Doing your own research (2 Viewers)

[gianmarco]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

 

[The Longtime Lurker]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

This is a good defense for doctors and you'll get no disagreement from me, your point is very well taken, but flipping it around from a patients perspective you can see their frustration aswell? The post you replied to finds that perspective disheartening and it is, but it shouldn't be all that surprising when you look at the big picture you just laid out.

 

[The Longtime Lurker]

I'll add a recent link about Duke Lifepoint's take over. On top of that our nurses are constantly on strike over conditions and pay. There's signs all over the community stating "patients over profits" and "Duke get out". I find it hard to believe that doesn't fall back onto the patient in the form of subpar care. If this is inaccurate reporting it's already fanned the flames, but it's in line with the degradation of care I'm noticing. My wife, my SIL, my niece, my brother, 4 close cousins all work in Healthcare, so i understand the challenges they face, but it doesn't change the subpar patient experience.

‘For them, it’s just a matter of what’s the most profitable thing:’ TV6 Investigates how private equity plays a role in rising health care costs

One report shows a $407 increase per day for inpatient care across the board.

www.uppermichiganssource.com

 

[Max Power]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

I've tried very hard to keep my comments my personal experience and not generalize. I know it's not fair to say all doctors, all patients, ect. I don't know what it's like to be a PCP, but i do know what it's like to be a frustrated patient, the son of a parent with a missed cancer diagnosis until it was to late, someone unhappy with a model built on treatment and not prevention (my experience, maybe that's not common elsewhere), feeling rushed out the door.

I was also surprised to see how many expressed similar experiences. It shouldn't be a blanket statement about all doctors, but bad experiences don't seem as uncommon as i thought they would be.

Mis/disinformation is certainly a factor, but so can misdiagnosis, dismissive attitudes, feeling like you're part of a turn and burn patient model (maybe that's not the reality everywhere, but it's the sense i get locally).

I don't live in a Healthcare mecca, so maybe that's why it's been hard to find the competent doctors described by some here. If you have a doctor like that, or you are one then you should know you're lucky, not everyone finds that so easily. I have found a great doctor that i really gel with, but it was a lot harder than i would have liked.

I've had my share of PCP churn for a variety of reasons. Loved a couple of them and didn't care for a few. My most recent turnover was due to a family practice selling out to a regional network. I moved to a smaller town about 3.5 years ago and it took almost 6 months to establish new patient care. I liked the practice and the community raved about the team there.

Little over a year ago they sold to First Health which has 163 locations in North Carolina (not all PCPs). The established doctors left and were replaced with couple younger FNPs (early 30s?). The community vibe doesn't appear positive right off the bat as most people feel the quality of care has become less experienced and less personable.

As family practices dwindle and are bought out by networks, it's entirely understandable for patients to view our medical system as assembly line.

This probably strays too political, but there are a multitude of reasons for this, almost none of which are doctor's fault.

Consolidation in health care is only going to continue - especially in rural areas - as a lot of their funding gets cut.

That consolidation is bad for everyone.

I agree and don't know the ins-and -outs behind it all, but I assume is mainly money/funding based. I don't blame doctors for establishing an excellent practice to ultimately retire and enjoy life. Sounds like we'll probably seeing more of that trend like you said.

I'm not blaming doctors for this evolution, but it does highlight some of the concerns people have with the healthcare industry and quality of care. Big corporations like to "do more with less", and its worrisome for the consumer. Doctors are just unfortunately on the front lines of the situation.

 

[gianmarco]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

This is a good defense for doctors and you'll get no disagreement from me, your point is very well taken, but flipping it around from a patients perspective you can see their frustration aswell? The post you replied to finds that perspective disheartening and it is, but it shouldn't be all that surprising when you look at the big picture you just laid out.

100%

Don't forget, physicians are patients too.

But, most importantly, physicians are fully aware and hate the system for the patients. Plus, administrators are very quick to let physicians know how much more and how much better they can do.

And, a couple more points to address a few things in this thread:

1) Your primary care physician may be seeing 25+ patients in a day (averaging 15 minutes to do so). When you see them typing/charting while you're in there, that's because they can either go that route, or, they have 25+ charts to complete at the end of the day (and having to go by memory or by simple notes). In the past, that could be done outside the patient room when finished. But, with limited time and having to hurry to the next patient, that's not possible most of the time anymore. Something that isn't realized, it seems.

