台大醫學系主任：醫生待遇不如前

[newshine]

對生意人來說
最重要的就是利潤

利潤來自於提高營收
降低成本

前者可以來自於單價或是總服務量提高

後者可以來自於減少相關成本
從人力、物力、供應鏈...等等

減少方法也是從量或是單價上減少


但是同時也擔憂所謂核心或是critical 人才或物料的不足
導致無法營利

因此
對於財團醫院來說
源源不斷的便宜的醫療人力絕對是一件重要的事情
而人力要便宜
就是要營造整體環境都認為應該要便宜

這就是醫師越來越賤的原因之一

[image]

對生意人來說
最重要的就是利潤

利潤來自於提高營收
降低成本

前者可以來自於單價或是總服務量提高

後者可以來自於減少相關成本
從人力、物力、供應鏈...等等

減少方法也是從量或是單價上減少


但是同時也擔憂所謂核心或是critical 人才或物料的不足
導致無法營利

因此
對於財團醫院來說
源源不斷的便宜的醫療人力絕對是一件重要的事情
而人力要便宜
就是要營造整體環境都認為應該要便宜

這就是醫師越來越賤的原因之一

量(?增加吧)或是單價上減少有其極限 增加單價提高附加價值提高營收才是企業賺錢的不二法門

以郭董的利害 也是要靠不斷衝刺營收高成長 如果鴻海營收停滯 股價大概會跌死

[newshine]

量(?增加吧)或是單價上減少有其極限 增加單價提高附加價值提高營收才是企業賺錢的不二法門

以郭董的利害 如果鴻海營收停滯 股價大概會跌死

單價
如果是人力成本單價
要下降很容易啊
就用責任制

無論是增加工時或是工作範圍
都會很划算

[image]

量(?增加吧)或是單價上減少有其極限 增加單價提高附加價值提高營收才是企業賺錢的不二法門

以郭董的利害 如果鴻海營收停滯 股價大概會跌死

單價
如果是人力成本單價
要下降很容易啊
就用責任制

無論是增加工時或是工作範圍
都會很划算

很難 人的部份也到頂了 一天也只有24小時 頂多奉獻18小時給你 何況 只在越來越少的大科實習住院醫師階段可以這麼作

何況 非醫師人員有工時限制 偷不了多少 還有 ~人員年年要求加薪 房租水電年年漲的壓力(經營診所 應該知道這些壓力)

責任制這麼好用 鴻海也不用年年加薪了吧

[newshine]

小的待過長庚
嘿嘿嘿

人的潛力是無窮的

[image]

小的待過長庚
嘿嘿嘿

人的潛力是無窮的

台大也很操啊 尤其young r 尤其 台大(以前)沒有助理人員 所有瑣事都住院醫師自己作

不過 媳婦熬成婆 我看主治都過的不錯~ (除了愛作研究的)

[newshine]

小的待過長庚
嘿嘿嘿

人的潛力是無窮的

台大也很操啊 尤其young r 尤其 台大(以前)沒有助理人員 所有瑣事都住院醫師自己作

不過 媳婦熬成婆 我看主治都過的不錯~ (除了愛作研究的)

台大我也待過
嘿嘿嘿

不一樣啦

一個是
learning by doing
一個是
learning by reading
結果就差粉多囉

[image]

小的待過長庚
嘿嘿嘿

人的潛力是無窮的

台大也很操啊 尤其young r 尤其 台大(以前)沒有助理人員 所有瑣事都住院醫師自己作

不過 媳婦熬成婆 我看主治都過的不錯~ (除了愛作研究的)

台大我也待過
嘿嘿嘿

不一樣啦

一個是
learning by doing
一個是
learning by reading
結果就差粉多囉

learning by reading?抽血驗尿追檢查送檢體....所有的雜事都自己作 不叫reading囉

[newshine]

哈哈哈

如人飲水囉

[lotusea]

感覺這類事情吵再多次,也沒有任何改變
沒有足夠大咖的人可以去協調

再大咖也沒用啦... 時代己經到了,誰都改變不了

除非全體醫師突然變的團結合作 , 沒有半點負面事件出來....

