Writing about medical practices is fun,
but far from easy. Presently, medical practice seems in a state of
flux. There has always been some jealousy among doctors, but not
like we are seeing today. Many medical organizations are feeling
that they are superior to others and applying pressures to state
legislatures to limit or prevent new ideas from gaining a solid
foothold in the medical community.
It is also surprising that some states
have provided opportunities for different ideas to flourish, and
other states use various means to try to restrict or limit new ideas.
Several states in the early days of concierge medicine worked hard
to prevent it from getting started. Two states invoked insurance
fraud and claimed the practices would avoid state policies of
medicine without insurance and they succeeded for a couple of years
until challenged in court.
Concierge medicine is growing and
becoming a larger force yearly. When two or more doctors join
together in a practice, they can often afford a nurse acting in
several capacities. When I wrote this blog, I was not sure I would
ever be involved with one. However, I am a volunteer peer mentor for
type 2 diabetes patients with a concierge practice and know of four
other peer mentors working with another practice. I have also added
another physician practice that I now serve as a peer mentor for type
2 diabetes patients.
Telemedicine is another growing area
that some practices are working hard to expand and again many state
legislatures are being lobbied heavily to limit the scope of practice
allowed. I have said this before, but it is worth repeating, the
word reciprocity is not in the vocabulary of the medical
associations. Any patient that has a regular doctor and travels to
another state should have the right to confer with their doctor back
home over the telephone, Internet, or other electronic media without
worry about some doctor in that state complaining that he/she was
denied access to treating the patient. Yet this is where it seems
headed.
Yet telemedicine is growing. Even some
private practices are utilizing telemedicine and using physician
assistants, nurse practitioners, and nurses in areas low in doctors
to do the examinations and then either passing this information onto
their primary care doctors, or when none are available, writing the
prescriptions electronically. Most are in states admittedly allowing
this and encouraging this. Some universities are also following this
practice and have centers organized to do this – Kansas and
Tennessee are two such states.
Although individual practices are
becoming harder to find, there are still a few in existence, but for
how much longer is the question. Hospitals are slowly putting the
stranglehold on private practices and becoming increasingly
monopolistic in their operations. They either hire the doctors out
of practices or buy out the practice and establish a clinic. Many
are concerned about the ethics involved as in some areas of the
country hospitals are establishing clinics and moving hospitals to
new areas, thus abandoning the inner city areas where they have been.
Under the current Affordable Care Act, will the physicians be able
to survive financially? Only time will expose the answer.
A simplistic, but accurate description
of the various forms of medical practices that a physician can opt
for are:
1. Academician: He/she can become an academician and start
teaching medical students.
2. Single specialty doctor: The doctor may decide to
specialize in a certain field and then carry on practice in that
field.
3. Multi-specialty: This happens when within the same company,
several medical specialties are employed who are in charge of
different fields.
4. Solo: The medical practice may decide to set up his/her own
clinic, which is a common practice in dentists.
5. Industry: The physician may decide to work for the research
based activities taking place in the industry and work for
pharmacological companies, research labs, and equipment
manufacturers.
6. Hospitalist: Employed and works for a hospital.
Some doctors may fit within two or more
of the practices listed above or may have two or more specialties
that he/she is qualified to practice.
I find the following statistics very
interesting and will quote, “According to
the Bureau of Labor statistics, there were nearly 700,000 doctors in
the United States in 2008. There are many ways to break down the
types of doctors who practice medicine in the country. Increasingly,
more and more medical doctors are becoming specialists, and the
number of specialists has grown rapidly in the last four decades.
According to the American Board of Medical Specialties, there are now
24 different categories of specialists that branch off into a total
of 147 and different doctors who can be board certified in their
specialty. But to handle the doctors in the country in a more
manageable number, there are 6 different medical doctors who see
patients somewhere in the country every day.
1. Doctor of Medicine. This
is an allopathic doctor, the one who earns an MD degree from medical
school and represents about 70 percent of all medical school
graduates. Many study specialties that concentrate on different areas
of the body, such as cardiology, gastroenterology and pulmonology.
2. Doctor of Osteopathy. This
is the second type of medical doctor who attends a medical school and
becomes an osteopathic doctor. These doctors attend an osteopathic
medical school, which is outnumbered by allopathic medical schools by
about 12 to 1. There is virtually no difference any more in the
training between the two disciplines, other than a technique called
Osteopathic Manipulative Medicine. This involves manipulation of the
joints and body parts to help in the diagnosis of injury or disease.
Many medical doctors with a D.O. degree go on to general practices,
in areas like family medicine.
3. Doctor of Dental Medicine. Most
people are familiar with dentists, who attend 4 years of dental
medical school and handle the medical care of the teeth and gums and
have a DMD or in their title. There also are doctors of dental
surgery who specialize in dental surgery and have a DDS in their
title. Many dentists specialize further into areas such as
endodontics, orthodontics and pediatric dentistry. This requires
additional schooling.
4. Doctor of Chiropractic. These
medical doctors go to 4 years of chiropractic medical college and
specialize in joint pain anywhere in the body. They have a DCM in
their title. Many chiropractic treatments involve the manipulation of
the spine and chiropractic doctors work on the principle that
misalignments trickle down to affect the nervous system.
5. Doctor of Optometry. This
medical doctor attends four years of optometric medical college and
has an OD in his or her title. They are the primary doctors for the
diagnosis and treatment of eye diseases and conditions.
6. Doctor of Podiatric Medicine. This
medical doctor undergoes 4 years of podiatric medical college and
then a residency program of 2 to 4 years to be able to diagnose and
treat diseases and injuries to the lower leg, including the foot and
ankle. In 2008, there were 8 accredited podiatric medical colleges in
the country, awarding a DPM to graduates.”
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