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You know - even though you're a medical provider - and I'm not - I have to disagree with you.
I've only had one surgery at the new Mayo hospital. Removal of some pelvic cysts. My surgeon (Dr. Chen) was top notch. My anesthesia team too, Although the latter was in the category of the see one - do one - teach one team. I had 3 anesthesia people - one attending and 2 residents - working on me. My surgery was admittedly "bread and butter". But my late FIL had more significant/complicated surgery at Mayo with people I thought were really high class surgeons perhaps 9 years ago.
I realize there are better surgeons/surgical teams than we have at Mayo JAX (my husband has a heart valve problem and the best surgeon should he ever need surgery is up at Mayo Rochester) - but I think it's hard to do do better for most surgeries in JAX than at Mayo.
Also - for a lot of secondary care here - Mayo is . My husband has MS - and his neurologist here is world class in terms of MS care/treatment. Robyn
P.S. My husband and I are retired medical malpractice lawyers and perhaps know more about medical care than most people.
I definitely agree that for certain specialties within specialties(MS for example), it's likely that you're going to find the best care at a large academic hospital. That's simply a reflection of the fact that certain types of subspecialists(especially that essentially just treat one disease state as many neurologists who focus on MS do...it's similar with Parkinson's) can only really work at a large academic center because of the structure and resources provided there(research collaborations, pilot studies, etc).
As a former resident and fellow(and very very inexperienced attending) who has trained at multiple large academic centers at various points(med school,residency, and fellowship), I've just seen too much to where I don't want residents or fellows to work on me. Of course if I have a rare brain tumor or something, I'm going to go to the large academic center where they have the very specialized subspecialists....but if my kid(and I don't have kids) needed his tonsils removed, I would pick an ent who had a good local reputation and has done hundreds/thousands of such procedures working independently for years. Not go to Emory(just to pick one) where a pgy-2 or 3 ent resident would be doing the surgery while the attending(who likely wouldn't even be scrubbed in for such a procedure) is physically present in the OR to meet that standard.
Of course, another thing to consider is that in any hospital system the care provided by physician level providers is just one component. How nice the rooms are, how well staffed it is in terms of nursing, how good the nurses are, etc can all be very important factors...for both overall pt care and pt satisfaction.
My two cents about Mayo is that during the transition-phase of our move to Jax, and having to stay at an extended-stay-type hotel that just happened to be somewhat nearby, we discovered that many of the other guests were staying at that hotel because they had traveled quite a distance to get treatment at Mayo for various illnesses. That's indicative, in my opinion, of quality care that many will purposely travel to get.
My guess is many of them had illnesses that would benefit from a certain subspecialist seeing them. These are of course going to be more concentrated in academic centers.
As a caregiver/patient advocate for two elderly parents, a college kid, and my husband, from 2005 until present, I can tell you that that is NOT the experience I had with the Mayo here in Jax.
I really don't have the energy to tell you my experiences, but the short version is this:
Elderly mother parent, cath procedure by an "attending" (to use your word) with allegedly great credentials, admitted to Memorial for one week because they could not stabilize her blood pressure after the procedure = horrible. During the hospitalization, no communication from the "attending" or anyone else. Charge nurse was a freaking zombie.
Elderly parent an in-patient at Orange Park Medical Center = a disaster. I can't even talk about it. The hospital personnel and all but one "attendings" were horrible. He went from feisty and ambulatory one day, to near death the next day, and died three months later, despite herculean attempts by my nurse sister to reverse the damage.
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I don't disagree at all that there are incompetent attendings out there....in a lot of different settings.
But going back to the first example- the cardiology attending that you cite as being terrible....think about it like this: that same attending at one point was a cardiology fellow, and if he is in fact subpar he was almost certainly even more subpar as a resident and fellow.
You'll have to see whether the plan is available here - what providers (doctors/hospitals) are in its network if it is available - what your co-pays/deductibles will be - what you have to pay if you go "out of network" - etc. - etc. and whether you want that plan after getting the information.