[fu0vu4su06]

請見洪浩雲的文章
我為何最後決定放棄外科走醫美
http://about-taiwan.blogspot.tw/2012/06 ... _3880.html
但問其詳?"您有參加民進黨不分區委員(上屆)-黃淑英委員的"住院醫師過勞死的"公聽會嗎???",您是問這個嗎?!公聽會:一個是外科總醫師夫人,一個是Intern夫人,都是有個 1-2歲小孩,被醫學界 醫院 勞盟 勞委會 教育部 推來,都是務農子弟,......;;
馬英九上任(2008)第一年去新光體檢,連任第一年(2012)去長庚醫院體檢,您說現在政府沒與財團掛勾,打死我也不相信!!!
台大何不將醫學院改為美 歐 英的四年制(Graduate Medical School),別再壓榨Intern&Resident(PGY1-3....)--Training了!!!

有些網址貼錯了,重貼
1總額制度,點值
http://greenhornfinancefootnote.blogspo ... /12/1.html
http://greenhornfinancefootnote.blogspo ... /12/2.html
2審查醫師
http://mypaper.pchome.com.tw/bear1002/post/1321122477
https://www.facebook.com/photo.php?fbid ... =3&theater
3防衛性醫療
https://www.facebook.com/hitachi.chi.9?fref=ts
4醫聲論壇
index.php
5醫勞盟
https://www.facebook.com/TMAL119?fref=ts
6現在吵得沸沸揚揚地醫療二法
https://www.facebook.com/yatche.cheng
7醫療常規?
http://www.libertytimes.com.tw/2013/new ... ?Slots=All
8健保=賤保
http://mypaper.pchome.com.tw/skindoctor/post/1321745224
台大醫科的心得文
http://mypaper.pchome.com.tw/skindoctor/post/1247118438
這篇文章被瘋狂轉載
9洪浩雲
https://www.facebook.com/Dr.AAATP?fref=ts
10 石崇良說，台灣的醫師不適用勞動基準法，「就算每週工時200小時，也不違法」(請自行計算24x7=?)
(住院醫師平均一天睡四個小時,一周工時可達到一百個小時)
11搶救急診室
https://www.facebook.com/SaveTheER?ref=stream
12柯文哲
https://www.facebook.com/DoctorKoWJ?fref=ts


1務農子弟根本主題有何關聯?

2馬英九去哪裡體檢,就可以看出政府跟財團有勾結

閣下大能,請受小弟一拜

3改成四年制是有差喔?

醫學生畢業一樣不走五大科,有差喔?
(目前不是患寡而是患不均,醫學生沒人敢走五大科....)

[李誠民]

1務農子弟根本主題有何關聯?

2馬英九去哪裡體檢,就可以看出政府跟財團有勾結

閣下大能,請受小弟一拜

3改成四年制是有差喔?

醫學生畢業一樣不走五大科,有差喔?
(目前不是患寡而是患不均,醫學生沒人敢走五大科....)
1.受害者家中父母期望醫師就改善了家中生活.....
2.民主先進國家領導者是最沒有自由的人,因為它擁有最大權利;新光副院長是衛生署財團法人--評鑑基金會董事長(?),長庚體系--台朔等員工最多,論人計酬(?)制度受益最大;何況廣告效益,您能告訴我嗎?!
3.四年制後,graduate medical student如果對臨床沒興趣,可趁早改行,不必經歷Intern&Resident(PG*1-3)--Trainee的壓榨(?),要想賺錢也可趁早改行,或有興趣研究,也可直攻Ph.D.
Surgeons set new standards for cosmetic treatments
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f590(Published 29 January 2013)
Cite this as:BMJ2
“The Royal College of Surgeons has said only surgeons should provide cosmetic surgery and that non-surgical cosmetic treatments should be carried out only by doctors, dentists, and nurses who have had appropriate training. Currently, procedures such as laser treatment or injections of botulinum toxin or intradermal filler can be administered by anyone.”….

