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FAQs
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What are electronic signatures used for?
The ETA does not contain a prescribed definition of what would be an ‘electronic signature’. Therefore, an electronic signature may take the form of an image of an individual’s handwritten signature, a typed name or a digital signature. There may be other forms as well. For example, the courts have held that a name appearing at the bottom of an email in normal typeface is a valid electronic signature.Section 9 of the ETA sets out three requirements for an electronic signature, being identification, reliability and consent:Identification is a question of fact, as the recipient must be able to identify the person signing (however, no formal verification of identity is required), and confirm that the person signing intends to be bound by the information communicated.Reliability is objectively determined by considering all the relevant circumstances and the purpose for which the electronic signature is required.Consent requires the counterparty to the document being electronically signed to agree to the signing party signing the document electronically. The case law demonstrates that this requirement is unlikely to require anything more than the counterparty using the chosen electronic mechanism, or engaging with the electronic execution process.To know more about Electronic signature visit at Digital Signature Devices, Software, Electronic Pads
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What industries must use electronic signature software?
Any industry involving a large amount of paperwork make use electronic signatures. In other words, all industries make use of electronic signatures because all of them have piles of paperwork to handle. Some examples of such industries include financial, life science, healthcare and pharmaceutical industries.Industries such as the pharmaceutical industry, have a number of licenses and other paperwork that they have to handle and keep track of. It can be a tedious task to perform such cumbersome paper processes. Therefore, e-signatures can facilitate an organisation in keeping a track of all this paperwork, by signing electronically.Healthcare industries usually involve time-sensitive documents, which need to be urgently completed. But, it can take days in case of the traditional wet ink paper signatures for the documents to signNow the signer and back, if the parties are geographically scattered. But with electronic signatures, that is not the case. Geographical barriers do not play a role. Documents which earlier needed days to be completed, can now be signed and sent back within minutes, in the click of a button. Furthermore, it takes a long time to bring assets under management. The time taken by the signing process, if wet ink paper signatures are used, may even further delay the process. But by using electronic signatures, the whole process can speed up.Apart from these, there are many paper prone industries which require huge amount of paperwork and with the use of electronic signatures they can make their everyday processes smoother and more efficient.
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Is it safe to send a fax online?
Receiving your faxes by email or computer is very much possible nowadays. There features on multifunction printers that provides several “send-to” options, as well as PC and mobile apps that archives digital faxes. Online fax services or e-fax are more convenient than the traditional faxing. You can virtually fax from anywhere to anywhere in the states or countries – that of course depends on your faxing service. But anyhow, it is possible. Later I’ll be teaching you on how to send an efax (you can skip reading this and go straight to the guide).Faxing is still is a thing to this day because it’s the fastest way to send a signature or any other signed documents. It’s convenient that way. Use of online fax however does not diminish the needs for use of the traditional fax machine. Not only does it have its own charm – (in physically and manually requiring you to fax) but in my opinion, still safer and more secure. Do I use online fax? Yes.If you’re not familiar with efax, let me give you some ideas on what you can do with these online fax service. Yes, it is a service. Just like an email, you are still required to subscribe and have your own local fax number to be able to send and receive. Some service features you can send/receive aside from the fax number are cover page, limited or unlimited number of faxes per day, international faxes and online storage. You can also send fax in different file formats. Prices range from free to $20 – or from what I know of.One of the most obvious advantages of an efax is being able to send a fax without the need for fax machine. You send it straight to another efax number or straight to a multifunction printer or stand-alone fax machine. What’s best about it, there are online fax services you can subscribe for free!Here are some free efax services you can try online for free:MyFaxPamFaxFaxZeroeFaxFaxBetterNow these are free online fax services so there are couple of features that are not available or limited. Subscription however is not that expensive with some like eFax have annual fee of less than $20. That’s not a bad deal. If you’re an occasional sender or just sends faxes on a small scale, free service will suffice. Below are the steps on how to send an online fax.Sign in to your online fax service.Tap/click ‘send faxes’.Add recipient (s) name, country/state and fax number. (You can also import your recipient (s) names and fax number from Gmail, Yahoo Mail or in a CSV file format)Attach the file you want to send. Choose the quality and format of your file.Tap/click ‘send fax’ button.That’s it. Easy peasy. You won’t need five minutes to send an efax from now on.Bonus information:Microsoft Word, Excel, Outlook and PowerPoint can be sent as fax. Yes, you read it correctly. If you haven’t heard of this feature, then you know now. Click on FILE button and select SHARE from the dropdown menu. Select EMAIL and from there, you can choose to send it as a PDF, XPS or aFrom How to Send Online Fax
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Why is Tokyo so unmodern?
