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Old 22nd May 2018, 01:58 AM   #81
P.J. Denyer
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Originally Posted by JoeMorgue View Post
Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.
UK

Back in January I received a Vehicle Excise Duty reminder and a a parking ticket for a vehicle that I'd traded in a year before. In theory when you sell a vehicle it is the seller's responsibility as much as the buyer's to notify the DVLC and failure to do so can result in a sizable fine and responsibility for taxes and fines relating to the vehicle, in practice when selling to a trader they will often retain the notification slip so that registration can be transferred directly to the next owner in order to minimise paperwork and delays, and prevent an extra 'previous owner' being added to the log book.

So here I am, a car I no longer possess is being driven around by someone else, I don't know where it is or who has it but there are taxes and fines due on it and I am liable for them and for not having carried out my responsibility to notify them. I don't know how much trouble this would be to sort out in the US, but I made one very quick phone call to the DVLA who told me to send them a signed letter containing the details of the car, the trader that bought it, and the date it was sold. A week later I received official confirmation that the changes had been made.
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Old 22nd May 2018, 02:00 AM   #82
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Originally Posted by JoeMorgue View Post
And, and again I'm being dead serious, do people in other countries just get better services in general from their government? Anything in American that operates on anything like a consumer level service organization is so bad they are their own metaphors. Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.
UK perspective.

I don't drive, so I have little dealing with the Driver and Vehicle Licensing Agency (DVLA) apart from filling in a paper form for the provisional licence I only have to use as photo ID. It's for ten years, so I don't need to renew it until 2024.

In most circumstances people have no need to have any direct contact with HM Revenue & Customs (HMRC). Like the vast majority of salaried workers, my wages for the day job are taxed as Pay as You Earn (PAYE) at source, with National Insurance deducted at the same time. If a person is paid monthly, a twelfth of the annual personal tax-free allowance (currently £11,850 if earnings are up to £123,700) is accounted for; if paid weekly, 1/52 will be applied. If that person has a break in employment, the system automatically adjusts for un-used personal allowance in the same tax year. For example, a few years back I took a break from work after taking voluntary redundancy, and only started working again in the fourth month of the tax year, so as a result had 4/12 personal allowance applied to that first month's pay, thus paying hardly any income tax at all. Similarly, if someone works for the first half of a tax year, but not the second, they will be due a PAYE rebate, having been taxed on six months salary with six months allowance, rather than six months with twelve months allowance. They will usually get that rebate automatically when they start working again. Similar rules apply to National Insurance payments, will a threshold of £8,424. The only caveat is that un-used allowances from a year in which a person pays no tax at all, or when they earn less than the allowance, are not rolled over. If someone only earns £10,000 they will pay no tax, but the £1,850 of un-used allowance won't be carried over to the next tax year.

However, as I also have some earnings from writing, I fill in a tax return online for that self-employment every year, which usually takes a few hours, as I keep a track of all income and expenditure in the required breakdowns in Excel. In the years where I make a profit, I can pay the tax due immediately online; in the years where I make a loss, I get a rebate on my PAYE from the day job by bank transfer in a few days (I could opt to have that rebate applied to my day job PAYE, but I like to keep them separate). In eight years of filing tax returns, the only time I had to contact HMRC direct was when I started working again after the aforementioned break. I had been paying voluntary self-employed NI contributions in the year I was off, but then needed to switch to an exemption on the grounds of low earnings, once I was paying enough NI through the day job. I could have had that exemption all along, but preferred to have a full NI record for the year, as it counts (eventually) towards state pension entitlement. It was dealt with in a couple of letter, no real fuss.

Generally the only people filling out tax returns in the UK are the self-employed, high-earners, or those with investments that aren't taxed at source or overseas income.

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Old 22nd May 2018, 02:32 AM   #83
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Originally Posted by JoeMorgue View Post
... Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with?
UK here. I'm aware that people in the US find the DMV deeply exasperating but I don't actually know what it is that people need to go there to do.

