Script For Health Care Professional In Service: Fill & Download for Free

No way can psychiatrists perform the role of a univeristy-educated research-oriented Ph.D. psychologist. They are not qualified to do advanced and complex psychometric testing, and have only very basic training in psychotherapy. Few teach and even fewer conduct serious research.Psychiatrists can be very helpful when medications are indicated, and of course some are gifted and brilliant; I’ve known my share. Psychiatrists also tend to think in terms of diagnosis and intervention, and are trained to have “answers.” That can be just what is needed some times.Culturally, medical doctors tend to have high prestige, because they are physicians, especially among less sophisticated consumers. Still, one psychiatrist told me, “Writing scripts for psychotropics all day is not rocket science — like radiation oncology or forensic pathology.” In fact nurse practictioners, physician assistants, some psychologists (and in some countries pharmacists) prescribe psychotropics on a daily basis.Psychiatrists make more money that psychologists, on average. They tend to have more prestige in certain circles. They provide an important part of health care, and some are amazing.Psychologists have a far broader range of opportunities for service in many setting, and in my humble opinion practice a profession that is much more fun and interesting and engaging (and long-term more helpful to people) that psychiatry.I have loved the privilege of being a psychologist — therapists, teacher, consultant, and expert witness — and am of course prejudiced. I’m sure a happy psychiatrist would feel just as strongly about his/her professional.They are both good jobs and useful to humanity.

Put simply - there is not one way. There's lots of options.Without meaning to dodge the question, I'm going to begin by focusing on how an individal GP makes money - rather than focusing on a 'GP Practice'. I'll briefly get to the diference between an individual GP (an employee) and the GP practice (a business) at the end.To understand a GP's income you need to understand a little about the Australian Health Care jugganaut that is Medicare. Medicare is a federal government department that dictates how much the government will contribute to the cost of a medical consultation or procedure. This information is freely available at MBS online.Any medical treatment that the government is willing to subsidise gets an 'item number'. If you attend a doctor and receive treatment that is covered by Medicare then the doctor will bill you that item number and you are then eligible to receive, from Medicare, the amount that they have decided to pay for that service.As an example, if you seach the MBS site for Item '23' you'll find the most common item billed by GPs. Item 23 is the fee for a standard consultation that lasts less than 20 minutes. For longer consultations there are different billing numbers (36 and 44). If you look at the description of Item 23 you'll see there is a set amount that Medicare will contribute to a standard consultation - $37.05. If your GP charges you an item 23 then you will be eligble for a refund from Medicare of $37.05.Doctors can provide care that is not covered by Medicare. This is not illegal, immoral or bad practice. It simply means that Medicare, the Australian tax-payer, will not pay the doctor, or give you a refund for anything you pay, for that service. Probably one of the most common would be a fee to collect a script from reception. If you want a script, without seeing a doctor, then Medicare does not contribute payment to that service. Similarly, phone calls and any documentation done without you physically present in the room cannot be charged. The doctor makes no income from any work when a patient is not sitting in front of them. I know it seems greedy and trivial to charge for something as simple as printing out a script but this free work quickly piles up - a recent study found that GPs are doing on average $15,000 per year in unpaid work.In summary, if medical care has an item number then Medicare will pay a fee for that service. If there is no item number then the government won't pay. Doctors have no say about what Medicare decides to pay for a service or which services they cover and which they don't. That's up to politicians and the voting public.Now, with the fees for all medical services set by Medicare doctors have a choice as to whether accept just that fee ('bulk billing') or to charge a 'gap' above the Medicare fee (private billing). If your doctor bulk-bills then you sign a form, Medicare sends the $37.05 directly to the doctor, and you walk away without paying anything. If your doctor privately bills then you pay the doctor's fee and then get the Medicare rebate refunded to you. Whether you get all, some or none of that gap back from your Health Insurance depends on your policy.It should be said that Medicare does offer an incentive to bulk-bill. For children and people who hold a Health Care Card a GP who bulk-bills can charge an Item 10990 on top of the service they provide. This pays the GP an extra $6.15 on top of whatever service they provided to the patient. For this select group of patients the doctor earns $43.20 for a standard consultation rather than $37.05.So the decision for the doctor is therefore whether to bulk-bill or privately bill? It would be nice if there was a "right choice" but unfortunately, from my personal experience, there doesn't seem to be one. The arguments for and against each, from the top of my head, largely seem to fall into ethical and financial reasons - or a combination of the two.Ethically, the reason to bulk bill is the principle of universal health care - the ideal that nobody in Australia is refused basic medical attention simply because they are unable to afford it. I love this principle and will support it until my dying breath. Therefore, a doctor may choose to bulk-bill to protect this ideal - to ensure that every Australian can access quality GPs even when they are unable to pay.That said, in the real world, the principle of universal health care has gone awry somewhere. It is designed to protect the most vulnerable - to ensure that we don't have to step over dying people on our way to work - and it works well at serving this purpose. However, it seems to have resulted in an expectation that ALL healthcare should be free. People rage about the 'gap' they have to pay for their breast implants, botox and Specialist appointments. Somewhere the idea that preventing people from dying due to poverty equates to the taxpayer (or doctors) being obliged to pay for every