I will dissent from some of the others and say that yes, in some ways Tokyo is quite unmodern.Here is how it is unmodern, and why.Tokyo is not a gleaming, hyper-futuristic jewel like Shanghai or Dubai. Why? Because Tokyo is a huge, old city. Like London and New York, it has had a 1-million+ population for two centuries. Tokyo became modern the way Shanghai and Dubai are, fifty years ago. Now it’s it’s like a middle-aged person, and doesn’t have to wear trendy flashy clothes any more. It doesn’t need to build a sleek cutting-edge subway system because the old one still works fine.Japan as a whole is unmodern in some ways. Stubbornly unmodern.For all its reputation as hi-tech, there are some aspects where it lags behind the rest of the world. An example that many people point out is the continued use of fax machines instead of e-mail. In general, adoption of personal computer technology lagged about 15 years behind the West because of the language barrier. Then there are other aspects of Japanese culture, such as the use of personal seals instead of signatures and the Imperial date system that is used in official government document. Things like these don’t get much attention from the globe-dominating American software industry, so there is less incentive to replace them with technology solutions.To visitors, probably the most noticeable way Japan trails behind the US and Europe is consumer financial technology. Japanese consumers still primarily use cash; it is still difficult to get by with just a credit card, never mind waving your smartphone. Like the people of most East Asian cultures, Japanese are averse to debt, so credit card usage is low. Japan is safe, so there is no risk of carrying large amounts of cash in public. (Not just being robbed, but dropping it - it is likely to found and delivered to the local police.) So cash is good enough and convenient enough for most situations. There are also cultural roadblocks to washing away the old: for example, in Japanese weddings and funerals, attendees bring envelopes of cash; that is the one proper way of doing it. Something like this isn’t likely to ever be replaced by a Bluetooth payment kiosk.Japan was the first country of non-European heritage to become an industrial-age world power. It has developed for 150 years on that path, and mastered the art of adopting foreign influences in a way that few other cultures have. Part of that mastery is deciding when things don’t need to be adopted, and keeping the clunky “unmodern”.
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I am in Washington DC for just three days and I am an Anesthesiologist. What places do you recommand to visit?