My only encounters with the equivalent DVLA are, for each of our cars, once a year they send a reminder form V11 to pay the car tax (which I can do online or at a post office). Otherwise it's only when buying or selling a car I fill out and post the relevant portion of the car's registration document to the DVLA and they send me (or the new owner if I'm selling) an updated one. The cars also need an annual MOT inspection but that's just a matter of booking an appointment and turning up at any number of local garages which are approved test centres; no customer dealings with bureaucracy at all.
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Old 22nd May 2018, 03:08 AM   #84
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Originally Posted by Jack by the hedge View Post
UK here. I'm aware that people in the US find the DMV deeply exasperating but I don't actually know what it is that people need to go there to do.

My only encounters with the equivalent DVLA are, for each of our cars, once a year they send a reminder form V11 to pay the car tax (which I can do online or at a post office). Otherwise it's only when buying or selling a car I fill out and post the relevant portion of the car's registration document to the DVLA and they send me (or the new owner if I'm selling) an updated one. The cars also need an annual MOT inspection but that's just a matter of booking an appointment and turning up at any number of local garages which are approved test centres; no customer dealings with bureaucracy at all.
By and large you don't need to go there often anymore. I have renewed and changed my address on my licence several times online as well as vehicle registration. The last time I had to go was getting my wife her license and transferring ownership of her mothers van to her.
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Old 22nd May 2018, 03:22 AM   #85
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Originally Posted by Information Analyst View Post
In most circumstances people have no need to have any direct contact with HM Revenue & Customs (HMRC).
For various complicated reasons, not entirely unconnected with me needing to know a little more about the tax system than I actually did, I've had quite a bit of contact with HMRC lately. This has taken two forms: (1) Online forms, generally very well designed and quite straightforward to fill in, though the level of security required to verify who I am can be (quite properly, in my opinion) quite high; and (2) occasional phone calls for clarification, to helplines which are manned in the early evening and on Saturdays and Sundays when I actually want to call them, by polite, friendly and efficient people who've been able to give clear, simple, useful and unambiguous answers to all the questions I've had for them.

The only problem I have, really, is when I get to the "How could we have improved our service to you?" dialogue boxes. I honestly can't think of anything to write in them.

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Old 22nd May 2018, 04:49 AM   #86
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Originally Posted by Jack by the hedge View Post
UK here. I'm aware that people in the US find the DMV deeply exasperating but I don't actually know what it is that people need to go there to do.
It can vary state to state. I live in Pennsylvania and the only reason you would need to go to the "DMV" (actually a "driver's license center") is to deal with something regarding your license. The most common reasons are

- Replacing a lost/stolen license.
- Getting a license for the first time
- Transferring your license from out of state.
- Renewing a license at a point that requires a new picture. You can renew your license online, but after a certain period you need a new picture.

I've spent HOURS there waiting in line. I've also been in and out of there in less than 20 minutes.
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Old 22nd May 2018, 06:01 AM   #87
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Originally Posted by Dave Rogers View Post
For various complicated reasons, not entirely unconnected with me needing to know a little more about the tax system than I actually did, I've had quite a bit of contact with HMRC lately. This has taken two forms: (1) Online forms, generally very well designed and quite straightforward to fill in, though the level of security required to verify who I am can be (quite properly, in my opinion) quite high; and (2) occasional phone calls for clarification, to helplines which are manned in the early evening and on Saturdays and Sundays when I actually want to call them, by polite, friendly and efficient people who've been able to give clear, simple, useful and unambiguous answers to all the questions I've had for them.

The only problem I have, really, is when I get to the "How could we have improved our service to you?" dialogue boxes. I honestly can't think of anything to write in them.

Dave
My girlfriend got into some hassles when she started a company (on my advice, would have been much better to stay as a sole trader). Her tax and Companies House stuff was a total mess. She got an accountant to help, explained the situation to HMRC, and says they were really nice to her, helpful, pleasant and easy to deal with. No stress, no threats, no penalties. Just accepted she didn't have a clue and worked forward from that.

Originally Posted by bonzombiekitty View Post
It can vary state to state. I live in Pennsylvania and the only reason you would need to go to the "DMV" (actually a "driver's license center") is to deal with something regarding your license. The most common reasons are

- Replacing a lost/stolen license.
- Getting a license for the first time
- Transferring your license from out of state.
- Renewing a license at a point that requires a new picture. You can renew your license online, but after a certain period you need a new picture.