Should the NHS work at weekends as it does in the week? Yes
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f621(Published 21 February 2013)
Cite this as:BMJ2013;346

“Some royal colleges recently advised that patients should get the same consultant led care at weekends as they do on weekdays. Bruce Keogh agrees that this would benefit patients, but Paul Flynn (doi:10.1136/bmj.f622) sees little justification for elective care at weekends and asks who’s going to pay”…..

Should the NHS work at weekends as it does in the week? No
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f622(Published 21 February 2013)
Cite this as:BMJ2013

“A patient died after a surgeon was pressurised into carrying out three radical procedures in a day as part of a lengthy list because of waiting time target pressures at United Lincolnshire Hospitals NHS Trust, a leaked letter suggests.

The trust, one of 14 under investigation by the NHS’s medical director, Bruce Keogh, because of high mortality rates,1 is in the news after its former chief executive Gary Walker spoke of a “culture of fear.”2 Walker broke a gagging clause in the compromise agreement that he signed after he was forced out of his job in February 2010, accusing the trust of putting targets ahead of the safety of patients.”……..

Kmietowicz Z. Fourteen hospital trusts are to be investigated for higher than expected mortality rates. BMJ2013;346:f960.
Dyer C. NHS trust will face “consequences” if gagging clause breached guidelines, warns health secretary. BMJ2013;346:f1083.
Fourteen hospital trusts are to be investigated for higher than expected mortality rates
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f960(Published 12 February 2013)

Drug company gifts to medical students: the hidden curriculum
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1113(Published 20 February 2013)
Cite this as:BMJ2013;346:f1113
Policies to restrict promotional gifts to students seem to affect later prescribing behavior美國醫師自今年(2013)納入"Sunshine Act"—申報超過十美元禮物與餐費,每年不可超過一百美元(主要醫學中心主治醫師以上)........

[李誠民]

美國歐巴馬總統去年因舉債上限問題,他宣示寧可不能連任也要推動健保改革,僅連任成功(債務上限經參院通過同意),;接著是今年一月財務懸崖問題,.歐巴馬只有答應縮減聯邦預算與砍掉十七萬聯邦人士,;美國總統是承諾換取參 眾院支持,三月又要兌現承諾;
台灣領導人是選前承諾(633,油電凍漲....)沒一項兌現的,還是好總統(?)當之無愧!

[無用]

醫生待遇不好，跟大老們應該也是有點關係吧？

[李誠民]

7醫療常規?
http://www.libertytimes.com.tw/2013/new ... ?Slots=All(?)

Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.e8525(Published 8 January 2013)
Cite this as:BMJ2013;346:e8525
Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study………
The nephrotoxic “triple whammy” of combining diuretics, ACE inhibitors, and diuretics
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f678(Published 19 February 2013)
Cite this as:BMJ2013;346:f678
Lapi and colleagues identified 2215 cases of acute kidney injury (AKI) during follow-up—an overall incidence of 7 in 10 000 (95% CI 7/10 000 to 8/10 000) person years.1 A recent US study reported a rapidly increasing incidence of serious AKI requiring dialysis—from 222 cases per million person years in 2000 to 533 cases per million person years in 2009—averaging a 10% increase each year.2 The reasons for this increase remain unclear.2 Despite the availability of renal replacement therapy in developed countries, AKI remains a public health scourge and preventive efforts to reduce its incidence are warranted.3 We have posited that angiotensin inhibition in older patients with chronic kidney disease may help explain this global pandemic…….
More evidence of nephrotoxicity with renin-angiotensin-aldosterone system blockers
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f661(Published 19 February 2013)
Cite this as:BMJ2013;346:f661
Lapi and colleagues provide more evidence that renin-angiotensin-aldosterone system (RAAS) blockers can be nephrotoxic in the long term in certain populations1 2—namely, older patients with chronic kidney disease, with or without diabetes.3