“The only difference between Las Vegas and Washington, D.C. is that at least Vegas has the decency to admit the town is full of hookers and crooks.”― Glenn BeckActually the times when Mr. Beck’s line above was true were long ago. DC is a surprisingly different city. It is great bar and restaurant town. It used to be a little old-fashioned but in the past 10 years has become, younger, uber-hip and a lot more accessible than New York for the same kind of things…. A lot of very cool places. DC is a very important test-market city. Before spending to open a chain of stores/restaurants/theatrical show/new product in NYC or on a national scale, a prototype is often launched there. And along with the National Theatre so often having something interesting going on and The Capital Steps We put the MOCK in Democracy preserving our sanity while staring at the bizarre abyss of National Politics, entertainment is always at hand. And if the atmosphere changes radically with administrations, most visitors won’t notice.But if you have to think about politics while in the District much these days, it is much less painful to make sure you aren’t sober while you do it. Fortunately there’s a whole new area of town full of artisanal distilleries where you can get juiced before starting your visit!Ivy City Distilleries and Brewery Tour – RecapWarning: You probably won’t be able to get to everything on this list in three days. With my customary long-windedness, I have overshared.DC, some places to see, eat, drink and fiddle before the capital is stained orange:Getting around in DC, where the weather usually seems either really hot or wet—or indeed freezing—is always a challenge. The metro goes way out in the burbs and even quite rural areas in Virginia and Maryland. but sometimes the stops are very far apart. And sometimes you feel like you’d rather walk a long way than go ALL the way down into the metro and the ALL the way back up again on the other end.The Metro Is quiet, extensive, safe. And very, very deep as it doubles as a Nuclear Bomb Shelter BehanceGood News. There is another useful option:The DC circulatorWashington D.C. Circulator It has expanded over the years and become more user-friendly. A group of circular-route frequent busses which is one of the best ways to get around DC. All through the tourist districts/governement/downtown without having to stay massed in a milling crowd of befannypacked zombies.DC’s Bike-share Program is pretty good, the bikes better than those in Paris, not as good as some other places, but they are practical, easy to find and spot stations. Fun way to get around though toiling up capital hill from the Mall or out to the zoo and Adams Morgan can be a challenge on the heavy machines. better around downtown, along the river, even out to Arlington.Capital Bikeshare: Metro DC's bikeshare service | Capital BikeshareAnd if the weather is nice both cruises and boat rentals on the Potomac are coolRentals | Kayaks, Canoes, Boats | Boating in DC SUPThe celebrated D.C. weather, be preparedMuseumsFor everywhere you go it is a really good idea to buy your tickets in advance online. Some places you can even reserve specific entry-hours so you don’t waste your time standing on line.Throughout the city you stumble on buildings evoking not just the history of the country but of so many countries and organisations from around the world. Most seem to have an embassy, a lobbying office or national headquarters here. And many of them have a museum, public tour or open house day. Wandering from the circles (usually with interesting monuments in their central areas) that break up the long blocks of the grid of central D.C. From Washington Circle up to Dupont and around to Thomas and Logan unearths a few score of them.My favorite:Society of the CincinnatiLarz Anderson House2118 Massachusetts AvenueSociety of the Cincinnati - WikipediaThomas CircleOverrated places…a lot of the big places are just long lines then nothing. The National Archives are full at all times with tourists waiting in line to see a few historical documents and not much else, and often superficial temporary exhibits, The Folger Shakespeare Library probably only worthwhile to see a play, there’s much better stuff at the Morgan in NYC.Just for the person who asked this question, as a medical professional you might enjoy the National Museum of Health and MedicineNational Museum of Health and Medicine (NMHM)Obviously the Smithsonian museums is always loads of fun and should be one of your primary destinationsSmithsonian Home | Smithsonian Institutionas is the National Librarybut you could easily spend all three