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Heck of a Way to Get a Compliment...
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ghporter
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Mar 23, 2021, 11:04 AM
 
Yesterday afternoon I had a very nice visit with an orthopedic surgeon. She said I was “young,” and “a great candidate.”

Unfortunately this was because I am “young for someone needing a hip replacement.” The good side is that I’m “a great candidate” because I’m relatively young, and except for a completely goobered hip, I’m healthy and in good shape.

Now, a bit of context: I’m an occupational therapist working (until about two weeks ago) in inpatient rehabilitation. I have many years of experience in helping people who have their hips replaced get - literally - back on their feet and take care of themselves again. So I pretty well know what I’m getting into.

I am much too healthy to qualify for inpatient rehab, and my post operative course will be pretty brief. And I’ll be able to get back into doing what I want, like walking, hiking and bicycling.

I turn 62 next month. I’ve been overworking myself since 1978, with a brief time (2005 to 2009) when I was a full time student in grad school to earn my OT degree. I got myself into this predicament by pushing myself harder than I should have. It’s this thing about “proving myself” to...well myself for one. But up until a few weeks ago, I was keeping up with people literally half of my age. And now I have had both reason and time to rethink this habit of pushing.

My new life plan is to get back to doing what I want to do, not just what I must do to keep working.

So one more bit of compliment here: I have a great prognosis, and I have plenty to do to keep myself busy without “working”. It’s a big change in personal identity, but I’ve spent years helping others get through such shifts, and I may be able to listen to my own advice about this sort of thing.

Glenn -----OTR/L, MOT, Tx
     
Laminar
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Mar 23, 2021, 11:14 AM
 
Can you bill your insurance for the OT assistance you'll be providing to yourself?

Have you scheduled the surgery yet?
     
Thorzdad
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Mar 23, 2021, 12:46 PM
 
Originally Posted by Laminar View Post
Can you bill your insurance for the OT assistance you'll be providing to yourself?
Actually...yeah, he might be able to. My wife works for a home healthcare service, and they regularly arrange billing so that a family member of a client can get paid for their time caring for their family member, which they would be doing anyway. I'm not sure if that's universally available through most insurance, or Medicare-only, though.
     
reader50
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Mar 23, 2021, 11:19 PM
 
What upgrade options did they offer?

It seems a shame to have invasive surgery, only to end up back where you were. After that level of inconvenience, I'd want to come out ahead.

Personally, I'd pass on the gold-plated option. Would consider the WiFi hot spot. And think about the Marvel package.
     
ghporter  (op)
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Mar 24, 2021, 10:02 AM
 
We are looking at June...no later than June. And every day I’m thinking it should be sooner...

While I think there are ways to bill for my own OT services I will be providing to myself, probably not with my insurance. TRICARE is the all-service medical coverage for active duty, family members, retirees and their family members, and so on. While not “free health care for you and your family for life” as I was promised when I enlisted, it’s pretty darn good coverage until I reach 65, at which time I enroll in Medicare and TRICARE becomes a secondary insurance. Which is another reason to not put off this surgery; I’d still get good coverage, but it’s more complicated once Medicare is the primary.

TRICARE is pretty affordable (despite not being free as I was promised), but the “buy in” to qualify for it is really significant. Especially to qualify for TRICARE Prime after retirement. It means at least 20 years of potentially putting one’s life on the line for whatever... Anyway...

My son asked if I could get upgrades like a WiFi hotspot. Probably not. At least not that they’re willing to talk about yet.

I’m supposed to start with PT in two weeks, but that’s really a side issue. I wound up with a small tear in one hamstring tendon at the pelvis (at the “ischial tuberosity” or “sit bone”), but the timeline for that kind of injury to heal isn’t very long - as long as I don’t push too much. So I’m really considering seeing what the PT can help me with, and if it isn’t much, I’ll go for an earlier surgery.

And this is really weird for me...I’ll be on the other side of the therapeutic equation for the first time. Therapists aren’t the best of patients, especially when it comes to an area they have experience in. I’ve been induced to promise my wife that I’ll be good, but I think that may be more challenging than the rest of the process.

Glenn -----OTR/L, MOT, Tx
     
Waragainstsleep
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Mar 24, 2021, 10:32 AM
 
Its always weird for me when I hear you guys talking about health insurance. I don't mean to be preachy but it really is the wrong way of doing things. What I don't get is how the folks who are desperately against "socialised" medicine don't see that an insurance based system is exactly the same thing but with a worthless greedy middleman taking a generous cut.
I have plenty of more important things to do, if only I could bring myself to do them....
     
andi*pandi
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Mar 24, 2021, 10:55 AM
 
Good luck with that, it must be pretty bad for them to do it so young.