A few years ago, the Mayo Clinic identified late onset renal failure from angiotensin blockade, where in older patients with chronic kidney disease the sole cause of worsening renal function was the use of RAAS blockers…..
guideline(?)在高血壓 糖尿病 或microproteinuria等的治療,都是ACEI or ARR為第一線治療藥物,如果高血壓控制不理想,就加上diuritics---造成hypovolemia,ACEI&ARR--是造成Afferent A. vasoconstriction 得最常見因素,NSAID--antianagiscs是常用的止痛劑--Prostaglandin 抑制,所以台灣透析病人世界最高,一點也不奇怪(多是醫學中心,愈大醫院愈常見),所以衛生署&健保局怪罪在基層透析中心,根本搞錯對象,台灣還在慢性腎病末期防治,基層透析中心就不會缺透析者(病人?),再降低點值吧!(0.81)活該,不健全基層醫療就等著浪費醫療資源吧!

[李誠民]

Leadership|
9/27/2012 @ 12:24PM |23,496 views
The Boston Globe just ran a front-page story in their “Ideas” section on organizational culture, inspired by some depressing events involving the Boston University hockey team. It was much more impactful than the average writing about culture, and raised the important question: Why do conversations about an important topic like culture typically go nowhere, leading companies to waste time and money with “cultural change efforts” which very seldom work?

Change Management vs. Change Leadership -- What's the Difference? John KotterContributor

Quick Thoughts on Innovation: It's About Nurturing Ideas John KotterContributor

Where does culture come from? It usually comes from the founders of the group. For whatever reason, they value certain things and behave in ways that seem to help the group succeed. Success is key. So it seeps into the group’s DNA……

Not safe in their hands
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1004(Published 20 February 2013)
Cite this as:BMJ2013;346:f10
By making the NHS available for private profit, the government has undermined
Since the current government came to power in May 2010, the NHS has been subject to a steady and intensely subversive stream of adverse propaganda, which was initiated, quite deliberately, at a time of unprecedented public satisfaction with the service…….

Culture change: Robert Francis’s prescription for the NHS
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f979(Published 13 February 2013)
Cite this as:BMJ2013;346:f
OLI SCARFF/ GETTY IMAGES

For several years we have known what went wrong at Mid Staffordshire NHS Foundation Trust, and why it happened. From the Healthcare Commission’s report (2009) and Robert Francis’s first report (2010) we learnt of appalling examples of nursing care and an extra 500 deaths that occurred between 2005-06 and 2007-08.1 2 We know that the appalling nursing was caused by the trust cutting its already depleted nursing establishment to build up a war chest in preparation for its application for foundation trust status. In the process, the board had become fixated on finance and targets to the detriment of patient care……

The British government’s Troubled Families Programme
BMJ2012;344doi: http://dx.doi.org/10.1136/bmj.e3403(Published 16 May 2012)
Cite this as:BMJ2012;344:e3403
A flawed response to riots and youth offending
The British government has recently established the Troubled Families Programme in response to the riots in England in 2011, scaling up a non-negotiable version of the previous government’s Family Intervention Projects. Their aim is to prevent further riots. Key workers will assess the needs of families identified as being troubled and coordinate a year long programme of intensive family support to tackle antisocial behaviour, misuse of drugs and alcohol, and youth crime. However, evidence for the effectiveness of family intervention projects is weak, being made up of small scale evaluations without external comparison groups.1 A systematic review commissioned by the previous government found no studies to support the claim that such interventions improve outcomes for families.2……..