I've spent HOURS there waiting in line. I've also been in and out of there in less than 20 minutes.
I can do all of that online, except changing states as we don't have any. Even pictures are done online.
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Old 22nd May 2018, 12:44 PM   #88
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Originally Posted by JoeMorgue View Post
Even with adjusting that to account for a veteran population obviously skewing older and with more health concerns than the general population the VA is punching well above its weight budget wise.

Not quite. In fact, the VA is finding it hard to spend some of its budget. See below.

Originally Posted by Skeptic Ginger View Post
It's not, it's a myth.

Physician shortages in the US and Canada are similar with not enough specialists in rural areas especially.

There are serious shortages of nurses and physicians in the US.

And that is why. The VA system is not suffering from budget issues, and it's nowhere near the hell-hole that has been previous described (there have been isolated issues with particular hospitals, but for the most part they're decent). The biggest problem the VA has right now is simply staffing, especially when it comes to doctors and nurses. They have thousands of openings for medical staff nationwide, and the budget to hire them, but simply cannot find enough people to fill those positions.

It's nearly as bad in the private sector, with many urgent care clinics staffed only by nurses and "physician's assistants". There are very few doctors going into general practice, most of them go to specialty practice and get snapped up by the big hospital networks.

The problem isn't budget or openings, it's education costs. The amount of debt that one racks up in medical school is so high that people simply cannot afford to be GPs anymore, between malpractice insurance, low rates of compensation allowed by medical insurance agencies, and the various costs of complying with the mountains of paperwork the insurance agencies require, it is effectively impossible to make enough to pay off the debt.

When my father-in-law, a GP himself for many years, finally retired he was nearly unable to even give away his practice, let alone sell it. No one wanted it, despite having a large, established patient base. The doctor who did pick it up reduced it from a full-week to two-day-a-week practice, alternating with her existing clinic elsewhere, and after a few years just shut it down entirely.
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Old 22nd May 2018, 01:01 PM   #89
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Originally Posted by bonzombiekitty View Post
It can vary state to state. I live in Pennsylvania and the only reason you would need to go to the "DMV" (actually a "driver's license center") is to deal with something regarding your license. The most common reasons are

- Replacing a lost/stolen license.
- Getting a license for the first time
- Transferring your license from out of state.
- Renewing a license at a point that requires a new picture. You can renew your license online, but after a certain period you need a new picture.

I've spent HOURS there waiting in line. I've also been in and out of there in less than 20 minutes.

Nowadays almost everything can be done on line, everything else I can think about can be done over the phone, by post, or at a post office which is how it was done pre internet. The only time I ever had to go to a dvlc regional office was to replace a stolen tax disc, that did eat up an afternoon but it wouldn't happen now as 1) road tax (vehicle excise duty) can be renewed/refunded on line, and 2) we don't actually have tax discs any more. So one afternoon in my life seems reasonable.
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Old 22nd May 2018, 09:18 PM   #90
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Originally Posted by Skeptic Ginger View Post

In the US here, with good health insurance. I need an echocardiogram. First available appointment—more than a month.

It took me more than two months to get an appointment with an oral medicine specialist at the UW hospital for a very serious medical problem.
Much faster than the NHS.
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Old 23rd May 2018, 12:20 AM   #91
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Originally Posted by Giz View Post
Much faster than the NHS.
I realise that anecdotes are not data, but that's not my experience.

I signed up for Biobank a large scale study of 40-60 year olds which aims to track a large cohort through to find out what ails us and what kills us. The first step was to go along for some basic measurements including height, weight and blood pressure.

On the day, my blood pressure was sufficiently high that they suggested seeing my GP with some urgency. It was already mid-afternoon so I had to wait until the next morning to see my GP. He took my blood pressure and said it seemed fine (perhaps "white coat syndrome" on the day) but was concerned about the fact that I seemed to have an irregular heartbeat.

The nurse at the GP's surgery was able to give me an ECG right then and there and the results were shared electronically with specialists within the NHS - though she was of the opinion that there was something unusual about my heart rhythm. I was also sent home with a monitor which took my blood pressure every 30 minutes for a 24 hour period.

