Some Chicago Boyz know each other from student days at the University of Chicago. Others are Chicago boys in spirit. The blog name is also intended as a good-humored gesture of admiration for distinguished Chicago School economists and fellow travelers.
Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.
First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.
They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.
The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.
This is all well and good. What happens when a patient comes in with a serious condition ?
The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.
I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.
I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.
But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls.
In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid.
But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.
And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016.
My earlier objections to Obamacare were that it promises too much and pays too little.
As it turns out, Medicaid patients can’t get appointments with physicians.
“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP.
We spent today at Ypres an the huge military cemeteries from the battles of the Ypres Salient.
This was an early battle of WWI and the “first battle of Ypres” occurred at the end of “The Race to the Channel.” I have read a bit about the First World War but it really comes home when you are standing the place that consumed the British youth in 1914 to 1918. The First Battle ended the Race to the Sea and began the trench warfare of the next four years.
We visited the “Sanctuary Wood Museum today, and I took some photos of the trenches which were preserved all these years by then owner of the small cafe where we had a beer.
Ypres
These trenches are the originals preserved by the property owner who probably has cleaned out debris over the years. The owners of the cafe are the children of the original owners of the property who preserved these relics. Their museum has many objects no doubt excavated from the fields around.
The bodies of 21 German soldiers entombed in a perfectly preserved World War One shelter have been discovered 94 years after they were killed.
The men were part of a larger group of 34 who were buried alive when a huge Allied shell exploded above the tunnel in 1918, causing it to cave in.
Thirteen bodies were recovered from the underground shelter, but the remaining men had to be left under a mountain of mud as it was too dangerous to retrieve them.
Nearly a century later, French archaeologists stumbled upon the mass grave on the former Western Front in eastern France during excavation work for a road building project.
The road building has been suspended for now but every construction project in this area uncovered evidence of war dead. Today we visited an enormous memorial for the war dead whose bodies were never recovered. It is called the Menin Gate Memorial and the names of 54,000 dead are posted on the walls representing most of the dead from the Ypres Salient who could not be identified.
The sheer number of dead whose bodies were destroyed, or lost, is staggering.
The city of Ypres (pronounced by our hosts as “eep” has been rebuilt as it was destroyed in the war.
The cathedral was rebuilt from a stump of the tower. The bottom 20 feet to so was protected by rubble and is in better shape. The entire city was rebuilt completely.
The city is surrounded by British war cemeteries of which there are about 150, each with about 500 to 1,000 graves.
One grave that particularly interested me was that of Sir William Osler’s only son who was killed by shrapnel while serving as an artillery officer in 1917. His fathers friends had tried to save him and his last words, reflecting many young men who were wounded, “Surely this (wound) will get me home. ” His last words.
Today, we arrived at Brussels and will do some touring tomorrow of the Waterloo Battlefield. We passed on the road one of Wellington’s battle fields from the 18th century.
The TV tonight is all about the “refugees” which we saw a few of today in Brussels.
Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.
A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.
They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.
The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.
This is all well and good. What happens when a patient comes in with a serious condition ?
