scanman’s posterous

stuff that's too long for twitter & not really apt for my blog 
Tags


Filed under

usa

 
April 25, 2009

federal democracy at work aka daylight robbery

a long conversation on twitter a couple of days ago between two US emergency physicians - symtym & movinmeat, one of them with a US law degree (but not yet licensed to practice), an Indian radiologist (me), an Australian surgeon (DrCris - sorry, I forgot to add you initially) and a US internist (changu) with contributions from 2 US psychiatrists (intueri & purplesque) about the seemingly simple, Byzantine medical licensing system in the USA. it's a long conversation with 42 tweets in all. my apologies if i've left out any relevant tweets.

it all started after i read this post by Tim (aka symtym) and asked him a question on twitter.

i have some thoughts about this, which i hope to put together in another post. any comments from others medtweeps who missed the conversation are welcome.

following the twitter timeline as always, with the oldest tweet at the bottom & the newest on top...

  1. changuchangu @scanman @movinmeat @symtym what licensing fees pay 4 .» link to AMNews: May 12, 2008. Doctor disciplinary actions down for 3rd year ... American Medical News IMC do anythin comparable? about 14 hours ago from digsby

  2. movinmeatmovinmeat @intueri "eavesdropping?" OMG I feel so violated! about 17 hours ago from Tweetie

  3. purplesquepurplesque @scanman Missed the entire licensure discussion, but it is insane. Not just the money, but the paperwork involved takes months. about 19 hours ago from web

  4. intueriintueri @symtym @scanman @movinmeat I enjoyed "eavesdropping" on that MD license/Constitution discussion y'all had. International forum. about 20 hours ago from web
    RT
  5. movinmeatmovinmeat @symtym very true. Just back from DC - great way to get the ol' patriotic/reverence for our system juices flowing again. 12:17 PM Apr 24th from Tweetie
    RT
  6. Tim Sturgillsymtym @scanman so disagree, you need to read McCullough's John Adams, etc. -- they got it right despite all the lawyers, politicians, etc. 12:12 PM Apr 24th from TweetDeck
    RT
  7. Vijay scanman @symtym @movinmeat they got so much right in the 18th century coz - lesser number of politicians, laws & lawyers 12:06 PM Apr 24th from iTweet
    RT
  8. DrCrisDrCris @scanman Ridiculous that we have to oppose something that we want. Like when we had republic referendum. Politics ruins everything. 12:04 PM Apr 24th from Tweetie
    RT
  9. Tim Sturgillsymtym @movinmeat don't disagree, but then I'm tending to see it as amazing that the guys got so much right in the 18th century, that lasts so long 12:00 PM Apr 24th from TweetDeck
    RT
  10. Vijay scanman @DrCris there's bound to be politics / political interference in any kind of regulatory set up. 11:59 AM Apr 24th from iTweet
    RT
  11. movinmeatmovinmeat @symtym won't say it's good/bad, just an odd unintended consequence of particular way the gov't here formed. could have been better, though. 11:34 AM Apr 24th from Tweetie
    RT
  12. Tim Sturgillsymtym @scanman most things US is one entity, but there are many aspects where we are truly 50 different states, all types of licenses r like this 11:03 AM Apr 24th from TweetDeck
    RT
  13. Tim Sturgillsymtym @scanman that's what I figured, I've heard the question before, common misconception for those out of the US 11:02 AM Apr 24th from TweetDeck
    RT
  14. DrCrisDrCris @scanman We are moving toward national registration in Australia (currently state-based) but the model makes medical appointments political. 11:02 AM Apr 24th from Tweetie
    RT
  15. changuchangu @symtym @scanman is much stronger here, and India could use a lot more policing of physicians , life time licenses that s just ridiculous! 11:00 AM Apr 24th from web
    RT
  16. Vijay scanman @symtym that's what I was looking for Tim. Trying to make sense of something that is beyond me. 10:59 AM Apr 24th from iTweet
    RT
  17. Tim Sturgillsymtym @scanman don't get nasty there, "lawyer" means license, don't got that, whole other set of fees...there are 50 of those as well 10:59 AM Apr 24th from TweetDeck
    RT
  18. changuchangu @symtym I actuallly appreciated symtym's photons, didnt realise licensure , had to do with police..Also think the fed structure contd... 10:59 AM Apr 24th from web
    RT
  19. Vijay scanman RT @symtym $890/3 yrs, DEA license $551/ 3 yrs, board recert every 10 probably $1,500 < Obscene. 10:58 AM Apr 24th from iTweet
    RT
  20. Tim Sturgillsymtym @movinmeat it seemed more like what @scanman was looking for, instead of "because" or "its that way" ;) 10:58 AM Apr 24th from TweetDeck
    RT
  21. Vijay scanman @movinmeat "granular level of detail" << you have to remember @symtym is a lawyer :) 10:57 AM Apr 24th from iTweet
    RT
  22. Tim Sturgillsymtym @scanman mine is $890/3 yrs, DEA license $551/ 3 yrs, board recert every 10 probably $1,500 10:57 AM Apr 24th from TweetDeck
    RT
  23. Vijay scanman @symtym @movinmeat @changu regulation = control = $ << very true. And the Americans have perfected it. 10:56 AM Apr 24th from iTweet
    RT
  24. movinmeatmovinmeat @symtym never said it was wrong - just funny/granular level of detail 10:55 AM Apr 24th from Tweetie
    RT
  25. Vijay scanman @changu It's a lifetime licence. If u're registered in Karnataka Medical Council no one's going to stop you from practising in Kerala or TN 10:55 AM Apr 24th from iTweet
    RT
  26. Vijay scanman @symtym @movinmeat Moreover our licensing fees, which are usually for life, are a pittance. About $50 - both national & individual states 10:54 AM Apr 24th from iTweet
    RT
  27. changuchangu @scanman there are 30 states now? I left when it was 22, am only licensed in Katnataka, prob expired now.. 10:53 AM Apr 24th from web
    RT
  28. Tim Sturgillsymtym @scanman my wife has 17 RN licenses to just to do telephonic nursing; regulation = control = $ 10:53 AM Apr 24th from TweetDeck
    RT
  29. Vijay scanman @symtym @movinmeat Our states have individual Medical Councils too, but they don't usually care if u're licensed in another state. 10:52 AM Apr 24th from iTweet
    RT
  30. Tim Sturgillsymtym @movinmeat @scanman at the risk of tossing more photons, for many aspect of US Gov u have 2 consider us as 50 distinct states, license = $ 10:51 AM Apr 24th from TweetDeck
    RT
  31. Vijay scanman @symtym @movinmeat And you guys complain of a doctor shortage!? *exits shaking head in wonder* 10:50 AM Apr 24th from iTweet
    RT
  32. Tim Sturgillsymtym @movinmeat @scanman obviously India is more advance, or we have an older democracy (federal form of democracy) 10:50 AM Apr 24th from TweetDeck
    RT
  33. Vijay scanman @symtym @movinmeat Why should a US doctor be forced to pay 50x to practice in 50 states. Shouldn't there be a national licensing authority? 10:49 AM Apr 24th from iTweet
    RT
  34. Vijay scanman @symtym @movinmeat - If I'm licensed by the Indian Medical Council - after paying a fee once, I can practice in all 30 states in India. 10:48 AM Apr 24th from iTweet
    RT
  35. Vijay scanman @symtym @movinmeat - I understand a federal set up. We have one in India too. But don't you guys have an overall national licensing body. 10:46 AM Apr 24th from iTweet
    RT
  36. Tim Sturgillsymtym @movinmeat what's your explanation for 50 licenses? 10:36 AM Apr 24th from TweetDeck
    RT
  37. Tim Sturgillsymtym @movinmeat I sent him the specific Amendment, the 10th, that is responsible for all state police powers, which is the source for licensure 10:35 AM Apr 24th from TweetDeck
    RT
  38. Tim Sturgillsymtym @movinmeat he asked why we have 50 licenses, it is because the Constitution guarantees that power -- specific question, specific answer 10:34 AM Apr 24th from TweetDeck
    RT
  39. movinmeatmovinmeat @symtym @scanman he asks about MD state licenses & you send him Constitution. That's like he if asks about rainbow & you explain the photon. 10:28 AM Apr 24th from Tweetie
    RT
  40. Tim Sturgillsymtym @scanman our constitution: » link to Tenth Amendment to the United States Constitution - Wikipedia, the free encyclopedia 8:32 AM Apr 24th from TweetDeck
    RT
  41. Tim Sturgillsymtym @scanman why, because we have a federalist system; the power of a general police power (nidus) is vested in the 50 states = 50 licenses 8:32 AM Apr 24th from TweetDeck
    RT
  42. aa Loading mentions Retweet
Filed under  //   friends   india   medbloggers   medicine   medtweeps   opinion   twitter   USA  

