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View Poll Results: Where do talented new doctors tend to establish themselves?
Near affluent, metropolitan areas where they can more rapidly recoup their investment 21 77.78%
Equally distributed and available most places 6 22.22%
Voters: 27. You may not vote on this poll

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Old 05-23-2014, 01:29 PM
 
14,260 posts, read 23,995,588 times
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Quote:
Originally Posted by Escort Rider View Post
I agree with a large part of what you are saying, except that personally I'll take the teaching hospitals because my level of confidence is higher. And yes, I myself take health care availability for granted, being that I live in one of the places you listed. Further I assume you used those four places as examples, not as a complete listing. My point was and remains that most people in the United States live in places like the examples and can therefore take health care availability for granted; we no longer have much of a rural population in this country as was the case before World War II.

Even when you get to smaller cities (250k residents), the number of available specialists is somewhat limited and those doctors have waiting lists of 4-6 weeks on NON-EMERGENCY cases.

The only thing that I am taking for granted moving from Chicagoland is that health care will be less readily available that in my current situation and will require some effort to get a medical team together.
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Old 05-23-2014, 02:51 PM
GLS
 
1,985 posts, read 4,847,602 times
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Quote:
Originally Posted by theoldnorthstate View Post
Where do talented younger doctors tend to establish their practices? In an urbanish area or equally distributed anywhere but includes a resortish type area?

My sister (who is a retiring nurse practitioner and I am not in the medical business) and I were at opposite end on this question. I was thinking it would be smart to pick my retirement location with a strong factor being that good specialists fresh out of the various fellowships, etc would be going for the places where they could recoup the financial output and pay off student debt. Basically that they know their value and would establish themselves accordingly. She believed that good doctors can be found everywhere and that you could retire even to an area without it being a concern. She maintained that good doctors are everywhere and with medical advances even in outlying areas, good care would be just as available.

Does anyone have any experience with this?
In my career I have been fortunate to have taught medicine and clinical pharmacology at several schools across the country. My observations of my students selection of areas to practice are as follows:

1. Geographic distribution is not much different now than it was 50 years ago. Since employment as a physician is available in both cities and rural areas, the choice is very personal and involves similar factors that most people use to make a decision on where to live. Single or married? Climate? Focus on material rewards or dedication to serving a specific population, i.e. indigent? Therefore, "talented" physicians can be found in many areas of the country.

2. Many medical students accept "scholarships" that have a service requirement upon graduation. They get tuition paid in return for an agreement to practice a certain number of years, usually in an under served area. This again ensures that "talented"
doctors are distributed to rural or inner-city practices that might otherwise not be able to attract physicians. Hence, the corroboration that you will be able to find a good physician in many places. As one example, my NDEA loan has a clause that I would have 10% of the loan forgiven for each year I taught up to a maximum of 5 years or 50%.

3. Your post uses the term "good specialists". This does introduce an aspect of geography into distribution of graduates of advanced programs with specialty residencies. This is technology dependent if the specialty, i.e nuclear medicine requires close access to very expensive equipment. This discourages specialists from locating in rural areas. However, this is not as true now as it was in the past. The internet and computer networks have given rural physicians rapid access to consults, lab data, etc. from specialists. One example is the excellent networking of the University of Nebraska system that links physicians in rural areas to specialist at the College of Medicine and tertiary care hospitals in Lincoln and Omaha.

4. If you were unintentionally using the term "good specialists" interchangeably with "good doctors", you need not worry about access. In my opinion, the most important physician is your primary care doctor or family practitioner. This physician knows you best, treats you as the "total" patient vs an organ system, and functions as the initial triage expert and referral. If you do have a medical condition that you already know requires a specialist, I advise you to research the specific geographical location you are considering in order to find specialist availability.

5. Another important factor to address your question is the tendency of new graduates to become "employees" of hospitals or large healthcare systems. Regulatory and financial barriers strongly discourage setting up a private practice. Insurance company restrictions, the complexity of documentation & reporting, i.e. HIPPA compliance, mandates for electronic medical record, all drive new grads away from private practice. This would be one factor pushing new physicians toward cities or at least towns large enough to support multi-physician systems.