2) Vaccines have been brought up. I doubt most are aware that vaccine administration in pediatric offices actually LOSE money. The reimbursement for them is lower than the cost to obtain them. But it's still done because it's the right thing to do.

And, on that note, there's a reason why pediatricians vaccination rates for their kids (on schedule) approach 100%. If it's good enough and safe enough for their own kids, that should tell all of you something if you still have doubts about them.

If I see my mechanic, and he tells me I should change my oil every 5000 miles and he's doing his own every 15,000, that's very telling. But if he's doing it himself less than 5000 miles, then it's probably something I should consider listening to.

 

[gianmarco]

I'll add a recent link about Duke Lifepoint's take over. On top of that our nurses are constantly on strike over conditions and pay. There's signs all over the community stating "patients over profits" and "Duke get out". I find it hard to believe that doesn't fall back onto the patient in the form of subpar care. If this is inaccurate reporting it's already fanned the flames, but it's in line with the degradation of care I'm noticing. My wife, my SIL, my niece, my brother, 4 close cousins all work in Healthcare, so i understand the challenges they face, but it doesn't change the subpar patient experience.

‘For them, it’s just a matter of what’s the most profitable thing:’ TV6 Investigates how private equity plays a role in rising health care costs

One report shows a $407 increase per day for inpatient care across the board.

www.uppermichiganssource.com

Another point, and part of the reason we are where we are.

Nurses have unions. As do other employees.

Doctors don't (and can't).

Until doctors start walking out (which actually happened recently and was a first), business will continue to take advantage of their desire to help and not abandon patients.

 

[gianmarco]

Finally, if the money/lifestyle is so great, why are 2/3rds of physicians not wanting their own children to go into medicine?

 

[The Longtime Lurker]

I'll add a recent link about Duke Lifepoint's take over. On top of that our nurses are constantly on strike over conditions and pay. There's signs all over the community stating "patients over profits" and "Duke get out". I find it hard to believe that doesn't fall back onto the patient in the form of subpar care. If this is inaccurate reporting it's already fanned the flames, but it's in line with the degradation of care I'm noticing. My wife, my SIL, my niece, my brother, 4 close cousins all work in Healthcare, so i understand the challenges they face, but it doesn't change the subpar patient experience.

‘For them, it’s just a matter of what’s the most profitable thing:’ TV6 Investigates how private equity plays a role in rising health care costs

One report shows a $407 increase per day for inpatient care across the board.

www.uppermichiganssource.com

Another point, and part of the reason we are where we are.

Nurses have unions. As do other employees.

Doctors don't (and can't).

Until doctors start walking out (which actually happened recently and was a first), business will continue to take advantage of their desire to help and not abandon patients.

Thank you. I was wondering why i didn't see doctors with the nurses rallying right along. That's the answer to a question i never thought to ask.

I hope we get to a point doctors do stand up for themselves and their patients against the profit ridden greed these corporations bring to the industry. I mentioned functional medicine which when i explorerd it was provided by an MD with all the schooling, abilities, and diagnostic/prescription capabilities of a regular MD. He had enough and changed his care model. Ultimately it wasn't for me, but for some (patients and doctors) it could be a better fit.

I'm with you, I'm with my doctor, I'm with my family that work in Healthcare, I'm also with the patients that have their care suffer. This thread went off the rails with finger pointing and talking past one another, but seems there's common ground.

I don't think i know more than my doctor, i don't think my doctor wants to harm or neglect me, but i do think the Healthcare model is broken and it makes me angry.

 

[gianmarco]

I'll add a recent link about Duke Lifepoint's take over. On top of that our nurses are constantly on strike over conditions and pay. There's signs all over the community stating "patients over profits" and "Duke get out". I find it hard to believe that doesn't fall back onto the patient in the form of subpar care. If this is inaccurate reporting it's already fanned the flames, but it's in line with the degradation of care I'm noticing. My wife, my SIL, my niece, my brother, 4 close cousins all work in Healthcare, so i understand the challenges they face, but it doesn't change the subpar patient experience.

‘For them, it’s just a matter of what’s the most profitable thing:’ TV6 Investigates how private equity plays a role in rising health care costs

One report shows a $407 increase per day for inpatient care across the board.

www.uppermichiganssource.com

Another point, and part of the reason we are where we are.