Of course replacements are very good now and much more longer lasting. When my father first asked about a knee replacement at 60 the surgeon said he would only do it when my father crawled in... replacements only lasted <20 years then and the surgeon did not want to take the chance of having to redo it when my father was 80.
     
ghporter  (op)
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Mar 25, 2021, 01:43 PM
 
I asked about how long I should expect the hardware to last. Based on current research, current hip prostheses should last at least 25-30 years. That puts me pretty elderly if it needs replacing.

On the other hand, that estimate is what I call “surgeon-speak.” All physicians, and especially surgeons, are gamblers. But they - especially surgeons - hedge every part of every one of their bets. So “surgeon-speak” means that “if I say it’s good for X, that means that it will either well outlast X, or long before that a new gadget will be available that will make this issue moot.”

I’ve helped rehab people in their late-80s from both hip and knee replacements. Knees are a LOT harder to bounce back from than hips. And remember that my patients were not really robust and full of vigor. So as long as I don’t goober up the replacement hip, and don’t turn into some sort of slug that develops problems that require multiple different specialists, I should be good

Glenn -----OTR/L, MOT, Tx
     
Paco500
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Mar 25, 2021, 04:04 PM
 
Feels.

I was 'awfully young' for losing my hair.
and
'awfully young for melanoma'
and
'awfully young for arthritis.'

Unfortunately, the arthritis in mostly in my fingers, and joint replacements in hands do not have a stellar success rate.

Now, it's spread to my shoulders, and I may need those joints replaced soon. It's getting hard to sleep.

BTW- I'm not really young any more. 50. Sucks.
     
Paco500
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Mar 25, 2021, 04:11 PM
 
Originally Posted by Waragainstsleep View Post
Its always weird for me when I hear you guys talking about health insurance.
As some may remember- I spent the first 35 years of my life in the US. Now that I have the NHS, the health care system in the US boggles the mind. I had pretty much Gold Standard health care for most of my life back in the states (was on my father's plan via IBM until I finished University, and always worked for companies with great insurance on my own) and even that can't really hold a candle to the NHS.

I have private health care in the UK via BUPA, but I almost never use it. It was great to have it so my wife could have a private room after breast cancer surgery, and I've invoked it a few times to see a specialist quicker, but the NHS has seen my family through health emergency after health emergency- with great care and great outcomes. Socialised medicine rocks.
     
Doc HM
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Mar 26, 2021, 07:29 AM
 
Originally Posted by Paco500 View Post
I have private health care in the UK via BUPA, but I almost never use it. It was great to have it so my wife could have a private room after breast cancer surgery, and I've invoked it a few times to see a specialist quicker, but the NHS has seen my family through health emergency after health emergency- with great care and great outcomes. Socialised medicine rocks.
But what about all those feckless wasters that are so much less deserving than me. Surely if they can't be bothered to save the $30,000 dollars plus it cost not to give birth to a child, or work themselves into a high paying job that valuers them enough to have healthcare plans that cover at least some of the basics then that's not MY fault. Why should I have to pay just to keep them healthy? It's literally communism.
This space for Hire! Reasonable rates. Reach an audience of literally dozens!
     
subego
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Mar 27, 2021, 05:25 PM
 
One of the things I always see mentioned is the median salary for doctors is really high in America. $200K vs. £60K in the UK. It should be noted the UK doctor will end up with higher taxes, but the US doctor will have a bigger tuition to pay off.

In theory, a higher salary is going to attract better people to the field.

To be clear, I’m not saying this means we shouldn’t adopt a more socialized model, but I don’t think it’s accurate to say insurance is doing the same thing as socialized medicine, only more expensive. The differences go beyond that.
     
Waragainstsleep
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Mar 27, 2021, 06:06 PM
 
But because the insurance is more expensive, theres more cash to pay doctors with. In the same way they will charge $50 or more for a bag of saline.
Any instance where an insurance company is paying, the company doing the work is overcharging. Though I guess the same is typically true when a government is paying as well.
I have plenty of more important things to do, if only I could bring myself to do them....
     
subego
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Mar 27, 2021, 06:20 PM
 
Well, that’s the thing. It doesn’t seem to manage to leak back to the practitioners as well in a socialized system. There’s also the issue of how even the best intentioned subsidies invariably end up screwing with supply and demand.

Again, I don’t think those are necessarily deal-breakers, but our system is not without its advantages.
     