I just realized that this post is getting too long and I am talking too much. You just hit on a subject near and dear to my heart. In summary, my advice is to analyze your personal medical needs and don't let "rural vs city" concerns deter you in selecting your retirement location. On the other hand don't just assume you will find the physician you need because the numbers in an area imply accessibility. You need to do the research on physician profiles, background & training, any malpractice suits, reputation, feedback from patients, etc. before you relocate. HINT: As an NP your sister can be a big help. A few calls to other NPs, PAs, and Nurses in the area and you will get a fairly accurate picture of who is a "good doctor". Good luck.
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Old 05-23-2014, 03:02 PM
 
Location: Waterville
332 posts, read 428,235 times
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Quote:
Originally Posted by Escort Rider View Post
I have long been of the opinion that most people who claim to have a great doctor really haven't the faintest idea whether that doctor is good, bad, or indifferent. What they mean is they LIKE their doctor - he somehow makes them feel good psychologically.

Any large, teaching hospital is almost certain to be a good one. There is tremendous snobbism at work with people convincing themselves that their hospital and/or their doctor is such hot stuff.

Hospitals which specialize in rare conditions/diseases may well be the exception. If one has that rare condition/disease, then a hospital specializing in it may be truly superior.

I have never quite understood the attitude/expectation that we are going to be very sick/have medical emergencies and therefore we need to plan our retirement around proximity to a large hospital. Most of the population of the United States lives in urban and suburban areas, not out in the boonies somewhere. Therefore most of us live in close proximity to good medical care - by definition.

What's all the worry and agonizing about? It seems to me to be some sort of anxiety disorder.
I couldn't agree more with the bolded paragraph. I have lived in the Albany NY area since mid-1981 and have yet to find a competent gynecologist who participates in my health plan despite tons of suggestions. Since I have never been in the baby-making business, I tend to distrust fertile women's opinions. After all, pregnancy is not an illness. I think that in medicine as in most American contexts, personality is an all-too compelling factor by which people form their opinions.

However, as to the rest of your comment I would point out that some of us already have progressive medical conditions that require consideration if we are contemplating a move. I want to return home to Maine and I would prefer to be in the 'boonies'. That would not be a prudent choice for me. I might find myself in the ludicrous 'fell-down-can't-get-up' position and/or medical services might be further than I need. I do not want to be snow-bound and helpless. I imagine that you have never had to consider this possibility out there on the left coast.
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Old 05-23-2014, 03:51 PM
 
Location: Los Angeles area
14,018 posts, read 17,740,386 times
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Quote:
Originally Posted by foglover View Post
I couldn't agree more with the bolded paragraph. I have lived in the Albany NY area since mid-1981 and have yet to find a competent gynecologist who participates in my health plan despite tons of suggestions. Since I have never been in the baby-making business, I tend to distrust fertile women's opinions. After all, pregnancy is not an illness. I think that in medicine as in most American contexts, personality is an all-too compelling factor by which people form their opinions.

However, as to the rest of your comment I would point out that some of us already have progressive medical conditions that require consideration if we are contemplating a move. I want to return home to Maine and I would prefer to be in the 'boonies'. That would not be a prudent choice for me. I might find myself in the ludicrous 'fell-down-can't-get-up' position and/or medical services might be further than I need. I do not want to be snow-bound and helpless. I imagine that you have never had to consider this possibility out there on the left coast.
You're right; I don't spend a whole lot of time worrying about being snow-bound here in Los Angeles! And naturally people who have a specific medical condition need to take that into account when thinking about retirement locations. I should have made allowance for that in my post. I was talking in generalized terms about people who seem to worry about all sorts of potential medical problems in the future. My attitude is why assume things will work out on the downside?

If you are in danger of finding yourself in the "fell-down-can't-get-up" position, that absolutely changes everything - it becomes an extremely important consideration.
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Old 05-23-2014, 08:51 PM
 
Location: Oceania
8,623 posts, read 6,251,386 times
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IMO - I am retired and the medical field in the DC area is probably the best. I can pick from JHU, GWU, WHC, Georgetown, a myriad of INOVA facilities and have used them all.
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Old 05-23-2014, 09:01 PM
 
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As someone who works in one of the top teaching hospitals in the US, I see where our residents end up - and they end up all over. Some want to live in major coastal cities, others want to go to the flyover states because that's where they grew up, and others take jobs in the middle of nowhere simply because the pay is substantially higher than any major coastal city. Good physicians can be found most areas.