Nurses have unions. As do other employees.

Doctors don't (and can't).

Until doctors start walking out (which actually happened recently and was a first), business will continue to take advantage of their desire to help and not abandon patients.

Thank you. I was wondering why i didn't see doctors with the nurses rallying right along. That's the answer to a question i never thought to ask.

I hope we get to a point doctors do stand up for themselves and their patients against the profit ridden greed these corporations bring to the industry. I mentioned functional medicine which when i explorerd it was provided by an MD with all the schooling, abilities, and diagnostic/prescription capabilities of a regular MD. He had enough and changed his care model. Ultimately it wasn't for me, but for some (patients and doctors) it could be a better fit.

I'm with you, I'm with my doctor, I'm with my family that work in Healthcare, I'm also with the patients that have their care suffer. This thread went off the rails with finger pointing and talking past one another, but seems there's common ground.

I don't think i know more than my doctor, i don't think my doctor wants to harm or neglect me, but i do think the Healthcare model is broken and it makes me angry.

Angry right along with you.

Also, I was incorrect in my post. Independent physicians can't join a union, but there are employed physicians that can and it looks like it's happening more. I wasn't aware of this and was always under the impression it wasn't possible.

It looks like it's still less than 10% that belong to a union, but maybe it's a start and can begin to effect some change.

 

[Dickies]

I blame social media. "Doing your own research" is usually people not wanting to say they saw it on social media and believe it to be true.

Your default assumption should be that anything you see on social media is false.

I think we've warped the word.

Amazon and consumer information online has led to people being able to do a ton of research for consumer items, vacations, where to eat dinner....etc. That is valuable information and worth the time to research. And almost all of it is based solely on experience and opinion of others.

Too many people have taken that consumer research to be the equal of scientific research which is not remotely close to the same thing and is based on verifiable fact, repeatable outcomes and expertise that comes from a lifetime of education.

I skimmed through most of this thread, but I feel like this post from the 2nd page very succinctly sums up why people are talking past each other in here.

 

[DA RAIDERS]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

This is a good defense for doctors and you'll get no disagreement from me, your point is very well taken, but flipping it around from a patients perspective you can see their frustration aswell? The post you replied to finds that perspective disheartening and it is, but it shouldn't be all that surprising when you look at the big picture you just laid out.

100%

Don't forget, physicians are patients too.

But, most importantly, physicians are fully aware and hate the system for the patients. Plus, administrators are very quick to let physicians know how much more and how much better they can do.

And, a couple more points to address a few things in this thread:

1) Your primary care physician may be seeing 25+ patients in a day (averaging 15 minutes to do so). When you see them typing/charting while you're in there, that's because they can either go that route, or, they have 25+ charts to complete at the end of the day (and having to go by memory or by simple notes). In the past, that could be done outside the patient room when finished. But, with limited time and having to hurry to the next patient, that's not possible most of the time anymore. Something that isn't realized, it seems.

2) Vaccines have been brought up. I doubt most are aware that vaccine administration in pediatric offices actually LOSE money. The reimbursement for them is lower than the cost to obtain them. But it's still done because it's the right thing to do.

And, on that note, there's a reason why pediatricians vaccination rates for their kids (on schedule) approach 100%. If it's good enough and safe enough for their own kids, that should tell all of you something if you still have doubts about them.

If I see my mechanic, and he tells me I should change my oil every 5000 miles and he's doing his own every 15,000, that's very telling. But if he's doing it himself less than 5000 miles, then it's probably something I should consider listening to.

my PCP is now using AI to take notes. my specialists still have scribes.

 

[Joe Bryant]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

Thanks. I think lots of people understand this.

Tons of excellent people in the medical field.

It's why I was clear to say at the outset:

And to be clear, some of the most altruistic honest high integrity people I personally know are in the medical field.

As I said, my best friend is one.

 

[Joe Bryant]

my PCP is now using AI to take notes.

Same. My MD friend says it's been a huge time saver and also allows them to be way more comprehensive.

My doctor last week turned on the recorder as soon as he entered the room and everything gets documented. Excellent.

 

[Terminalxylem]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

Holy crap, this is an amazing post, encapsulating just about everything wrong with contemporary medicine. Wonder why some physicians find taking extra time to dispel “research”* so off-putting?