Waragainstsleep
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Mar 28, 2021, 08:25 AM
 
I think the overall quality or standards are probably higher. If TV is to be believed, you guys run more specific tests than we tend to. Lots of trial and error instead of definitive diagnostics. Or maybe I've watched too much House.
I have plenty of more important things to do, if only I could bring myself to do them....
     
ghporter  (op)
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Mar 28, 2021, 12:33 PM
 
One thing that slips past most people is that US physicians frequently work their tails off. That "$200k" comes with very little time off. It's not 8 hour days, and in particular it's not that way for specialists and surgeons.

Surgeons start at 7am and spend much of every day in surgery. They have some time for office hours - usually to set up new surgeries and do follow ups with their patients - and back into surgery. It's often a 14+ hour day.

And there's always continuing education, licensure, professional associations and conferences - which are WAY more expensive than the pricey stuff I have had to pay for. Staying up-to-date on your field takes a bunch of time, and costs a lot to have access to the new stuff.

So what you get for that $200k includes a lot of time and recurring cost just to stay working. Not to mention servicing that lovely (and increasing) student debt you incurred (usually 8 years in class plus 3-7 years of residency in your specialty). Average student debt for a physician graduating in 2019 was over $200k, which winds up being over twice that at final repayment. Close to HALF a million dollars just to be a physician.

Glenn -----OTR/L, MOT, Tx
     
Thorzdad
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Mar 28, 2021, 12:42 PM
 
Originally Posted by Waragainstsleep View Post
Or maybe I've watched too much House.
Probably. House used expensive diagnostics the same way some people use air, and without any regard for the patients' ability to pay for any of it.

Testing is hit-and-miss, and a lot of what does or doesn't get done is based on whether the patient's insurance will approve it. For instance, in a lot of cases an MRI or CT would probably be the better diagnostic tool to use to identify certain injuries. But, my experience has been that those procedures require pre-authorization from the insurer (otherwise they will refuse to cover the procedure and the patient will be on the hook for the full price), and insurers will insist that an old-school xray is done first, because those are much cheaper and might, if you look at it just right, hint at the problem.

I've been going through something like this for awhile now. I have a shoulder injury. The ortho doc thinks it's a torn rotator cuff, but my insurer would only approve xrays, so nothing definitive was obtained. Then, instead of surgery, the insurer insists that I go through a round of PT before surgery and a more appropriate scan is approved.
     
Waragainstsleep
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Mar 28, 2021, 01:08 PM
 
That sort of reinforces my point about insurance. If the policy covers it, might as well order it right?
I think you'll find our doctors do similarly long days, if not even longer. Especially at the moment.
I have plenty of more important things to do, if only I could bring myself to do them....
     
Paco500
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Mar 29, 2021, 01:12 PM
 
Originally Posted by subego View Post
One of the things I always see mentioned is the median salary for doctors is really high in America. $200K vs. £60K in the UK. It should be noted the UK doctor will end up with higher taxes, but the US doctor will have a bigger tuition to pay off.
I'm not saying it's wrong, but it doesn't feel right- I wonder if those two figures are comparing apples to apples. I found a site that shows the average pay for UK doctors (based on current job listings) was ~£58k- which is basically what you said. But I noted- looking through the job listing, a good many of them were for Junior Doctors- which unless I am mistaken, is the equivalent of 'residents' in the US. I wonder if the avg salary for Junior Doctors in UK is included but residents in US are not.

The reason it seems off to me is totally unscientific- I know quite a few doctors socially. No way they are making anything near as low as £60k/yr based on their lifestyle. And most of these are GPs, not specialists.

Dunno.
     
Thorzdad
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Mar 29, 2021, 02:06 PM
 
The tax thing is more complex, too. In terms of federal income tax, the US takes a lower percentage in absolute numbers. But, in the US, you also have state taxes to consider (if you live in a state that collects income tax). Some states also allow counties and cities to take a bit, too. Probably the biggest difference is property tax, which can be pretty high in the US, depending on where you live. In the UK, there's the council tax, which seems to be lower than a lot of US property tax. The US also has sales tax and UK VAT, which is bit different and baked into the price before it gets to the shelf.

Overall, the US probably still comes out with a lower rate of taxation compared to the UK. But you also have to consider what you get for paying those taxes, and the big difference is that, in the UK, paying taxes gets you healthcare, which is a huge value-add.
     
andi*pandi
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Mar 29, 2021, 02:11 PM
 
Originally Posted by Thorzdad View Post
I've been going through something like this for awhile now. I have a shoulder injury. The ortho doc thinks it's a torn rotator cuff, but my insurer would only approve xrays, so nothing definitive was obtained. Then, instead of surgery, the insurer insists that I go through a round of PT before surgery and a more appropriate scan is approved.
A year ago while doing PT for another issue my shoulder was hurting, to the point I couldn't do the exercises the PT was asking me to do (for a neck thing). PT agreed it was odd so I went to the ortho and they did an xray and all they said was it was arthritis haha you're old. Got a cortisone shot but that was it. A year later it's still bothering me so I go to a different ortho, who after doing a little visual testing (raise your arm, do this do that) decided it was a torn tendon and immediately ordered an MRI. The first ortho never did that and just blew me off. I got another cortisone shot and will start PT next month. Different doctors also effect diagnosis. First ortho was a surgeon, and a patronizing SOB.
     