What can't be found everywhere are specialists for more complicated treatments or procedures for several reasons: 1) highly specialized physicians require additional training, and there are generally few spots for those specialties, hence few graduates/practitioners; 2) The more complicated the treatment and procedures, the more specialized nursing staff you need for the follow-up care. Teaching hospitals are likely to be the only places that offer such highly trained specialists, though some do wind up smaller hospitals and not really in private practice.

I will agree with the poster who said that many people decide their physician is good simply because of how they make a person feel. Some excellent physicians have zero bedside manner and others have an excellent bedside manner. Some lousy physicians have a great bedside manner and others have a lousy one. While I believe most of them really want to be great and strive to be great because they sincerely care, some are just careless and dangerous. There are also some who rely simply upon the reputation they have built and they become careless, leaving the bulk of their work to their unattended residents. To me, that's not a great physician, despite his or her tremendous capabilities. In my opinion, it takes time to determine whether or not a physician is genuinely good at his or her profession. But good physicians can be found anywhere.
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Old 05-24-2014, 06:02 AM
 
Location: Central Massachusetts
4,800 posts, read 4,847,776 times
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The real point here is where there are people that is where the doctors are. If there are too many doctors per person then there will be a glut. Now if you want high quality health care then Massachusetts should be on your list.
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Old 05-24-2014, 09:16 AM
 
Location: Up North in God's Country
670 posts, read 817,707 times
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I didn't vote, because I am a nurse, and I know that most talented new doctors WANT to practice in metropolitan areas. However, they can get some of their loans forgiven by practicing in certain underserved rural areas...so many of them do. Unfortunately, as soon as they put their time in, they move on to metropolitan areas.

I am living in a rural small town right now, and there are some doctors who live up here because they actually like to live in rural areas...the lakes, hunting, skiing, the four seasons, etc.
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Old 05-24-2014, 10:27 AM
 
Location: Glenbogle
730 posts, read 1,027,323 times
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Quote:
Originally Posted by jlawrence01 View Post
Second, I have worked in a number of teaching hospitals and a number of community hospitals. I strongly prefer the latter as you are treated by physicians that know you and have worked with you for years. In the large teaching hospitals, you have so many medical students that often you get a lack of continuity of care. In my local hospital, I know the doctors, many of the nurses from prior visits. I am not saying that there is not a place for the Northwesterns and the Medical College of Virginia or Mass General and the like. However, they are not for me.

Third, there are a lot of us with chronic conditions who need access to medical care fairly quickly. Moving to some hamlet in Costa Rica two hours away from a city is just not an option. And the quality of health care does vary substantially across the country.
I wish I could give you 10x reps for this post; so true!

There is a large teaching hospital here on LI which is certainly NOT regarded overall as a particularly great place to get care. On the other hand there is a large network of private hospitals (NSLIJ health system) that has a reputation and ratings that often cannot be matched by the BEST regarded hospital in many other states.

Often a person's perception of what their health needs are going to be, and their comfort level with quick access to medical care of a quality that gives them peace of mind, can vary greatly -- not only between one person and another but between one time of life and another. Ten years ago I was in excellent health (barring a few non-QOL-impacting conditions since childhood) and would never have made "proximity to excellent medical facilities" one of my relocation priorities. However, in the past five years I have been hit with a laundry list of medical conditions, one after the other, that would choke a horse (starting with cancer). As a result, my priorities and perspective on what's important re: my chosen living location have changed quite a bit. Most of my current conditions are permanent; none are going to improve, and some are certainly going to get worse. There is also the potential of other new conditions arising in the future. However much I hate this state of affairs, this is my 'new normal' and I have had to adjust my life and my thinking to account for it (and to plan ahead so that I won't be making life more difficult for myself in the future).

There is a difference between being pessimistic and being realistic. I belong to the "hope for the best but plan for the worst" camp, myself.

ETA: To get back to the original topic, I don't want to be seen by some rookie MD -- no matter how bright or innovating his/her thinking may be. Because I have multiple conditions which affect each other in various ways, I want a doctor with as much experience as possible and who is established in his/her profession.
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Old 05-24-2014, 10:46 AM
 
5,392 posts, read 6,535,307 times
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Thank you all for your comments. You have helped a lot. Appreciate your perspective.
interesting that community and private hospitals get positive mentions.

thanks
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