*To recap, I don’t mean not answering questions, discussing options, or considering complementary and alternative medicine. Nor am I describing dismissive, know-it-all doctors ignoring preventative care, only offering prescriptions and an expectation that patients STFU.

 

[Terminalxylem]

I'll add a recent link about Duke Lifepoint's take over. On top of that our nurses are constantly on strike over conditions and pay. There's signs all over the community stating "patients over profits" and "Duke get out". I find it hard to believe that doesn't fall back onto the patient in the form of subpar care. If this is inaccurate reporting it's already fanned the flames, but it's in line with the degradation of care I'm noticing. My wife, my SIL, my niece, my brother, 4 close cousins all work in Healthcare, so i understand the challenges they face, but it doesn't change the subpar patient experience.

‘For them, it’s just a matter of what’s the most profitable thing:’ TV6 Investigates how private equity plays a role in rising health care costs

One report shows a $407 increase per day for inpatient care across the board.

www.uppermichiganssource.com

Another point, and part of the reason we are where we are.

Nurses have unions. As do other employees.

Doctors don't (and can't).

Until doctors start walking out (which actually happened recently and was a first), business will continue to take advantage of their desire to help and not abandon patients.

Thank you. I was wondering why i didn't see doctors with the nurses rallying right along. That's the answer to a question i never thought to ask.

I hope we get to a point doctors do stand up for themselves and their patients against the profit ridden greed these corporations bring to the industry. I mentioned functional medicine which when i explorerd it was provided by an MD with all the schooling, abilities, and diagnostic/prescription capabilities of a regular MD. He had enough and changed his care model. Ultimately it wasn't for me, but for some (patients and doctors) it could be a better fit.

I'm with you, I'm with my doctor, I'm with my family that work in Healthcare, I'm also with the patients that have their care suffer. This thread went off the rails with finger pointing and talking past one another, but seems there's common ground.

I don't think i know more than my doctor, i don't think my doctor wants to harm or neglect me, but i do think the Healthcare model is broken and it makes me angry.

Unfortunately, doctors are notoriously bad at organizing, in part due to egos. But the bigger issue is, if doctors strike, who will take care of the patients?

 

[The Longtime Lurker]

I'll add a recent link about Duke Lifepoint's take over. On top of that our nurses are constantly on strike over conditions and pay. There's signs all over the community stating "patients over profits" and "Duke get out". I find it hard to believe that doesn't fall back onto the patient in the form of subpar care. If this is inaccurate reporting it's already fanned the flames, but it's in line with the degradation of care I'm noticing. My wife, my SIL, my niece, my brother, 4 close cousins all work in Healthcare, so i understand the challenges they face, but it doesn't change the subpar patient experience.

‘For them, it’s just a matter of what’s the most profitable thing:’ TV6 Investigates how private equity plays a role in rising health care costs

One report shows a $407 increase per day for inpatient care across the board.

www.uppermichiganssource.com

Another point, and part of the reason we are where we are.

Nurses have unions. As do other employees.

Doctors don't (and can't).

Until doctors start walking out (which actually happened recently and was a first), business will continue to take advantage of their desire to help and not abandon patients.

Thank you. I was wondering why i didn't see doctors with the nurses rallying right along. That's the answer to a question i never thought to ask.

I hope we get to a point doctors do stand up for themselves and their patients against the profit ridden greed these corporations bring to the industry. I mentioned functional medicine which when i explorerd it was provided by an MD with all the schooling, abilities, and diagnostic/prescription capabilities of a regular MD. He had enough and changed his care model. Ultimately it wasn't for me, but for some (patients and doctors) it could be a better fit.

I'm with you, I'm with my doctor, I'm with my family that work in Healthcare, I'm also with the patients that have their care suffer. This thread went off the rails with finger pointing and talking past one another, but seems there's common ground.

I don't think i know more than my doctor, i don't think my doctor wants to harm or neglect me, but i do think the Healthcare model is broken and it makes me angry.

Unfortunately, doctors are notoriously bad at organizing, in part due to egos. But the bigger issue is, if doctors strike, who will take care of the patients?

Certainly, shutting down entire hospitals would be worse. I was thinking more like days off or after/before a shift and maybe all/ most/some/none do, you just don't see it expressed outright at the nurse/tech rallies or through the local media.