It took a couple of days for an NHS cardiologist to get back and say that I needed to come in for more tests. I would have been able to have done the tests within a week had I wanted to go to the Bristol Royal Infirmary (BRI) but the parking there is a nightmare. Instead I went to Frenchay Hospital because the parking was a lot better.

Within two weeks of my GP appointment, I had a full battery of tests including more ECGs, now under load, and echo-imaging of my heart (watching an image of your heart beating is a funky experience). After about a week I got the news that I do have an irregular heartbeat but because it rectifies under load there is nothing to worry about. It really does go boom-diddy-boom-diddy-boom-boom-boom - goodness gracious me

So from initial "scare" through GP visit, thorough investigation and diagnosis in less than three weeks - not too shabby IMO. I had an initial investigation and preliminary diagnosis within 24 hours.

That's likely because, as a 40-something man with suspected heart issues, I was a priority case.

I've seem similarly quick reactions to other priority cases. Sadly I have too many female friends and relations who have had breast cancer diagnoses. Those in the UK have had diagnosis and treatment at least as quickly as those in the US and because in the US the trend seems to be for mastectomy and reconstruction in one long complex operation and in the UK for separate operations, my UK friends have got over the initial surgery much more quickly.

OTOH it took several months to get my ACL rebuilt on the NHS. Just persuading them to do an MRI was a pain because I was, to all appearances, fully mobile (I was running half-marathons) and my GP simply didn't believe the French doctor in the ski resort who said I had torn my ACL, she suspected a stretch or partial tear.

IIRC it was at least 6 months before I could persuade them to do the MRI (which confirmed that I I snapped the ACL) and from that point it was another 3 months before the surgery. It took me several weeks to persuade them that a 40-something man who had a sedentary job, could run half-marathons and who really only wanted to go skiing again needed his ACL reconstructing at public expense. Had I been under 40 or had a physically demanding job or had limited mobility as a result of my injury then there would have been no question.

That said, I'm sure there are plenty of cases in the US of people having to persuade their insurance companies that their procedure is necessary.
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Old 23rd May 2018, 12:57 AM   #92
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Originally Posted by Giz View Post
Much faster than the NHS.
You've been away a long time, haven't you?
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Old 23rd May 2018, 01:55 AM   #93
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Originally Posted by Giz View Post
Much faster than the NHS.
Is it? Evidence? And not evidence consisting of one outlier story in the Daily Mail, actual statistic evidence please.

I'm not doubting that it might be true - the Tories have yet again underfunded and harmed the NHSs since 2010 as is their usual policy so lots of the good work at improving the NHSs have been undone.
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Old 23rd May 2018, 02:59 AM   #94
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IIRC I waited less than two weeks for a non emergency echo cardiogram. The event that triggered the need for it was dealt with immediately including electro cardiograms, drugs, and overnight hospitalisation for observation.
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Old 23rd May 2018, 03:14 AM   #95
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Originally Posted by luchog View Post
Not quite. In fact, the VA is finding it hard to spend some of its budget. See below.




And that is why. The VA system is not suffering from budget issues, and it's nowhere near the hell-hole that has been previous described (there have been isolated issues with particular hospitals, but for the most part they're decent). The biggest problem the VA has right now is simply staffing, especially when it comes to doctors and nurses. They have thousands of openings for medical staff nationwide, and the budget to hire them, but simply cannot find enough people to fill those positions.

It's nearly as bad in the private sector, with many urgent care clinics staffed only by nurses and "physician's assistants". There are very few doctors going into general practice, most of them go to specialty practice and get snapped up by the big hospital networks.

The problem isn't budget or openings, it's education costs. The amount of debt that one racks up in medical school is so high that people simply cannot afford to be GPs anymore, between malpractice insurance, low rates of compensation allowed by medical insurance agencies, and the various costs of complying with the mountains of paperwork the insurance agencies require, it is effectively impossible to make enough to pay off the debt.
This isn't exactly true though. The average medical school debt is just not that big for school loan debt and compares well to the income even of a GP. The thing is that specialists earn far far more than GP's. So it isn't getting squeezed out of being a GP it is making the choice to be a more lucrative specialist.
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Old 23rd May 2018, 03:15 AM   #96
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Originally Posted by Giz View Post
Much faster than the NHS.
Please provide the studies that prove this.
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Old 23rd May 2018, 04:03 AM   #97
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Well, this thread is all horrible.