days at either.Nearby are: the small US Botanical Garden right under the capital (Chocolate plants!)and also next door to the very neat Museum of the American IndianWelcome to United States Botanic Gardenand The outdoor Sculpture Garden of the Nat Galhttp://www.nga.gov/content/ngawe...There are a lot of other greats which don’t disappoint—the National Gallery itself , which is of course amazing, National Gallery of ArtThe National Zoo out in Rock Creek Park, Arlington can be funand The Nat Geographic museum are some of the tourist destinations that don’t disappoint, they really are always worth the trip. But I haven’t been to either in several years.but some of my favourites, that a lot of people don’t visit:Dumbarton Oaks Harvard’s Mesoamerican and Byzantine collections at a research institution in one of the most beautiful buildings with one of the most exceptional gardens in the world. Very limited hours, so you have to plan.Dumbarton OaksIt may seem a little ways out but really is in the heart of the old communities climbing the hills above Georgetown and is perfectly suited to doing in combination with that august collection of antiquarian Washington residences.The world-class, really amazing Phillips Collection1600 21st St NW(between N Q St & N Hillyer Ct)Washington, DC 20009(202) 387-2151The Phillips CollectionDupont Circle Metro Station (Red)Of the For-Profit newer museums The Spy Museum is really fun and might appeal to a father and daughter team. The gift shop yields fun presents.Buy TicketsThe National Building Museum is also surprisingly diverting401 F St. NW, (202) 272-2448 WEBSITEThe National Building Museum is located at 401 F Street NW, between 4th and 5th Streets, across the street from the Judiciary Square Metro (Red Line). Wheelchair access is available through the G Street entrance.To see what’s new and cool that I may have missed between visits, check out the best of dc awardsBest of D.C. 2017 - Washington City PaperBest neighbourhood to walk around might be the U streetWalk on 14th street out to U.This is the centre of the new hip-cool DC. 10-12-15 years ago, like much of DC this area used to be, hmm, a bit dodgy. Now it is safe full of young people, hip bar, after funky restaurant, squished between Art spaces and galleries. Lots of places to recommend but I’ll let you wander… except maybe: hard to get modern spanish food this good in Spain. But casual and fun.14th Street | Barcelona Wine BarOr the newly revitalized old Capital hill district 8th Street, lots of bakeries and shops in older restored townhouses. The wait on line can be intimidating but one of the hottest places to eat in town is here, Home | Rose's LuxurySee below about the Eastern MarketOne of the many institutions with headquarters in DC from infamous to celebratedAlso the district right around the Foggy Bottom metro station is newly hoppingThere are roof bars all over DC now, but the one that started it all really is POV roof bar/resto of the W right next to the white house has great views of the White and is one of the inn-est if not hippesy places in town.Boutique hotels Washington, D.C. | W Washington D.C.but there is alsoADCatDonovan House1155 14th Street NWWashington, DC 2000518th st lounge with roof terracehttp://www.eighteenthstreetloung...hteenth Street Lounge1212 18th St. NW, Washington, D.C.At Jefferson Pl. and Connecticut Ave,Metro: Dupont Circle (.Nellie’s Station Kitchen and Cocktails DC in Embassy Row hotel roof deck2015 Massachusetts Ave NWWashington, DC 20036Cafe/BookstoreKramerbooks & Afterwords Cafe |right on Dupont Circle Kramer cafe and bookstore the georaphical-intellectual centre of the city. Good books of every sort and nice relaxed place for luncEvehttp://www.restauranteve.com/ind...is one of my favourite places in the world. In Alexandria Old town, which you guys will love. Oodles of charm. The restaurant is in beautifully restored early american townhouse. Incredbly witty, inventive, clever food and drink from an Irish chef who is charm incarnate. Named after his daughter, nearby there’s a casual Irish fish and chip shop he owns named Eamon’s Dublin Chipper after his son.The DC institutionHow can you go to DC without trying a Half-smoke?Ben’s THE DC Half-smoke hotdog houseHome | Ben's Chili BowlFounding Fathers bars and restosAre a chain serving really good, well sourced American foodOur Locations | Founding FarmersFounding Farmers D.C.1924 Pennsylvania Ave. NWWashington, D.C. 200063 blocks west of whitehouse B, L and DAstro chicken and doughnuts were the best doughnuts in DC last I checked1308 G St NWWashington, DC 20005metro centerHill Country BBQSelf