Evolution of this thread was interesting. Glad to see the temperature come down. Wilma insisting her skin tag is super rare cancer is bad "research". Joe 6 pack educating himself to ask good questions and understand the answers isn't. Easy enough.

Like what's being discussed in the other related thread with "facts vs feels" I think "do your own research" has been a meme phrase for a little while now and in our political climate can come off as dismissive of people questioning a broken system, but i don't want to continue to beat a dead horse. I understood the OP and it's intent. Having humanities collective knowledge at your fingertips has unintended consequences and some people are better at using that information than others.

 

[The Dreaded Marco]

I am surprised at the number of FBGs that think, or at least have implied in this thread, that primary care physicians are greedy, patient-assembly-line-churning, omniscient, deaf, uncaring, quacks.

Very disheartening.

This is it right here

I believe it's now close to 80% of physicians work for healthcare/hospital systems or business/private equity companies that own practices. They are the ones that determine schedules, number of patients seen (and how much/little time that encounter can be), which insurance is taken, and the negotiated contracts with insurance that determines reimbursement and billing. They can and do let physicians go that don't satisfy what they're looking for. Increasingly, physicians are getting replaced by nurse practitioners who are paid less but have a fraction of the training/experience and really aren't equipped to practice independently. Groomers at Petsmart have more clinical hours experience than nurse practitioners, especially newer ones that complete most training online.

Unfortunately, many don't realize that a lot of their healthcare decisions are now being determined by business executives and insurance companies. Prior authorizations and peer to peer reviews being completed by non-physicians. In other words, a physician will order a test or a medication or a surgery and the insurance company has someone that isn't a physician telling them they can't.

So, the physician is given, say, a 15 minute time slot to be able to establish rapport/trust, find out what's going on, do their exam, and discuss options. And those slots can get double booked (or even triple booked) if necessary by the office staff. Physician can't get everything done in time? Now everything starts running late and patients complain about having to wait. How to avoid that? Rush through and patients complain about not having enough face time with their doctor. And there's no way to address a list of problems. That will have to be for another visit. Ideal? Absolutely not. How much control does the physician have over that? Other than leaving that practice and basically starting their own practice, overhead, hiring staff, malpractice insurance, etc, .....none. Want to leave? Good luck with non-competes. Or finding another office/hospital that isn't the same.

And, after that visit, all the documentation and charting still needs to be done. And reviewing lab results. And making those calls to insurance for peer to peer reviews for denials that make no sense (and can literally take an hour or more on the phone). And answering questions that come through the electronic medical record now. And even just reviewing/learning/researching (yes, researching) difficult or challenging patient cases.

How much of that extra time (usually hours) is billable? None of it. There's 0 compensation for those calls to insurance or any of the other number of activities that happen outside the patient room. What can/does take hours before/after actual patient care to do these things isn't billable. Good luck getting time for free from your attorney or really most any other business.

Then, when you get that bill that's $500 for 15 minutes? That's determined by the insurance company. And most of that amount goes to things like "facility fees" that has nothing to do with the physician billing. Your radiologist reading your CT scan, for example? They are getting MAYBE $30 for the reading. The rest of your cost? The owner of the CT scan, the insurance company, the facility that has the staff.

Oh, and reimbursements are actually still DECREASING.

On top of that, it's actually illegal for your physician to either overcode or undercode. They document, and then coding is predetermined for what it will pay.

In essence, most physicians have virtually no control over any of the financial aspects of the care they provide. That's why you're starting to see them leave for "concierge" care where they avoid all of that and can spend as much time as they want/need to provide optimal care. That's what virtually all physicians WANT to do despite the sentiments here to the opposite.

So, in the 11-17 years of POST-GRADUATE training, very little to none of that is about the financials. That's why these business administrators have taken over because they can make it more profitable without having to worry about the actual care being provided.

If you're wondering why there's some pushback in this thread to the sentiment that doctors just churn patients for money and don't do what they do for altruistic reasons, maybe that's a glimpse as to what it is.

Holy crap, this is an amazing post, encapsulating just about everything wrong with contemporary medicine. Wonder why some physicians find taking extra time to dispel “research”* so off-putting?