Working towards “health in all policies” at a national level
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1096(Published 18 February 2013)
Cite this as:BMJ2013;346:f1096
The World Health Organization has challenged governments to adopt the principle of “health in all policies” to tackle the social determinants of health and health inequalities.1 However, policy making is complex, especially across multiple government departments, which makes implementing such an approach challenging. The Welsh government is consulting on whether and how to introduce this principle, asking whether there is a “need for a public health bill to place statutory 法令的duties on bodies to consider public health issues……..
Policy-maker應該包括醫界大老吧?!台大醫學系主任應該也是大老吧?!總不該是幫派老大吧?!全聯會統計有四萬兩千個醫師((GP,基層醫療人力),台灣應該不缺醫師吧!!!缺的是Intern&Resident--Trainee得被壓榨的一群吧!!!

[李誠民]

Leadership|
9/27/2012 @ 12:24PM |23,496 views
The Boston Globe just ran a front-page story in their “Ideas” section on organizational culture, inspired by some depressing events involving the Boston University hockey team. It was much more impactful than the average writing about culture, and raised the important question: Why do conversations about an important topic like culture typically go nowhere, leading companies to waste time and money with “cultural change efforts” which very seldom work?

Change Management vs. Change Leadership -- What's the Difference? John KotterContributor

Quick Thoughts on Innovation: It's About Nurturing Ideas John KotterContributor

Where does culture come from? It usually comes from the founders of the group. For whatever reason, they value certain things and behave in ways that seem to help the group succeed. Success is key. So it seeps into the group’s DNA……

Not safe in their hands
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1004(Published 20 February 2013)
Cite this as:BMJ2013;346:f10
By making the NHS available for private profit, the government has undermined
Since the current government came to power in May 2010, the NHS has been subject to a steady and intensely subversive stream of adverse propaganda, which was initiated, quite deliberately, at a time of unprecedented public satisfaction with the service…….

Culture change: Robert Francis’s prescription for the NHS
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f979(Published 13 February 2013)
Cite this as:BMJ2013;346:f
OLI SCARFF/ GETTY IMAGES

For several years we have known what went wrong at Mid Staffordshire NHS Foundation Trust, and why it happened. From the Healthcare Commission’s report (2009) and Robert Francis’s first report (2010) we learnt of appalling examples of nursing care and an extra 500 deaths that occurred between 2005-06 and 2007-08.1 2 We know that the appalling nursing was caused by the trust cutting its already depleted nursing establishment to build up a war chest in preparation for its application for foundation trust status. In the process, the board had become fixated on finance and targets to the detriment of patient care……

The British government’s Troubled Families Programme
BMJ2012;344doi: http://dx.doi.org/10.1136/bmj.e3403(Published 16 May 2012)
Cite this as:BMJ2012;344:e3403
A flawed response to riots and youth offending
The British government has recently established the Troubled Families Programme in response to the riots in England in 2011, scaling up a non-negotiable version of the previous government’s Family Intervention Projects. Their aim is to prevent further riots. Key workers will assess the needs of families identified as being troubled and coordinate a year long programme of intensive family support to tackle antisocial behaviour, misuse of drugs and alcohol, and youth crime. However, evidence for the effectiveness of family intervention projects is weak, being made up of small scale evaluations without external comparison groups.1 A systematic review commissioned by the previous government found no studies to support the claim that such interventions improve outcomes for families.2……..

Working towards “health in all policies” at a national level
BMJ2013;346doi: http://dx.doi.org/10.1136/bmj.f1096(Published 18 February 2013)
Cite this as:BMJ2013;346:f1096
The World Health Organization has challenged governments to adopt the principle of “health in all policies” to tackle the social determinants of health and health inequalities.1 However, policy making is complex, especially across multiple government departments, which makes implementing such an approach challenging. The Welsh government is consulting on whether and how to introduce this principle, asking whether there is a “need for a public health bill to place statutory 法令的duties on bodies to consider public health issues……..
Policy-maker應該包括醫界大老吧?!台大醫學系主任應該也是大老吧?!總不該是幫派老大吧?!全聯會統計有四萬兩千個醫師((GP,基層醫療人力),台灣應該不缺醫師吧!!!缺的是Intern&Resident--Trainee得被壓榨的一群吧!!!