Here's Martin Short instructing Kate Middleton's obgyn:

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Old 23rd May 2018, 06:18 AM   #98
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Originally Posted by luchog View Post

It's nearly as bad in the private sector, with many urgent care clinics staffed only by nurses and "physician's assistants".
Pedantic: It's Physician Assistant, not Physician's assistant. PAs tend to get miffed when called the latter as it tends to imply something more along the lines of a secretary. Also, in a situation like urgent care where there is not a doctor on staff, you are being seen by a nurse practitioner, not a nurse. You wouldn't have a PA without a supervising physician (not that the doctor has to be present, but they would have to be on staff and sign off on what the PA does at some point). NPs can practice independently, but their scope of practice is a bit more limited.
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Old 23rd May 2018, 07:15 AM   #99
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Originally Posted by ponderingturtle View Post
This isn't exactly true though. The average medical school debt is just not that big for school loan debt and compares well to the income even of a GP. The thing is that specialists earn far far more than GP's. So it isn't getting squeezed out of being a GP it is making the choice to be a more lucrative specialist.

I think you need to get a little more up-to-date on the current problem, because it's much worse than you are apparently aware of. I don't have the resources available right now, but they've been posted here in the past. It is very difficult to survive as a GP right now. Moreso the farther out from the big urban centers and hospital networks you go.
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Old 23rd May 2018, 08:19 AM   #100
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Originally Posted by luchog View Post
I think you need to get a little more up-to-date on the current problem, because it's much worse than you are apparently aware of. I don't have the resources available right now, but they've been posted here in the past. It is very difficult to survive as a GP right now. Moreso the farther out from the big urban centers and hospital networks you go.
Unlikely to be really any worse than any other profession and student debt. You need hundreds of thousands in debt to qualify for $45k jobs now. This isn't some huge issue because of medical school costs and doctors are not the ones suffering the worst.

So unless things have dramatically changed in the last couple of years this is not major problem specifically for doctors, and they are far from the ones hit hardest by it.
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Old 23rd May 2018, 09:17 AM   #101
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Originally Posted by The Don View Post
I realise that anecdotes are not data, but that's not my experience.

I signed up for Biobank a large scale study of 40-60 year olds which aims to track a large cohort through to find out what ails us and what kills us. The first step was to go along for some basic measurements including height, weight and blood pressure.

On the day, my blood pressure was sufficiently high that they suggested seeing my GP with some urgency. It was already mid-afternoon so I had to wait until the next morning to see my GP. He took my blood pressure and said it seemed fine (perhaps "white coat syndrome" on the day) but was concerned about the fact that I seemed to have an irregular heartbeat.

The nurse at the GP's surgery was able to give me an ECG right then and there and the results were shared electronically with specialists within the NHS - though she was of the opinion that there was something unusual about my heart rhythm. I was also sent home with a monitor which took my blood pressure every 30 minutes for a 24 hour period.

It took a couple of days for an NHS cardiologist to get back and say that I needed to come in for more tests. I would have been able to have done the tests within a week had I wanted to go to the Bristol Royal Infirmary (BRI) but the parking there is a nightmare. Instead I went to Frenchay Hospital because the parking was a lot better.

Within two weeks of my GP appointment, I had a full battery of tests including more ECGs, now under load, and echo-imaging of my heart (watching an image of your heart beating is a funky experience). After about a week I got the news that I do have an irregular heartbeat but because it rectifies under load there is nothing to worry about. It really does go boom-diddy-boom-diddy-boom-boom-boom - goodness gracious me

So from initial "scare" through GP visit, thorough investigation and diagnosis in less than three weeks - not too shabby IMO. I had an initial investigation and preliminary diagnosis within 24 hours.

That's likely because, as a 40-something man with suspected heart issues, I was a priority case.

I've seem similarly quick reactions to other priority cases. Sadly I have too many female friends and relations who have had breast cancer diagnoses. Those in the UK have had diagnosis and treatment at least as quickly as those in the US and because in the US the trend seems to be for mastectomy and reconstruction in one long complex operation and in the UK for separate operations, my UK friends have got over the initial surgery much more quickly.