medical expense for every person. And, personally, I don't think this is an economically sustainable expectation.Furthermore, some people have developed an attitude that if you CAN get medical care for free then you'd be stupid to pay for it. Sometimes this is as simple as people being 'unable' to afford medical care because they would prefer to spend their income on alcohol, cigarettes and gambling. They literally have no money left over to pay to see a doctor. However, others do have spare income to pay - paying for a GP visit would cause them no financial difficulty at all - but they choose not to because ... why would you pay when you can get it for free? You don't win the race to accumulate as much wealth as possible by paying for things you don't have to. Also, if 'those people' wasting their money on booze and cigarettes don't have to pay then why should I?!?The final frustatrating fact about bulk-billing is that it somehow de-values GP care. I'm not quite sure how, or why, it does this. Part of the blame can be laid at the feet of doctors (and I will cover this later) but patients are also at fault. The fundamental issue is that good medicine simply cannot be delivered in a single visit to a doctor. You can't just attend a doctor once, irrespective of how good they are, and have all your past, present and future health problems solved. Good medicine is delivered by attending the same doctor, on multiple visits, over a long period of time.There is no reason that bulk-billing should interfere with the process of good health care. It is just as easy to visit the same bulk-billing doctor for each visit as it is your private billing doctor. There is no reason that someone who is simply unable to afford doctor's bills couldn't attend the same bulk-billing doctor each time and receive excellent health care. But, unfortunately, there are people who simply do not care about good medicine. To them a GP is nothing but a source of pills, medical certificates and Disability forms. Each sore throat, runny nose and cough is a unique medical emergency that needs to be sorted by whichever doctor is the first available. These patients will jump from doctor to doctor - even to the point of seeing one doctor for the initial problem and then another doctor to get the results.So what, you may ask? Who cares if someone doesn't want what doctors say is good for them - they're paying my salary, just shut up and print the script. My point is that, as a doctor who is interested in providing quality health care, it is extremely frustrating to be working in a practice that attracts people who aren't interested in what I am offering. And, faced with a person not interested in their own health, it becomes very easy to provide that person with quick and poor medicine, get their bulk-billing payment and pass their problems on to the next doctor that they choose to see. Therefore, the final ethical problem for doctors who choose to bulk-bill is that patients who have no interest in their health will gravitate to the 'free' service. You're choosing to see people who don't value what you are providing.The 'ethical' decision is therefore whether you want to strive to provide good health care in a bulk-billing practice - accepting that this is not what a lot of your patients are interested in but hoping you can sometimes twist their arm - or whether you want to charge a fee, thereby encouraging that type of patient to go elsewhere for the poor health care that they want, and saving yourself the frustration.The other main area of argument, about whether to bulk-bill or charge a gap, surrounds financial reasons. And, the debate is probably the opposite of what you'd expect. It may seem obvious that a doctor who charges around $75 for a standard consultation is making a lot more than the bulk-billing doctor accepting only the $37.05 or $43.20 Medicare rebate for the same consultation. Actually, the opposite is often true. This means that the doctor who charges you a gap has often made a decision to make less income - instead they would rather the job satisfaction of having time to devote to quality health care.How can this be? Well ... item 23, the standard consultation, can be charged on any visit less than 20 minutes. This means that a consultation where the doctor listens to your chest and gives you a scipt for antibiotics for your cold gets the same billing number as a doctor who spends 15 minutes working out whether you have a viral or a bacterial infection and then explaining why your virus won't respond to antibiotics. If you set up a business that attracts a lot of people who have no interest in their own health, and provides these customers with the poor, fast and free health care that they were seeking, then you'll make a lot more money than taking the time to deliver quality health care. Rather than the altruistic desire to provide good health care to those who cannot afford it, a lot of bulk-billing practices are merely trying to capitalise on the high demand for poor health care. They provide a fast service that reflects what you pay for it.These companies are often not owned by doctors. They are owned by business people who operate it just like any other business. The motivation is income and profit, not good health care. And, if you don't like the idea of people profiteering from the provision of poor health care then you need to stop attending these practices. The fact is that they are very busy, make lots of money and, therefore, justify the reason they were established.The final reason to choose private billing over bulk-billing is really a merger of financial and ethical reasons. The fact is, in Australia, the government has been effectively cutting GP's pay each year for over twenty years. The Medicare rebates have simply been falling further and further behind inflation.Doctors who choose to bulk-bill are simply accepting this slash to doctor's incomes. This may be out of a desire, despite the personal cost, to ensure that the principle of universal health care survives and that people have access to health care whether they can afford it or not. Or, it may be out of greed - hoping to maximise their income by providing fast health care to those who have no interest in their health.You might feel these pay-cuts are justified - that doctors have been overpaid for too long and that their incomes are merely moving to where they should be. Unfortunately, most people don't like accepting less and less income. The choice for doctors has therefore become to charge people for the provision of good medicine, or, to find a way to see more and more patients, in the bulk-billing model, to maintain their