Comments [0]

February 28, 2009

any comments from #medtweeps in the US?

The future of medicine - gold diggers or concerned debtors? | moneduloides

There has been an ongoing debate in JAMA for quite some time on the topic of specialty choice by graduating seniors in U.S. medical schools. Many of the letters written in have come from concerned physicians in the specialties of family practice or internal medicine, who describe the future of their specialties as grim. They see graduating seniors increasingly choose more competitive residencies such as radiology and emergency medicine over theirs, and attribute this to the increased pay received by those specialties.

Dr. William Hueston of the Department of Family Medicine at the Medical University of South Carolina has, I believe, finally “hit the nail on the head” as it were. Taking these previous claims to task, and using their same data set, he has demonstrated that the relationship between medical student interest and mean salary is a specious one at best. As you might be able to see from the graph provided above (From Hueston’s letter):

A better gauge of student interest is the numerator (how many students selected the specialty). For example, in looking at the Figure in the study by Ebell, it may appear that no one is going into family medicine. However, more US seniors chose this residency specialty than all but 2 other specialties (internal medicine and pediatrics).

He ends his letter by positing that perhaps more students would choose the competitive specialties if more positions were available, but this simply isn’t the case - it isn’t reality. And this fact demonstrates the difficulty of determining motive for specialty choice from aggregated data. When the number of available positions is not equal for every specialty, how do you go about teasing apart the gold diggers from the legitimately “in debt up to my eyeballs” MDs?

via moneduloides.com

 

Loading mentions Retweet
Filed under  //   medbloggers   medical education   medicine   twitter   USA  

Comments [0]