[李誠民]

腎病末期需長期透析(腹膜或血液)是唯一靠科技而能延續有尊嚴生命的治療,所以個民主先進國家(包括解體後蘇聯各國,甚至中國大陸)都有長期透析(包括腎移植)社會福利醫療,僅是政策(Policy)不同,因為各國財政不同:;但沒有任何一個 國家是台灣的透析政策;.......
因為通貨膨脹(Inflation)與人事費增長(Salary--部分是抵銷Inflation之用),通貨膨脹是政府(政客?)所造成的,憑甚麼用點值,總額給付來懲罰醫療提共者?台灣透析人口有因健保透析改變,而下降嗎?
2005 or 2006年有許多symposium 檢討contrast nephropathy,現在有檢討Guidelines 的文獻,英國的NICE guideline是用來保護GP(或所有醫師)的Guideline!!!

[chungo]

單比薪資是不公平的.
請把工時 風險 壓力 教學研究等加總衡量

[hjh]

再等醫師納入勞基法
保證主治醫師連15萬都沒有

why?
勞基法把錢拿到哪去了?

[李誠民]

請問一下 NSAID是透個什麼 mechanism傷害 kidney的?
若是透過 prostagladins pathway(前輩?!不敢當!)
那為什麼 steroid 不會也傷到腎?

若 steroid 會傷腎
為什麼腎不好的痛風病人不給 NSAID卻給 STEROID?
2005年對於Menbranous Nephropathy就有Guideline訂出治療方式:第一個月 第 三個月 第六個月用Methylpredisone1.0Gm,其間用1-2(?)mg/K.w./D;但在許多醫學會議上提出--從沒下文;
一年前NEJM有文章:專治關節藥物,掺有類固醇(FDA U.S.)也僅是仿單加註Steroid長期使用的副作用(因是健康食品?),
我願舉例說明:Avendio Actos Metophormin都是一類藥,僅是Metaphormin 是50年以上老藥(Aventio Actos在英國是禁止使用的),原因為何?!想必當然!
美國透析(血液)單次給付,參院改為Bundle(總額)自2013-1-1起實施,至2014年檢討,主因靜脈注射藥物有另外給付,(EPO-2007年FDA warnbing.,Active Vit.D.靜脈注射劑行興起...)
台灣健保政策仍停留在藥價黑洞 藥價自付額爭議中,實施新政策又沒有檢討,,多麼無聊!就拿Guideline 當成醫療糾紛的法律判定,不要說:健保審核自3-1起,交醫 藥專家審訂?為什麼不交由法律人審?法官可由Guideline 訂醫療專業問題,為什麼不行?!

亞東醫院又出事了!急診判斷出誤(媒體報導),有真相的 一天嗎?!

[李誠民]

摘錄上月Am.J.Med. 主編 Dr. Alpert的 文章;Dr.Alpert 是Cordiologist,值得省思::

