a way for lay people to discern this?
I doubt it.
Any value to Doximity's Residency Navigator, in your opinion? Granted, the link below is not to the primary information source, but, for now, let's either assume accuracy or that we would be in a position to verify it.

https://www.teawithmd.com/2018/07/doxim ... 2018-2019/

In that case, if one identifies doctors who attended a top-ranked program, both in reputation and research output, and includes this "short-list" of names among the universe of doctors one considers meeting and ultimately selecting one as their specialist, do you think that this would at least be a step in the right direction? Or is it no better than just randomly selecting a physician?

Broken Man 1999
Posts: 3486
Joined: Wed Apr 08, 2015 11:31 am

Re: Physician quality and experience

Post by Broken Man 1999 » Mon Aug 26, 2019 2:01 pm

rjbraun wrote:
Mon Aug 26, 2019 1:15 pm
toofache32 wrote:
Sun Aug 25, 2019 9:10 am
Swansea wrote:
Sun Aug 25, 2019 6:49 am
toofache32 wrote:
Sat Aug 24, 2019 10:04 pm
Swansea wrote:
Fri Aug 23, 2019 8:29 am
I rely heavily on where the doc did residency for my choices.
How do you find out which are the good residencies for a particular specialty? For example, in my surgical specialty, Harvard is the laughing stock of the USA, although everyone has heard the name Harvard.
That is a good point that I had not considered. Is there a way for lay people to discern this?
I doubt it.
Any value to Doximity's Residency Navigator, in your opinion? Granted, the link below is not to the primary information source, but, for now, let's either assume accuracy or that we would be in a position to verify it.

https://www.teawithmd.com/2018/07/doxim ... 2018-2019/

In that case, if one identifies doctors who attended a top-ranked program, both in reputation and research output, and includes this "short-list" of names among the universe of doctors one considers meeting and ultimately selecting one as their specialist, do you think that this would at least be a step in the right direction? Or is it no better than just randomly selecting a physician?
Perhaps. On the other hand perhaps your doc was last in his/her class.

I was assigned my current doc by my insurance company in 1999. My last visit to a doctor prior was in June of 1973 when the company doc gave me a physical prior to being offered a job at MegaCorp. The next time I saw a doctor was in March of 1999, after my accident. The various people I would give that tidbit of info to were surprised I knew when my last visit was, but since I knew my hire date, no big deal.

I had been extremely healthy, as was my father. Good genes I suppose.

Even today my issues are related to injuries, rather than general health.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

toofache32
Posts: 1868
Joined: Sun Mar 04, 2012 6:30 pm

Re: Physician quality and experience

Post by toofache32 » Mon Aug 26, 2019 2:30 pm

rjbraun wrote:
Mon Aug 26, 2019 1:15 pm
toofache32 wrote:
Sun Aug 25, 2019 9:10 am
Swansea wrote:
Sun Aug 25, 2019 6:49 am
toofache32 wrote:
Sat Aug 24, 2019 10:04 pm
Swansea wrote:
Fri Aug 23, 2019 8:29 am
I rely heavily on where the doc did residency for my choices.
How do you find out which are the good residencies for a particular specialty? For example, in my surgical specialty, Harvard is the laughing stock of the USA, although everyone has heard the name Harvard.
That is a good point that I had not considered. Is there a way for lay people to discern this?
I doubt it.
Any value to Doximity's Residency Navigator, in your opinion? Granted, the link below is not to the primary information source, but, for now, let's either assume accuracy or that we would be in a position to verify it.

https://www.teawithmd.com/2018/07/doxim ... 2018-2019/

In that case, if one identifies doctors who attended a top-ranked program, both in reputation and research output, and includes this "short-list" of names among the universe of doctors one considers meeting and ultimately selecting one as their specialist, do you think that this would at least be a step in the right direction? Or is it no better than just randomly selecting a physician?
Thanks, I have not seen that. That list is interesting to me because it's geared towards medical students looking for a residency, not patients.
While this can identify good programs, it's still no guarantee. But I do agree with you it's a good start in a world where there really is no answer.
My (small) surgical subspecialty is not listed, but my residency where teach is considered a top 10 program by most in our specialty. We treat certain problems and perform certain surgeries that only about 5 other places in the USA perform. With that being said, we sometimes have a resident that makes us wonder what we were thinking to accept them. In other words, although we are a good residency program, this doesn't mean every resident is an all-star.

shell921
Posts: 344
Joined: Fri Jul 06, 2018 5:13 pm

Re: Physician quality and experience

Post by shell921 » Mon Aug 26, 2019 2:42 pm

dm200 wrote:
Sat Aug 24, 2019 1:47 pm
A part of the "quality" of a Physician, in my opinion and experience, is how well or how poorly he/she communicates (both directions) with patients. I believe (just my opinion and experience) this "communication" with patients is more important for Primary Care Physicians.

I believe female Physicians tend to be better with such patient communication - which is one reason I lean slightly towards Female Primary Care Physicians. This "leaning" works very well with my Kaiser plan, since about 2/3 of the Kaiser Primary care Physicians in this area are female.

Over time and experience, some Physicians get better at such patient communication, while others do not - and even become more set in their ways.
+1

I always go for a female physician if I can get one. My primary is a female as are my dermatologist and allergist.
They all respond to email and phone communication and I am happy with all of them in all aspects.

Topic Author
sawhorse
Posts: 3461
Joined: Sun Mar 01, 2015 7:05 pm

Re: Physician quality and experience

Post by sawhorse » Mon Aug 26, 2019 8:21 pm

shell921 wrote:
Mon Aug 26, 2019 2:42 pm
dm200 wrote:
Sat Aug 24, 2019 1:47 pm
A part of the "quality" of a Physician, in my opinion and experience, is how well or how poorly he/she communicates (both directions) with patients. I believe (just my opinion and experience) this "communication" with patients is more important for Primary Care Physicians.

I believe female Physicians tend to be better with such patient communication - which is one reason I lean slightly towards Female Primary Care Physicians. This "leaning" works very well with my Kaiser plan, since about 2/3 of the Kaiser Primary care Physicians in this area are female.

Over time and experience, some Physicians get better at such patient communication, while others do not - and even become more set in their ways.
+1

I always go for a female physician if I can get one. My primary is a female as are my dermatologist and allergist.
They all respond to email and phone communication and I am happy with all of them in all aspects.
I've seen a lot of doctors, and I can honestly say that I haven't noticed that one gender is better than another. I've seen both good and bad from both. At a previous location, I specifically chose a female doctor. She was pretty incompetent, and when I saw a male at that practice as a once-off, he was much better in every way.

I will say, however, that the worst manners I've encountered have been from two male doctors. Like really bad. Shockingly bad. Not just to me but also to staff there. One made a remark to a medical student that was flat out sexual harassment. The third worst manners was also a male, but he wasn't on the same level in terms of offensiveness. But they were the exception, and I've seen many male doctors with great manners.

All else equal, I would prefer a female primary care and female gynecologist because there are some female health topics I feel more comfortable discussing with another female. But the most incompetent gynecologist I've seen was female, and I've seen a great male (as well as some great females). So now I really have no preference when looking for a doctor.

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