*To recap, I don’t mean not answering questions, discussing options, or considering complementary and alternative medicine. Nor am I describing dismissive, know-it-all doctors ignoring preventative care, only offering prescriptions and an expectation that patients STFU.

Agreed. gianmarco's post is spot on and I thank him for it.

I decided to take a brief hiatus from the thread after my post on Monday that set off a lot the posts the past couple pages. Shortly after posting it realized I had replied in haste and anger and did not take the time to really think it through. I should have deleted it, slept on it, considered more and posted a more thoughtful, mannered post later on (like gianmarco's post above). I apologize for my post.

I had an awful day at work that day dealing with one of the issues we've been discussing in this thread and then I was triggered by a couple comments I read that night so responded as I did. After thinking about it for awhile that night I realized I was way overgeneralizing the FBG thoughts about primary care physicians, and again, I apologize for that. I certainly think the overwhelmingly large majority do not feel that way about all physicians---too broad of a brush stroke. And there are definitely physicians that fall into that trap (many due to the issues gianmarco outlined above, some just do that). I also think that some of those sentiments in my post have been expressed, some tangentially and some more overtly, in this thread but then thought those folks may have been doing the same as I did, over-generalizing it to all physicians--I get it. I'm going to do my best not to do that any more when responding in threads--not helpful for anyone.

The timing of my self-imposed hiatus was actually fortuitous as I had a total knee replacement the next day. So I definitely was in no condition to respond in this thread for a couple days. It's feeling better today but I have not yet started physical therapy. If anyone has recommendations on rehabbing after a total knee replacement, even some discovered doing your own research , I'm all ears. Of course, I'll also be taking advice from my surgeon and physical therapist as well.

Cheers!

 

[Mister CIA]

To the point others have made about pharma advertising meds on television, today I received an email from LabCorp begging me to do my own research.

Marketeers won't stop until all the dirt has been squeezed out of the turnip.

 

[The Longtime Lurker]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

 

[Sparky Polastri]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

 

[The Longtime Lurker]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

 

[Sparky Polastri]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

 

[The Dreaded Marco]

The state where I live, Utah, was
the first in the nation to completely remove fluoride from all municipal water statewide as of last month. Our dental community is up in arms as are we.

 

[dgreen]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

I wouldn't say that people are "doing their homework into it to be so confident". I'd guess like 90% of people can't even tell you what flouride is. I feel like people can reach a really high level of confidence without doing any homework. My top wish for society might actually be that people have fewer opinions. Ok, peace and love and no world hunger, but after that would be "stop having so many opinions." The older I get, the fewer opinions I have. Somehow we've created a society where everyone has to have an opinion on everything. And you usually have to place yourself into one of two positions on each topic.

 

[Ramblin Wreck]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

What is settled?

 

[Max Power]

The state where I live, Utah, was
the first in the nation to completely remove fluoride from all municipal water statewide as of last month. Our dental community is up in arms as are we.

At least it's job security right?

 

[Sparky Polastri]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

I wouldn't say that people are "doing their homework into it to be so confident". I'd guess like 90% of people can't even tell you what flouride is. I feel like people can reach a really high level of confidence without doing any homework. My top wish for society might actually be that people have fewer opinions. Ok, peace and love and no world hunger, but after that would be "stop having so many opinions." The older I get, the fewer opinions I have. Somehow we've created a society where everyone has to have an opinion on everything. And you usually have to place yourself into one of two positions on each topic.

This triggered a memory with me and my dad, though on a completely different subject of SCUBA diving. My grandparents took he and my uncle on vacation to Hawaii for Christmas one year. All the hotels they stayed at had some sort of "try scuba" event at their pools, so he did. He was hooked. At the last place they were at they had an option of learning some skills in the pool and then going on a guided dive with a dive master from shore. Just walk in the ocean and explore. He was DEFINITELY hooked by then. He was like 20 or 21 somewhere around there. He came back from the trip and saw that his school had a three hour class where you could get certified AND get three hours college credit. He took the class. In that class he was hit with a stark realization that what he "learned" while on vacation was just enough to get him confident enough to get in the water and do some serious damage to himself. In other words, he didn't know what he didn't know and in this case, what he didn't know was plenty to kill him.

 

[Sparky Polastri]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

What is settled?

The pros and cons of fluoride and how it impacts the body.

 

[Ramblin Wreck]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

What is settled?