Service, kid friendly sometimes live music410 7th St. NW, (202) 556-2050Home - Hill Country Washington D.C.Elephant & CastleFuller’s Beer pub with big outdoor terrace1201 Pennsylvania Ave. NWWashington, DC 20004Pub and Restaurant in Washington D.CIf you are getting tired and are on the Pennsylvania Avenue side of things, a good place to stop for a snack, drink, or bathroom break ;)Cool resto cocktail barRis2275 L St NWWashington, DC 20037b/t N New Hampshire Ave & N 22nd StTransit information Blue Orange Foggy Bottom Metro More infoPhone number (202) 730-2500With so many different nationalise gathered in the capitol there are great places for most kinds of foods…. A few of our favorite suggestions:Centrolina (first rate modern Italian)Mercato e Osteria974 Palmer Alley, Washington, D.C. 20001http://centrolinadc.com/contact/Convivial (modern Franco-American801 O Street, NWWashington, DC 20001http://www.convivialdc.com/contactDel Campo S. American grill by a talented Peruvian chef777 I (EYE) Street NWWashington, DC 20001Phone: 202-289-7377ChinatownVery good Mexican right downtown, is:http://www.oaxacaindc.comhttp://oaxacaindc.com/menu.html2106 18th ST NWWashington, D.C. 20009Stachowski kosher deli 28th and P1425 28th St NWWashington, DC 20007b/t N P St & N O StGeorgetownRASIKA INDIAN one of group of superlative modern Indian places1190 New Hampshire Ave NWWashington, DC 20037b/t N M St & N L St near 22nd and New hampshireWest EndFoggy Bottom MetroPhone number (202) 466-2500http://rasikarestaurant.comThere are Biergardens like the 2000 sq. feet rooftop deckSauf Haus DC1216 18th St NWWashington, DC 20036b/t N Connecticut Ave & N M StDupont CircleRed Farragut North MetroPhone number (202) 466-3355http://saufhausdc.comIf you like cigars, for people watching and meeting very interesting locals, one of the best cigar bars around it is worth the ride out on the metro tohttp://civillounge.com5335 Wisconsin Avenue NW, Washington DC 20015Friendship HeightsCivil Cigar LoungeOr alternatively enjoy a drink and a snack on the Quill Bar Cigar Terrace of the Jeffersonianhttp://www.jeffersondc.com/dinin...W. Curtis Draper (640 14th Street NW) 4th oldest cigar store in the USThe Observatory at The Graham in Georgetown(cigar friedly)1075 Thomas Jefferson Street NW, Washington, DC 20007202.337.0900Jack Rose Dining SaloonCigar friendly good bar2007 18TH ST NW, WASHINGTON, DC 20009 | TEL. 202.588.7388 | SUN - THUR. 5PM-2AM | FRI-SAT. 5PM-3AMin Adams MorganLocal 16Categories: Lounges, American (New) [Edit]1602 U St NW(between N 16th St & N New Hampshire Ave)Washington, DC 20009Neighborhood: U Street Corridor(202) 265-2828http://www.localsixteen.comFarm-owner restaurateur serves low-key fresh food, heated smoking terraceJ R CIGAR1730 L St NW, Washington, DC(202) 296-3872 · http://jrwashingtondc.comSignature Cigars - Pre-Embargo Cuban TOB Cigars1817 M Street NorthwestWashington, DC 20036Ozio DC Bar resto cigar lounge1813 M Street, NWWashington, DC 22036202-822-6000 Ph202-822-0626 FMonday - Thursday 5:00 pm - 2:00 amFriday 5:00 pm - 3:00 amSaturday 6:00 pm - 3:00 amClosed on SundaysNearest Metro StationsFarragut North and Dupont (Red Line)Farragut West (Blue & Orange Lines)Shelly’s Back Room1331 F Street NW(between 13th & 14th Street)Washington, DC 20004Phone (202) 737- 3003 Fax (202) 737- 3706Phone orders for pick up welcome.Hours of Operation:Monday – Thursday 11:30 AM – 2:00 AMFriday 11:30 AM –3:00 AMSaturday 12:00 PM – 3:00 AMSunday 12:00 PM – 1:00 AMPublic Transportation:Metro Center MetroRail Station(Use 13th Street Station Exit)Metrobus Routes: 52, 54Metro Information: http://www.wmata.comMarketsThe DC markets are really worth checking out. Local products, usually entertainment, etc.The best, newly refurbished in the middle of the old wholesale market districthttp://unionmarketdc.com/market/1309 5th Street NEMETRO ACCESSTake the Red Line to the NoMA-Gallaudet U stop. Turn right on Florida Avenue NE. Turn Left on 5th Street NE. The Market will be on your left.Eastern Market225 7th St SEWashington, DC 20003b/t S C St & S North Carolina AveCapitol HillGet DirectionsTransit information Blue Orange Eastern Market Metro and 1 more stationPhone number (202) 698-5253Also the Flea Market and in the center of old capital hillPenn Quarter street market, DC (est. 2003)Thursdays, 3 to 7 pm (Apr. 2 to Dec. 17, 2015)Location: North end of 8th St. NW, between D and E Sts. NW. Click here for map.Nearest Metro: Gallery Place (Red, Yellow or Green lines) or Archives (Yellow or Green line). For more public transportation options, see http://www.wmata.com.by the White House, DC (est. 2009)Thursdays, 11 to 2 pm (April 9 