income. Even more unfortunately the above graph has meant that the best doctors - those providing quality medicine to those who cannot afford to pay - are simply accepting pay cuts to ensure the principle of universal health care survives.For doctors who choose to privately bill they'll often base their fees on the Australian Medical Association's (AMA) recommended fees. These are basically what the AMA believes the Medicare rebates should be had they kept pace with inflation.So ... the first part of the answer is that a GP's income is derived by charging patients for the service that they provide while the patient is in the room with them. That's the only way they can make money. For this service they can either accept the Medicare rebate alone or charge a gap above that fee.However, this does not mean that the doctor's salary equates to the total of those fees. We don't pocket $37.05 or $75 for every patient who walks into our room. Instead, most GPs are employed by a practice and earn what is called a "percentage of billings". Something needs to go back to pay for the receptionists, printer cartriges, Women's Day magazines and caviar in the staff room. In short, the GP takes home a percentage of the amount the patient pays - pretty much like the cut a prostitute pays to their pimp. This percentage varies - usually around 55% to 70% - and more is not necessarily better. If you look at job advertisements for GPs, any practice offering 70% billings and bulk-billed appointments is either a company looking to exploit the high demand for poor health care or an area that stuggles to accept staff (usually for a reason). This means that for your standard appointment your GP could take home anywhere between 55% - 70% of $37.05 - $75.I promised to briefly explain how a 'GP pratice' makes money - and I hope it's explained by the 'percentage of billings' / pimp analogy. The practice takes a cut of the fees provided by any health care professional who uses their rooms. Sometimes the practice is owned by the doctors who work there - so they're not only earning their percentage fees but also equity in the business. Other times the practice is owned by a business person who hires health professionals to do the work. Sometimes the pratice will simply pay a health care professional an hourly wage (e.g. Practice Nurses) and take all of the billings (whether they're higher or lower than the cost of the wage) and other times they'll simply rent out the room and let the provider take whatever they make (e.g Psychologists).I hope the above suffices to explain that there's not one way for a GP practice to make money. I hope I've also shown that there will be real difference in the quality of health care that is being offered. Substandard care can be partially blamed on businesses looking to maximise income, but, some of the blame needs to lie with the people who demand the services they offer. If you are looking for quality health care I would encourage you to look around and to think about whether your practice is motivated by profit or health care. Think about whether the $35 gap charged by privately billing practices is a reasonable price to pay for a doctor who has decided to make less money by devoting more time to allow for quality medicine?

Speaking from my personal experinece only as a user over the past 15 years… things used to be better ( and cheaper).Avaialbility of qualified health care professionals can be “skimpy” in some parts of te countryI moved from Connecticut , where i had established PCP ( real doctors) to Northern Vermont, where it was difficult to get past a PA ( Physicians Assitant) to see an M.D.Care provided by “care givers” ( thats we we call them now, because many are not doctors) is erratic , some good experiences when routine tests are needed and some terrible expereinces with inconsistent diagnoses and poor delivery bordering on malpractice.Charges for some services like ER are extraoridinary - I recenlty was billed over $800 for a five min visit at local ER for an antiobiotic script on a weekend - NO walk in medical care facilities hereFor low income and unemployed people in a state that is “favorable” for medicaid ( Like Vermont) , care is doled out to the tune of tens of thousand of dollars for anyone who persists , and these people often get better attention , becaue they dont have an issue with te cost - its all paid for…Avoid the big prestigiuos facilities. MY expereince with a large prominent health care facility ( with medical school) in NH was hoffiric - they processed elderly people in need like cattle, and again the use of PAs was prolific, and in my case, at least two were incompetent. On one occasion, Iw as told I could not see te doctor, because he was busy with patients - the PA advised I needed a knee replacement and wanted to schedule appointments - I though it was a good idea to speak with the surgeon - Whne I finally met with trhe surgeon ( after refusing to leave) , he told me the PA never told me I need a knee erplacement—fortunately , I had a witness in the exam room, and the surgeon just went silent. I file a complaint with customer relations at this place and followed up once and never had a repsonse.People in need of care need to get involved in undersatnding teir malady and options and often keep pushing the care giver ( I hate this term now) for a resolution. Otherwise, they send you home with a script or other instruction and tell you to come back next year. Unless you have a bone protruding from your arm and the needed care isnt obviuos, you may get sloughed off…For those with private insurance, payment for a service may be denied on the first claim, requiring an appeal to resolve, not a straight forward process for many people.Years ago, my daughter had a surgery to remove a large birth mark and repairs with a skin graft ( taken from her bottom) Insurabce would not pay for the graft part because they said it was a separate procedure and they dont cover 2 procedures processed at same time - this was eentually reversed.Health insurance providers may deny a procedure that requires preapprovalFortunatley , I have been healthy most of my life and havent had need for health care , other than routine exams, but as a senior now and some more reasons for health care needs, I find health carein the US to be stressed from not enough supply to meet the demand. With our population growing so fast over past 50 years and the probability of a socialized heat care deilvery system pushing talented health care physicians for more lucrative opportunities, it seems things will get a lot worse…I think the best days of health care in the US are in the past.