Some Reflections on China, US-Chinese Relations, and Healthcare in China
Joseph S. Alpert, MD Editor-in-Chief, The American Journal of Medicine
During recent years, I have made a number of trips to China, Taiwan, and Korea on behalf of the publisher of The American Journal of Medicine, Elsevier, which has cosponsored a number of Asian continuing-education programs aimed at promising young clinical investigators.
The goal of these programs in China is very clear. The Chinese government has gained world respect in a number of areas, for example, economics and athletics. Now, the Chinese would like to be respected for performing world-class clinical research. A goal often expressed to me in China is the desire to see a Nobel Prize in medicine and physiology come home to China in future years.
……. the major difference between the English and Chinese languages, which makes writing in English difficult for Chinese native speakers
……. The hospitals themselves are often housed in older buildings. Patient rooms contain 3 to 6 beds. I have been told repeatedly that Chinese do not mind this communal arrangement because they are almost always in the presence of others throughout their lives, given the huge population of China
……. This family dynamic is seen clearly in the hospital, where patients are often accompanied day and night by a family member.
……With respect to the type and quality of care received in Chinese hospitals, I must admit that I only visited what were considered the best institutions in the biggest cities. The care there was excellent, with the major but not exclusive emphasis on Western-style medicine, for example, invasive interventional therapy for patients with non–ST-elevation myocardial infarction
……. Many patients also take a variety of Chinese herbal remedies simultaneously with the application of Western allopathic medicine. On one trip, I developed an upper-respiratory viral illness and was given several Chinese herbal tablets reputed to be effective for this illness
…….. Many young Chinese physicians spoke to me about the Chinese system of medicine and its simultaneous use in their patients alongside Western therapies. I saw many shops selling various dried herbs, minerals, and animal parts. All were said to be helpful in managing a wide range of illnesses. Chinese medical remedies are widely used and often prescribed by nonphysicians.
…….. The hospitals that I visited were equipped with modern medical instrumentation, most of which was imported from Europe, Japan, or the United States
….
……. The epidemic of diabetes and atherosclerotic disease now occurring in China and throughout Asia is the result of major changes in lifestyle in recent decades. Fast-food emporia are on all sides serving various Chinese versions of what I call “greaseburgers,” as well as heavily sugared soft drinks. Smoking and urban high stress also are ubiquitous
……. I have thoroughly enjoyed visiting with colleagues in China and the rest of Asia. The similarities between their lives and ours is striking. I am looking forward to spending more time with my Chinese cardiology colleagues in the future there, here in the United States, and at international meetings. Our personal goals are identical: to deliver the best possible care to our patients with heart disease.
Some Reflections on China, US-Chinese Relations, and Healthcare in China
The American Journal of Medicine - Volume 126, Issue 3 (March 2013
去年NEJM 有文章報導:Flue 治療,用Chinese Hurb Drugs是有效的,但也有To editor:指出中藥是複方的,以西方科學論證是有困難的!因為到底是哪一方藥草的功效,討論空間相當大,甚至有中國醫師提出:某一種中藥,會因產地不同,而有不同功效………
可能未來的Nobel price 得主(Medicine or physiology,Dr.Apert 預測)是Flue 治療嗎?!

[李誠民]

bundle reimbursment of hemodialysis 在美國參院通過:由2012-1-1Medicare 試辦,至2014年檢討
美國是資本主義自由市場,私人保險機構或醫療提供者,最喜歡bundle(總額)給付,因為私人企業是以追求利潤為目的,(總額)bundle reimbursment 是最單純的,只要給付中的利潤先提出就好:;以長庚體系(全聯會 護理師官方網站)為例::林口長庚大學畢護理師,以NT39,000/mon.起薪,;高雄長庚卻是42,000 起薪,為甚麼?!同一企業員工起薪應該是生活指數為考量吧!長庚醫師薪水愈來愈減少,更不可諒解的是改為雇傭關係,而非和夥關係(稅當場提高),那律師事務所 會計事務所,為甚麼 可以和夥關係,同樣是專業人士(獨立行使專業行為),......,為甚麼?谁能解答?!
二 三年前,BMJ有文章:感冒 流感(?)常合併喉嚨痛,雖不嚴重,但是很惱人,所以主張用Steroid兩 三天;Myo'clin. proc.也有對感冒合併慢性鼻竇炎,也是有一樣主張,在台灣健保審核由醫 藥專業擔任審核,不是剝奪醫師的專業嗎?醫師谁敢處方類固醇,一件簡單事,不是複雜化了!(病人一點好處沒有).............