There are lots of MA plans here - and many have very restrictive networks (and/or providers that might not be to your liking). Note that none of our doctors (including those at Mayo) accepts MA patients (including those at Mayo). I don't think Mayo hospital accepts MA patients either.
There are 2 additional wrinkles when it comes to Mayo. Mayo is currently not accepting new Medicare patients for primary care. If you want primary care at Mayo - you have to join its concierge practice. My husband and I did that after our primary care doc closed up shop in 2012 - but most people don't care to spend that money/can't afford it.
Also - although Mayo accepts traditional Medicare patients - it does not "accept Medicare". Therefore - it bills you not only Medicare allowed amounts - but an extra 15% on top of that when it comes things covered under Part B. There is a Medigap supplement that covers not only the Medicare co-pays/deductibles - but also that extra 15% (Plan F - which I have). But I don't think any of the other current Medigap plans covers the 15%.
FWIW - in terms of my crystal ball - MA plans are increasingly becoming relatively worthless as their funding is cut (and I've written numerous messages to that effect in other forums here). I think the whole health care delivery system is becoming stratified - and people on MA plans will pretty much wind up being lumped together with people on Medicaid and perhaps some in the "low priced spread" ACA HMO plans. So - if you can afford to switch to traditional Medicare with a good Medigap supplement when you move (you may be able to avoid "medical underwriting" when you move) - do it. It's usually easier to go back to a MA plan than to change to traditional Medicare with a good Medigap policy. Of course - if you can't afford it - you can't afford it. OTOH - a lot of people used to think that MA plans were a good deal and they could use the money they saved using MA to live "higher on the hog". I think those days are going/going/will soon be gone.
Note that there are tons of messages about this stuff in the Retirement/Health insurance forums here (mostly the latter). So - if you want more info in this area - those are probably the best places to ask questions. Robyn
I definitely agree that for certain specialties within specialties(MS for example), it's likely that you're going to find the best care at a large academic hospital. That's simply a reflection of the fact that certain types of subspecialists(especially that essentially just treat one disease state as many neurologists who focus on MS do...it's similar with Parkinson's) can only really work at a large academic center because of the structure and resources provided there(research collaborations, pilot studies, etc).
As a former resident and fellow(and very very inexperienced attending) who has trained at multiple large academic centers at various points(med school,residency, and fellowship), I've just seen too much to where I don't want residents or fellows to work on me. Of course if I have a rare brain tumor or something, I'm going to go to the large academic center where they have the very specialized subspecialists....but if my kid(and I don't have kids) needed his tonsils removed, I would pick an ent who had a good local reputation and has done hundreds/thousands of such procedures working independently for years. Not go to Emory(just to pick one) where a pgy-2 or 3 ent resident would be doing the surgery while the attending(who likely wouldn't even be scrubbed in for such a procedure) is physically present in the OR to meet that standard.
Of course, another thing to consider is that in any hospital system the care provided by physician level providers is just one component. How nice the rooms are, how well staffed it is in terms of nursing, how good the nurses are, etc can all be very important factors...for both overall pt care and pt satisfaction.
I tend to agree and disagree with you. I also think there are some things you haven't covered. So I guess I have to explain my thinking .
Increasingly these days - we hear about the concept of a "medical home". I'm sure you've heard the phrase. But - for people who haven't - it's basically the notion that it's better to have centralized as opposed to fragmented health care. This kind of dovetails with another recent development. Hospitals buying up other hospitals and forming hospital networks. Also buying up physician practices. Or entering into contracts with physicians where physicians try to keep things "in house" in terms of referrals - using particular hospitals - etc. IOW - health care consolidation. I'm sure anyone who lives in Jacksonville can relate to this if they think of a place like the Baptist system. Its hospitals - and all the doctors located near its hospitals who are basically part of the Baptist network. Here in JAX - we have not only Baptist - but St. Vincent's - Memorial - Mayo - and perhaps I've forgotten one or two.
This consolidation isn't complete yet - but it's getting there - slowly but surely - and will probably near completion as people who are young today get old (I'm already old).