Waragainstsleep
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Mar 29, 2021, 02:34 PM
 
GPs and consultants are on way more than £60k I'd say.
I have plenty of more important things to do, if only I could bring myself to do them....
     
subego
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Mar 29, 2021, 07:06 PM
 
FWIW, I also feel like GPs here pull in more than $200K.
     
Paco500
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Mar 30, 2021, 05:21 AM
 
I wonder if another factor in income disparity is the cost of Malpractice insurance. I would imagine in large HMOs, that cost is absorbed by the company, but I would also assume the pay rate for someone working for Kaiser is lower than someone in independent practice.

Malpractice insurance isn't really a thing for NHS doctors. I would guess it probably exists for those in private practice, but I would also assume they earn way over the avg.
     
subego
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Mar 30, 2021, 08:14 AM
 
As an aside, the one time I served on a jury was for a doctor suing his hospital because their malpractice insurance paid out for one of his patients, thus declaring him guilty of committing the malpractice. He claimed he wasn’t guilty.

We decided in his favor, but awarded him only $1.
     
Laminar
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Mar 30, 2021, 08:37 AM
 
Originally Posted by subego View Post
FWIW, I also feel like GPs here pull in more than $200K.
Family medicine here (MD, DO, also maybe NP?) starts in the high $100s. Income is based on production which varies until a doc builds up a patient base. They usually have a minimum guarantee for the first year or two and then it goes to production. Urgent care docs can easily make $200k+ picking up whatever odd shifts they care to do. The cardiology group here had to undergo a "market correction" a few years back...they were all making $700k+ when market value was more like $450-500k. Non-profits can't pay so far above market value without attracting some unwanted scrutiny. Not sure how it got that bad, but they weren't pleased when it was "fixed."
     
ghporter  (op)
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Mar 30, 2021, 10:22 AM
 
Originally Posted by andi*pandi View Post
A year ago while doing PT for another issue my shoulder was hurting, to the point I couldn't do the exercises the PT was asking me to do (for a neck thing). PT agreed it was odd so I went to the ortho and they did an xray and all they said was it was arthritis haha you're old. Got a cortisone shot but that was it. A year later it's still bothering me so I go to a different ortho, who after doing a little visual testing (raise your arm, do this do that) decided it was a torn tendon and immediately ordered an MRI. The first ortho never did that and just blew me off. I got another cortisone shot and will start PT next month. Different doctors also effect diagnosis. First ortho was a surgeon, and a patronizing SOB.
A lot of surgeons are pretty egotistical. It’s kind of necessary: “I’m going to cut you open and fix your problem, and you’ll be fine afterward” takes a pretty large amount of self confidence. Unfortunately a lot of surgeons wind up also being a$$holes - it usually comes from the surgeons they studies under.

But when a physician is patronizing, you’ll probably want to say “thanks doc” and go find someone else. I’ve been fortunate in only coming across a few such jerks.

Glenn -----OTR/L, MOT, Tx
     
ghporter  (op)
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Apr 9, 2021, 01:48 PM
 
Well the pace of things has picked up. Yesterday I finally got to have my physical therapy evaluation. Interestingly, the PT and I went to the same school (different departments, of course), but he remembered me! Honestly, I stood out in my class - a 40-something guy with a beard among a sea of 20-something, smart, fit and attractive young women. But we graduated 12 years ago. Anyway, PT plan is to maintain mobility and strength to keep things relatively comfortable until surgery.

And then yesterday afternoon, I got a call: my surgery is scheduled for two weeks from now.

So after almost a month of near inertia, I suddenly have a bunch of things to do. I got the blood work drawn this morning, I have the “medical clearance” appointment Monday, and the pre-op appointment Thursday.

I’m glad for the end of the vagueness, which was certainly not helping me feel bright and optimistic. And since I’m still processing how I feel about the whole “artificial joint” thing, the definite date for surgery is good as a distraction. Let’s just say that this is a bit more of a “body modification” step than having my ears pierced was... Still, it’s a step moving forward.

Glenn -----OTR/L, MOT, Tx
     
   
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