OTOH it took several months to get my ACL rebuilt on the NHS. Just persuading them to do an MRI was a pain because I was, to all appearances, fully mobile (I was running half-marathons) and my GP simply didn't believe the French doctor in the ski resort who said I had torn my ACL, she suspected a stretch or partial tear.

IIRC it was at least 6 months before I could persuade them to do the MRI (which confirmed that I I snapped the ACL) and from that point it was another 3 months before the surgery. It took me several weeks to persuade them that a 40-something man who had a sedentary job, could run half-marathons and who really only wanted to go skiing again needed his ACL reconstructing at public expense. Had I been under 40 or had a physically demanding job or had limited mobility as a result of my injury then there would have been no question.

That said, I'm sure there are plenty of cases in the US of people having to persuade their insurance companies that their procedure is necessary.
My family experience (or in-law experience in the US) has been that the speed and standard of USA care is far better.

Note: comparing USA private care in Alabama and Mayo Clinic to NHS in West Sussex and London. (So this may well be a case of comparing good US insurance to a stretched part of the UK). ( But the response and care have really been night and day - the nhs has been pretty terrible).
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Old 23rd May 2018, 10:01 AM   #102
luchog
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Originally Posted by ponderingturtle View Post
Unlikely to be really any worse than any other profession and student debt. You need hundreds of thousands in debt to qualify for $45k jobs now. This isn't some huge issue because of medical school costs and doctors are not the ones suffering the worst.

So unless things have dramatically changed in the last couple of years this is not major problem specifically for doctors, and they are far from the ones hit hardest by it.

You're not taking into account the amount of schooling required for any medical profession, let alone doctors. It's about twice as long as nearly any other profession, and med school graduations don't even start earning an independent income for 5-10 years later than other professions.

Further, doctors' salaries have been dropping dramatically for the last decade or so; while costs to maintain a practice have been steadily rising.

And you're ignoring the costs borne by doctors, especially GPs with their own practices, that other professions simply do not have to deal with, or do not have to deal with to the same degree. Most notably the ongoing-education requirements.

https://www.cbsnews.com/news/1-milli...ming-a-doctor/
https://www.usnews.com/best-graduate.../debt-rankings
https://www.studentdebtrelief.us/new...l-school-debt/

Further, you're wrong about student loan debt as well. The average student loan debt is only in the low tens of thousands. Less than 4% of students end up with more than $100,000 in student loan debt, and less than 10% between $50,000 and $100,000.

https://www.usatoday.com/story/money...ate/100893668/
https://en.wikipedia.org/wiki/Studen...#United_States

And that doesn't include the "lost opportunity" costs incurred by the delay in employement compared with the overwhelming majority of university graduates, which can approach withing spitting distance of a million dollars.

https://www.bestmedicaldegrees.com/i...t-financially/

Even if you were right, which you're demonstrably not, it doesn't matter if they're not the ones suffering the worst, they are suffering bad enough that few people can afford to be GPs, thus the shortage. But in fact, General/Family Practitioners (along with Pediatricians) are definitely among the worst for student debt compared to non-medical professions.
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Old 23rd May 2018, 10:58 AM   #103
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Also let's not forget the cost of malpractice insurance. My father was actually a Family Practitioner, which takes 3 more years than a GP and requires regular continuing education and recertification. He had to give up most of the parts of practice that extra 3 years was supposed to have trained him for, though.

The number of pregnancies and births he saw was not enough to pay the malpractice premiums for small-volume obstetrics. Nor were the accreditation and malpractice insurance to keep a lab in the office, saving patients from having to wait extra days and getting separate bills. He still read his own radiology films, but any fancier imaging had to be done off-island.

At this point, the island has one remaining clinic, and that's run by a nonprofit. All the other clinics and doctors are gone, even the hospital-owned ones, because they didn't make a profit. For a while, you couldn't get any medical help outside of the aid car on-island, and anything the clinic can't handle has to take the ferry to the mainland or be life-flighted.