[image]

長庚醫師薪水愈來愈減少,更不可諒解的是改為雇傭關係,而非和夥關係(稅當場提高),那律師事務所 會計事務所,為甚麼 可以和夥關係,同樣是專業人士(獨立行使專業行為),......,為甚麼?谁能解答?!
.............

這要問那隻羊~

[image]

再等醫師納入勞基法
保證主治醫師連15萬都沒有

why?
勞基法把錢拿到哪去了?

如果一天九小時的藥師只能上七小時 必須多請ㄧ位藥師

原來的藥師有可能不減一點薪嗎?

[hjh]

再等醫師納入勞基法
保證主治醫師連15萬都沒有

why?
勞基法把錢拿到哪去了?

如果一天九小時的藥師只能上七小時 必須多請ㄧ位藥師

原來的藥師有可能不減一點薪嗎?

那如果請不到藥師了呢

[image]

再等醫師納入勞基法
保證主治醫師連15萬都沒有

why?
勞基法把錢拿到哪去了?

如果一天九小時的藥師只能上七小時 必須多請ㄧ位藥師

原來的藥師有可能不減一點薪嗎?

那如果請不到藥師了呢

那就得縮減門診時間

一樣加減減薪

[dtemer92]

再等醫師納入勞基法
保證主治醫師連15萬都沒有

如果一天九小時的藥師只能上七小時 必須多請ㄧ位藥師
原來的藥師有可能不減一點薪嗎?

醫生的薪水來自於健保局
藥師的薪水來自於醫生

藥師要不要減薪水? 看醫生良心跟認知
至於減薪後藥師要不要跑? 那也是藥師的自由

結論: 醫師活該

[hjh]

再等醫師納入勞基法
保證主治醫師連15萬都沒有

why?
勞基法把錢拿到哪去了?

如果一天九小時的藥師只能上七小時 必須多請ㄧ位藥師

原來的藥師有可能不減一點薪嗎?

那如果請不到藥師了呢

那就得縮減門診時間

一樣加減減薪

藥師應該是大大的一個比喻

晚輩的原本的意思是
如果醫師納入勞基法
短時間內如果沒有外國醫師補充
醫院無法「多請一位醫師」
醫師上班時間因勞基法而變少 服務量自然變少 申報點數就變少 可是健保總額不變
只要醫師量沒增加 總額沒減少 醫師薪水自然不會因為勞基法而減少
醫師上班時數長短不是醫師薪水高低的重點
反過來說也許更容易理解
即便不納勞基法 醫師上班時數超級長 可是如果醫師量增加一堆 總額沒增加 保證大家薪水會下降
勞基法的不納入 政客和民眾是實質獲益者 醫院只是把血汗盡數轉嫁給醫師
據此 晚輩是支持入勞基法的

[image]

why?
勞基法把錢拿到哪去了?

如果一天九小時的藥師只能上七小時 必須多請ㄧ位藥師

原來的藥師有可能不減一點薪嗎?

那如果請不到藥師了呢

那就得縮減門診時間

一樣加減減薪

藥師應該是大大的一個比喻

晚輩的原本的意思是
如果醫師納入勞基法
短時間內如果沒有外國醫師補充
醫院無法「多請一位醫師」
醫師上班時間因勞基法而變少 服務量自然變少 申報點數就變少 可是健保總額不變
只要醫師量沒增加 總額沒減少 醫師薪水自然不會因為勞基法而減少
醫師上班時數長短不是醫師薪水高低的重點
反過來說也許更容易理解
即便不納勞基法 醫師上班時數超級長 可是如果醫師量增加一堆 總額沒增加 保證大家薪水會下降
勞基法的不納入 政客和民眾是實質獲益者 醫院只是把血汗盡數轉嫁給醫師
據此 晚輩是支持入勞基法的

自費的部份減少+最重要的 減床減少服務量....健保局隔年就砍錢了.....還是得減薪

贊成納入勞基法啊 不過 要有薪水(尤其是時薪)不變的保證