Now perhaps someone who is pretty young - someone with few or no health concerns - can just treat the current consolidating system as an "a la carte menu" - picking and choosing services/providers as they need them (assuming their health insurance allows that). Once you get older and/or if you have any significant health issues - you want something more coordinated than that (at least that's what my husband and I want).
And that's why we chose Mayo - because it meets almost all of our health care needs and is a totally integrated system. Not that we have anything that terribly wrong going on - it's more of a laundry list of minor/medium things (my husband has MS and a leaky heart valve but he has been relatively fortunate with both situations).
It is unfortunate that Mayo will not accept new Medicare patients in primary care except through its concierge practice. We thought it was worthwhile to get into that - can afford it - and don't regret it for a minute. We think our primary care docs (I have one - my husband has another - and the 3 Mayo concierge PCP docs each has a maximum of 150 patients) are our quarterbacks. They are all board certified internists (it used to be the norm - but it's increasingly rare when it comes to PCPs today) - so they can deal with a lot of routine stuff themselves. There's no "Tinkers to Evers to Chance" when it comes to a simple adjustment of a BP or statin med (like you might run across if your PCP is a NP - and you first get referred to a family doc (board certified or otherwise) - and then perhaps to an internist - and then perhaps to a specialist. And lots of other things.
They tell us when they think we need specialists (we usually know - but appreciate confirmation or - occasionally - non-confirmation) - which ones we need - and their office sets up appointments with them. In HMOs - they might be called "gate-keepers" - people who try to lock you out. For us - they're doctors who always get us where we should be if the need arises - but they don't send us on wild goose chases either. They are even pro-active in terms of ordering tests that are necessary before specialist appointments - so we don't waste the specialist's time - or ours - by arriving at appointments without the right paperwork/test results in hand.
I have found just a few deficiencies in the Mayo system since we started using it (quite a few years ago for most things except the concierge PCP practice). It is not geared up to do extremely routine things the way we prefer. For example - routine annual skin cancer screenings (a must if you've lived in Florida for 40+ years like we have). Those are done exclusively by residents at Mayo. The problem isn't that the residents aren't competent. It's just that they're here today - gone next year or the year after. We like more continuity than that. So we use a Mayo trained dermatologist who has a private practice. She knows us - and - more important - all of our "skin doodles". OTOH - my husband and I have both needed Moh's facial skin cancer surgery within the last 5 years. And - for that surgery - we went to Mayo.
Ditto when it comes to annual routine eye exams. We use an outside Mayo local opthalmologist. He's not only good with our glasses - but can do the tests my husband needs to monitor his MS. If his routine tests ever turn up something other than a change in an eyeglass Rx - we'll have to find someone to deal with it.
And the last is I get large wax accumulations in my ears. The best provider I've found to take care of this is a board certified ENT who accepts Medicare (he uses expensive equipment to do the job - and charges less not only than Mayo - but also the NP at Walgreen's who uses a syringe and warm water!).
FWIW - I couldn't care less how nice the rooms in a hospital are (or how good the food is either). The rooms happen to be very nice at Mayo (I spent about 15 hours in one in 2010) - but I hope always to avoid lengthy hospital stays. And current reimbursement rules try to get you in/out ASAP. My 2010 surgery was to remove pelvic cysts (vaginally). Surgery was at about 3 pm. I went to the hospital room. Once it was determined that my urinary/bladder and bowel functions were intact and functioning (I had to consume some pretty awful food - overcooked fish and the like - to prove those things) - I was kicked out (and was glad to be kicked out).
BTW - what's your specialty? Robyn
Last edited by Robyn55; 01-05-2014 at 05:21 PM..
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. My husband has MS - and his neurologist here is world class in terms of MS care/treatment. Robyn
) needed his tonsils removed, I would pick an ent who had a good local reputation and has done hundreds/thousands of such procedures working independently for years. Not go to Emory(just to pick one) where a pgy-2 or 3 ent resident would be doing the surgery while the attending(who likely wouldn't even be scrubbed in for such a procedure) is physically present in the OR to meet that standard. 