The pros and cons of fluoride and how it impacts the body.

So you’re not open to other opinions unless someone brings. A peer reviewed study to you? Seems quite weird and dismissive.

 

[The Longtime Lurker]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

From a Google search these countries do not add fluoride to their water:

"Austria, Belgium, Bulgaria, Cyprus, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and United Kingdom (most areas)."

AI explanation for Germany is:

"Germany does not fluoridate its public drinking water primarily due to the legal classification of fluoride as a medication and the principle that medication should be administered voluntarily, not mandated through public water supplies"

I would imagine this kind of thing would have been mentioned.

 

[Sparky Polastri]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

What is settled?

The pros and cons of fluoride and how it impacts the body.

So you’re not open to other opinions unless someone brings. A peer reviewed study to you? Seems quite weird and dismissive.

Fish as you wish, but that's correct. I won't simply substitute a random opinion for what's been studied, analyzed many times over. That's how the science community works and how I work. Call me weird and dismissive if you like. I don't really care. From my perspective its weird and dismissive if Billy Bob comes to me with some random unverified experiment results or a youtube video or "something I saw on facebook" etc and takes the word of it over all the documented and verified science saying something else. To each his own

And, of course, none of that is to say, should I be presented such evidence and study, I won't read it and study it. I absolutely will as will many many many others in the scientific community. Again, that's how the process works.

 

[Peggy]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

This can't be the standard. This is not analogous to peer reviewed scientific studies. It IS settled. For those claiming that it isn't, they need to be bringing peer reviewed scientific studies showing otherwise.

What is settled?

The pros and cons of fluoride and how it impacts the body.

So you’re not open to other opinions unless someone brings. A peer reviewed study to you? Seems quite weird and dismissive.

Fish as you wish, but that's correct. I won't simply substitute a random opinion for what's been studied, analyzed many times over. That's how the science community works and how I work. Call me weird and dismissive if you like. I don't really care. From my perspective its weird and dismissive if Billy Bob comes to me with some random unverified experiment results or a youtube video or "something I saw on facebook" etc and takes the word of it over all the documented and verified science saying something else. To each his own

And, of course, none of that is to say, should I be presented such evidence and study, I won't read it and study it. I absolutely will as will many many many others in the scientific community. Again, that's how the process works.

The Fluoride Debate: The Pros and Cons of Fluoridation - PMC

Fluoride is one of the most abundant elements found in nature. Water is the major dietary source of fluoride. The only known association with low fluoride intake is the risk of dental caries. Initially, fluoride was considered beneficial when given ...

pmc.ncbi.nlm.nih.gov

Conclusion:

Dental treatments are expensive throughout the world. The cost of dentistry has hardly been reduced, even in countries where the decline in caries began 30 years ago. Thus, extension of preventive dentistry is still indispensable for improving oral health (12). The absence of dental care and poor hygiene are still considered the main causes of dental decay (34). Although multifactorial in origin, caries is a preventable disease, with fluoride as a preventive agent used worldwide. Several modes of fluoride use have evolved, each with its own recommended concentration, frequency of use, and dosage schedule. Concurrently, recent opposition has been growing worldwide against fluoridation, emphasizing the potential and serious risk of toxicity. Since the fluoride benefit is mainly topical, perhaps it is better to deliver fluoride directly to the tooth instead of ingesting it (34). Fluoride toothpaste, rinses and varnish applications have proven their effectiveness in some countries, but they are still not universally affordable.

 

[Terminalxylem]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

I wouldn't say that people are "doing their homework into it to be so confident". I'd guess like 90% of people can't even tell you what flouride is. I feel like people can reach a really high level of confidence without doing any homework. My top wish for society might actually be that people have fewer opinions. Ok, peace and love and no world hunger, but after that would be "stop having so many opinions." The older I get, the fewer opinions I have. Somehow we've created a society where everyone has to have an opinion on everything. And you usually have to place yourself into one of two positions on each topic.

