ugghhh efex!!! Do think there will really be that many changes during his 4 year tenure? What have you seen and heard already? Is it a reality that socialized medicine is just around the corner, just for the sake that we are losing numbers of doctors due to retirement and can't sustain applicant pools year to year????

I read somewhere that he is urging or will be urging medical schools to increase matriculation by 30%...over how long a period I don't know

I do think there will be many changes in his tenure...for example, providing universal healthcare to ALL will place a HUGE demand on the already overworked and poorly compensated PCP, me thinks, many of these "new" patients will be seeing NP/PA and these will be the "easier" (aka a la algorithm medicine) patients. This will in turn mean that PCP will be mostly seeing those patients with a plethora of co-morbidities and over 30 medications which will then translate into super long visits....it is not looking good. Medicare is set in decreasing re-imbursement, hospitals are now seeing increased demands regarding medicare patients and "in-hospital" events that will NOT be getting re-imbursed.
Unless, Obamanomics, curtails who gets what with his panacea of providing healthcare to all, we will be screwed. Most residents are NOT going into PC because of all that is taking place and unfortunately not everyone can go into the ROADE specialties hence a lot are now doing locum tenens and hospitalists or just getting out.

Other things to consider...unless he provides tuition FREE medical school who in their right mind will be going into FM/IM primary care? unless more states adopt tort reform who in their right mind will be doing ob/gyn/neurosurgery/x or y specialty with high malpractice rates in those states?
Unless patients start getting zinged via a larger co-pay, or whatever for NOT taking preventive measures seriously, who will be ecstatic getting their taxes used for those folks that choose to not take their Plavix, yet keep eating daily junk food and smoking like a chimmney? ???? Personal responsibility has left the building in the US. We keep providing heroic measures at the end of life "because we want grandma/grandpa" to have 1 more nanosecond of a semi-vegatative state....I could go on and on.

Check out http://thehappyhospitalist.blogspot.com/2009/03/is-it-reasonable-to-get-it-right -100-of.html and google Panda Bear MD for some horror stories.

Yep. I totally agree. :banghead:
So very few people actual take responsibility of their own health, scary!

Oh my gosh...that is too funny about the 85 year old grandpa who is all but dead, the family holding on for dear life, running expensive machines and room rental, adding yet more work to already overworked nurses. etc. etc. This is not a fun outlook for the future.

Thanks for the link!

Both are fabulous points.

As much as I'm a fan of civil liberties, our health care system can't handle the above any more. Bring on the smoking bans and fast food regulations and stricter drunk driving laws. Unfortunately people won't do it for themselves, so this is the consequence. We can't afford to financially support this kind of self- (and others-) destruction anymore.

Also, re: ICU end-of-life....I think the best thing anyone can do to educate families is start a reality show based in the ICU so America can watch (and learn) that this happens all the time and watch people role model how (*and how NOT*) to handle their loved one's imminent death despite the machines. Families are under the impression that withdrawal decisions only happen in epic, Terry Schaivo-like proportions. Nope, it happens every day, in *much* more straightforward ways. Okay, I don't know how to keep this post short, so I'm going to stop here...

OMG! what a FABOLOUS IDEA!

We must pitch this to someone? this would be the best thing ever to educate patients...TLC please do this!

Don't want to be negative to people with their hearts set on becoming MDs (and not suggesting that being a PA is for everyone), but to be balanced there are more pluses to becoming a PA than the shorter training time (which in itself is no minor point for me--I want to start my family in the next 5/6 years, and I like that I'll be done with training by then). One thing I really like is that you can enter any specialty, including ones that I think I would be very interested in but wouldn't enter as a doc because of long training/working hours and very high liability (OBGYN and surgery, for instance). I recently saw an ad for an OBGYN PA, 100k/year, 40 hour week (and no nights and weekends), including assisting in surgery. If you want to work nights and deliver babies the doctor was willing to train the PA for this, but it wasn't mandatory. I've found this generally about PA posts--it seems that in most cases the doctors are willing to train motivated and intelligent PAs pretty far.

I also love the fact that you can move around--I met one PA who currently works in OBGYN, but has previously worked in FP, ER, and orthopedic surgery. You just don't get that career flexibility as a doc. Finally, I like that if I want to take 5 years off from my career I can go back into a PA job without much problem.

I think good reasons for becoming a doctor over a PA are if you really want to be the expert on an area of medicine, if the status of the MD title is very important, or if you want the earning potential (although this doesn't always hold that you should become a doctor if you want a higher income--for instance I know of a nurse anesthetist who makes 250k/year).

Again, not trying to say that being a PA is "better"--just something to consider since it has some pretty great benefits, I think.

Glad you like it. Seriously, there would never be a dull moment. And, not to be crass, but if it saved the taxpayers even 2 weeks of unnecessary (and cruel) life-support, the TV show could pay for itself! AND families would be so much more at peace with making such hard and real decisions.