to Nov. 19, 2015)Location: 810 Vermont Ave. NW (between H St. NW and I St. NW). Click here for map.Nearest Metro: McPherson Square (Blue and Orange Lines). MetroBus stops: S2, S4, S9, 42, X2, L2, G8 and 11Y. For more public transportation options, see http://www.wmata.com.Foggy Bottom, DC (est. 2005) Farmer’s marketWednesdays, 3 to 7 pm (Apr. 1 to Nov. 25, 2015)Location: 23rd and I St. NW WalkwayNearest Metro: Foggy Bottom (Blue or Orange Line). For more public transportation options, see http://www.wmata.com.If you've made it this far, to the end of this, Wow. I’m too surprised to actually add in an easter egg. But I’ll give one more picture to rest the eye upon….The DC headquarters of the SPCA…or was it PETA?
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What is a registered exporter system (REX)?
In Simple Words REX is Compliance system initiated by European union for Certification of Origin.If one wants to export goods value exceeds 6000 EUR to Europe then has to attach this certificate with consignment.In Official Frame of words:Subject: – Certification of Origin of Goods for European Union Generalised System of Preferences (EU-GSP) – Modification of the system as of 1 January 2017.In exercise of powers conferred under paragraph 2.04 of the Foreign Trade Policy, 2015-2020, the Director General of Foreign Trade hereby inserts a new sub para (c) under Para 2.104 Generalised System o...
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What is it about being a primary care physician that medical students are avoiding the field?
In the shortest explanation, money & respect.The role of a primary care physician is so vital. They are the gatekeepers, the coordinators of all our care, but they're generalists. They diagnose, treat illnesses, & refer patients out to specialists as needed. They often have nurse practitioners &/or physicians’ assistants for routine care, & they mentor them in the care of chronic & acute conditions. They keep the costs of healthcare lower than it would otherwise be. Yet for this, they get little respect & less money.Everyone knows about college debt, but let's take a closer look at the primary care physician & physicians in general. First of all, they can't be easily grossed out & do what they do, & they have to be smart. Next, they have 4 years of pre-med, usually majoring in biology, biochemistry, & other scientific & medical fields. That's 4 years of debt right there. Next is 4 years of medical school, considered post graduate work & thus much more expensive than a baccalaureate degree. They need lab coats, a good stethoscope, & it never hurts to have an otoscope (to look in the ears) & an ophthalmoscope (to check out the eyes), plus a good calculator & a good flashlight, a good pen & mechanical pencil, & references that they can carry in a pocket (I still remember docs with medical references, lab references, notepads, wiring implements, in lab coat pockets bulging & weighted down & tearing apart…now, they can put all that in their smartphones...but the references still cost a LOT). They start rounding on inpatient units & o serving outpatient areas in their 3rd & 4th years of medical school so they can observe patient care & they're also used a lot for scutwork. If they're particularly brilliant, they can become sub-interns, able to write orders which cant be filled until they're cosigned by the attending, the last semester of med school. All those bills pile up, they graduate, then have to take medical board exams, which cost a LOT, then pay as much as $2K a year (depending on the area, it's cheaper in some areas than in others) just to get a license to practice medicine. If they live in, say, the Washington, D.C. area, where people come from MD, VA, WV, DE, & D.C., in order for their prescriptions to be filled at their local pharmacies by patients from all those areas, they have to buy a license in every one of those states. D.C. is very expensive for any type of licensure, so is VA. MD, DE, & WV aren't quite as bad but it can still end up at least $6K a year in total doctors' licensing fees for multiple state licenses.Interns are paid a salary, usually the same as a brand new nurse or even less. Finding a place to live, a reliable vehicle, & paying off student loans is a tall order, & even when they work on call 96° straight, they don't get overtime. They have to go through not just an internship (or a first year residency, something they're calling interns now to differentiate them from other types of interns)…they then have 2-3 years of residency for a total of 4 years at low pay levels…plus they have to start looking at finding