This triggered a memory with me and my dad, though on a completely different subject of SCUBA diving. My grandparents took he and my uncle on vacation to Hawaii for Christmas one year. All the hotels they stayed at had some sort of "try scuba" event at their pools, so he did. He was hooked. At the last place they were at they had an option of learning some skills in the pool and then going on a guided dive with a dive master from shore. Just walk in the ocean and explore. He was DEFINITELY hooked by then. He was like 20 or 21 somewhere around there. He came back from the trip and saw that his school had a three hour class where you could get certified AND get three hours college credit. He took the class. In that class he was hit with a stark realization that what he "learned" while on vacation was just enough to get him confident enough to get in the water and do some serious damage to himself. In other words, he didn't know what he didn't know and in this case, what he didn't know was plenty to kill him.

Yep, the Dunning-Kruger effect is a real problem.

As I get older, I try to be more open-minded, while constantly being reminded of my ignorance. It’s a work in progress, as it seems our minds prefer being set.

Humility goes a long way here. Also, whenever arguing, I try to ask myself what, if anything, the opposing viewpoint could reveal to change my mind.

If the answer is “nothing”, probably best to disengage, and self-reflect.

 

[Sparky Polastri]

This seems to fit in here. There's a few local municipalities looking to remove fluoride from drinking water recently, one had a meeting last night and was at capacity for comments. It made me think of this thread. Local reporting seems to have the comments pretty split, with more in favor of keeping it. I would imagine very little actual "research" went into formulating both groups opinions.

It is an interesting question, but i doubt very much the ideas expressed from the majority of those commenting were from an extensive look into the science, but the passion on the topic appeared pretty high.

You are likely spot on. Though I'd caution at setting the bar at "group opinion" here. That's never wise IMO. And honestly, these things should be really simple to adjudicate in the public square. Merely asking for peer reviewed scientific studies to support positions and having the "sides" present them is all that needs to happen. But that's not what typically happens. What typically happens is someone will make a claim and then demand be proven wrong putting the onus on the other "side" to show their work.

Sure, i agree it should be that simple. That was my opinion based on what i know of the leaders and the community. I should have gone to hear more of the comments than what was picked by the media. If it gets discussed again I'll likely attend.

I would imagine plenty of evidence was presented from both sides, but bias cuts both ways, so I'm also generalizing that no matter what no minds were changed.

To my knowledge we've had fluoride in the water my entire life and I don't remember anyone complaining until recently so people must be doing their homework into it to be so confident for and against. Whether or not it's educated homework is anyone's guess, but it's not just doctors navigating the public's health perceptions, which ofcourse is a given.

Whether it is or isn't healthy isn't for this thread I just thought it was interesting to see something else that appeared settled for so long all of a sudden became controversial with so many differing opinions.

I wouldn't say that people are "doing their homework into it to be so confident". I'd guess like 90% of people can't even tell you what flouride is. I feel like people can reach a really high level of confidence without doing any homework. My top wish for society might actually be that people have fewer opinions. Ok, peace and love and no world hunger, but after that would be "stop having so many opinions." The older I get, the fewer opinions I have. Somehow we've created a society where everyone has to have an opinion on everything. And you usually have to place yourself into one of two positions on each topic.

This triggered a memory with me and my dad, though on a completely different subject of SCUBA diving. My grandparents took he and my uncle on vacation to Hawaii for Christmas one year. All the hotels they stayed at had some sort of "try scuba" event at their pools, so he did. He was hooked. At the last place they were at they had an option of learning some skills in the pool and then going on a guided dive with a dive master from shore. Just walk in the ocean and explore. He was DEFINITELY hooked by then. He was like 20 or 21 somewhere around there. He came back from the trip and saw that his school had a three hour class where you could get certified AND get three hours college credit. He took the class. In that class he was hit with a stark realization that what he "learned" while on vacation was just enough to get him confident enough to get in the water and do some serious damage to himself. In other words, he didn't know what he didn't know and in this case, what he didn't know was plenty to kill him.

Yep, the Dunning-Kruger effect is a real problem.

As I get older, I try to be more open-minded, while constantly being reminded of my ignorance. It’s a work in progress, as it seems our minds prefer being set.

Humility goes a long way here. Also, whenever arguing, I try to ask myself what, if anything, the opposing viewpoint could reveal to change my mind.

If the answer is “nothing”, probably best to disengage, and self-reflect.

I agree. I don't know why people have such a hard time acknowledging they don't know everything.

There are only a few topics I engage in with any sense of confidence. Economics, vaccines and cardiovascular study are what I've lived and breathed in academics. Most of the rest I was to work to understand. No problem admitting that. Trait my dad taught me.