And just to bring this back on topic, my dad did work with the VA, so that vets could get routine medical care without having to go off-island.
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Old 23rd May 2018, 11:02 AM   #104
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Dad wasn't in it for the money, by the way. But he did find it frustrating that often he couldn't pay himself, once he'd paid the staff and overhead.
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Old 23rd May 2018, 08:41 PM   #105
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Yeah, the whole "Family Docs are going out of business" thing is real. A lot of FP's suspect it's intentional underpayment by the third party payers to replace them with more guideline obedient and less expensive NPs and PAs.
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Old 23rd May 2018, 08:44 PM   #106
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Originally Posted by deadrose View Post
Dad wasn't in it for the money, by the way. But he did find it frustrating that often he couldn't pay himself, once he'd paid the staff and overhead.
It's kind of hard to help people when you can't even afford to keep the lights on. Very sad. My favorite docs have been FPs.
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Old 27th May 2018, 09:51 PM   #107
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Originally Posted by Planigale View Post
maternal mortality USA 14/100,000; UK 9/100,000 (deaths/births)
infant mortality USA 5.8/1,000; UK 4.3 (deaths / live births)
courtesy of the CIA

Cuba 4.5 - with a considerably higher proportion of Afro descendants than the USA.
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Old 6th June 2018, 12:49 AM   #108
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Just to wrap this up. the current court case against the doctor has ended. She made an error in trying for a vaginal delivery and not carrying out a caesarian section. The claim that she failed to obtain proper consent was dismissed, the urgency of the emergency meant that it was not possible for a full and detailed discussion of options to be be carried out. The consent was appropriate for the situation. The doctor will be allowed to continue in practice as a doctor as their is no evidence of systematic failures; a single error even with a disastrous outcome is not justification from banning her from practising her profession ever again.

The case for damages is against the employer / hospital and will be heard elsewhere.

The police / prosecution authorities have investigated and decided there is no criminal case.

The doctor no longer works for the hospital, I am unclear if she resigned or was dismissed. If the latter then she may have a case for wrongful dismissal as making a single isolated error would probably not be grounds for being sacked.
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Old 13th June 2018, 05:24 AM   #109
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Originally Posted by JoeMorgue View Post
And, and again I'm being dead serious, do people in other countries just get better services in general from their government? Anything in American that operates on anything like a consumer level service organization is so bad they are their own metaphors. Do you guys have like super advanced DMV and IRS equivalents that aren't hair pulling hard to deal with? Like I'm trying to imagine a more perfect image of Hell then a hospital run with "government efficiency" and I'm drawing a blank.

How does stuff like bureaucracy and impossible to fire civil servants and just the general fact if you only have one option there's zero reason for that one option to do anything more then the absolute bare minimum not ruin everything for you guys?

Just in general is dealing with your government a lot more pleasant experience in other countries?
Yes. I'm from the Netherlands, and in general, I have a pleasant experience dealing, as a citizen, with government agencies.

A month ago, I had to get a new passport. I went to the website of my municipality, made an appointment (in 10-minute slots) at town hall, went a few days later to town hall with my old passport, paid the fee and then you can pick it up a week later. (I paid extra for next-day service because I needed it real quick for a visa).

A driver's license is the same procedure.

Just yesterday, I bought another car. The dealer where I bought it went online to the Dutch DMV and registered the car to my name. As proof, he gave me a paper report, and the DMV will mail me the credit-card sized title card in the next few days.

The Dutch tax office? I requested a VAT number in 1999 because I started doing entrepreneurial things next to my waged day job. I got a visit from a consultant from the tax office who explained me my duties and gave me a nice bookwork where I could read it back. Since 2007 I've been filing my income tax as a sole proprietor, which means I have to file revenue and balance sheets. In all that time, I've never had an audit. Income tax filings for years have been done via a computer program, now via a website. I think for waged/salaried employees, the tax office even fills out most of the questions for you in advance .

OTOH, one of my clients is a Dutch social services agency. I bill them my services as text captioner for deaf/hard-of-hearing employees, and they're incompetent, stubborn and rude. I had to take them to court to get some of my bills paid. Then even their lawyer who was on the case claimed that she could not pay some of my bills from 2015 "because said client was only entitled to my services since 2013".
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