a practice their last 2 years especially. Buying into a practice is REALLY expensive. Because of HIPAA (which keeps your information safely from you & your family but allows medical device & drug companies to advertise to you unless you tell the medical records department, in writing, to seal your records away from greedy corporate goons), most healthcare facilities & doctors' offices outsource patient record keeping to specialized companies that promise to eat the cost of HIPAA bsignNowes in data security, & they charge a fortune. Practices also have to be near ophthalmologists, radiology facilities, lab facilities, physical rehab facilities, MRI facilities, because patients like one stop shopping…many are also near medical supply companies, drugstores, even alternative medicine facilities. Since all doctors are supposedly rich (according to the general populace), landlords charge a fortune to these doctors & other healthcare places nearby. Many medical offices hire phlebotomists (blood drawers) to draw labs, RNs to assist the doctors & act as chaperones, plus receptionists to coordinate appointments & of course, the full contingent of people to bill health insurance, including documentation specialists to make sure the physicians' notes support the claims for care rendered, medical coders who use the documentation to input diagnostic & procedural codes to help ensure payment, claims specialists who know how to submit claims for primary, secondary, gap, & public insurance plans (e.g., Medicaid), & reimbursement specialists who deal with payment denials by the appeals process, & must know whether or not coding or the notes or the submission process are likely at fault for denied claims. There are also IT & database personnel who keep the computer system running & secure. Office furniture has to be replaced periodically. Outside companies are hired for CPR & ACLS/PALS advanced life support training for renewals & updates, plus maintaining AEDs (most physicians' offices don't have “crash carts,” but use automated external defibrillators that staff are trained to use during CPR certification/renewal). Then there is the physical security system, e-faxing software, printers, computers, the network they're on, plus copy machines & sometimes even actual fax machines…the costs of paper, ink, toner, electronic signature, etc. Since it costs so much to set up & maintain a practice, & there is always the malpractice insurance & the legal firm on retainer for lawsuits & risk management as well, buying into a practice & sharing the cost of maintaining it is very high. Due to the concerns for risk management, larger practices really scrutinize how young doctors have interacted with staff & patients during their training, so it takes a long time & a lot of nerve-wracking interviews before a doctor can buy into a practice. It is not uncommon for a young doctor to be in debt for several hundred thousand dollars y the time they are in a practice.And that's just primary care. If you want to be a specialist, you have to apply for & be accepted to a program & spend 3-4 years as a fellow (often called a post doc). Anyone who plans to go into public health also usually has at least a masters degree in public health if not a PhD, which means more student loans to pay off. Researchers usually get a masters or even a PhD in some science like neueopsychiatry, biochemistry, chemistry, biology, etc. More loans. Once a fellow has been awarded recognition in their specialty, they have even more bills to pay…& dues to professional organizations, higher malpractice costs, higher licensure costs…even more debt than the primary care physician.But the PCP gets less respect & can charge less than a specialist. In many coastal big cities, a visit to your PCP runs you ~$45-60, but a specialist will run you at least $400 a visit. They also get more respect. Since they train more, their learning should be respected…but the crucial role of the PCP deserves respect for undertaking the difficult job of triaging medical issues, getting to the root causes, trying to help the patient live healthier lifestyle, deal with restrictions due to chronic conditions, & coordinating care of the patient by everyone from a physical therapist to a diabetes educator to a dietitian & others, & in some cases, alternative medical practitioners like acupuncturists, naturopaths, herbalists, chiropractors, even dentists, pain specialists, addictions specialists. optometrists/ophthalmologists, & more, as the patient needs & their conditions require.It's well past time for tort reform. I once reviewed charts for a risk manager & one lawsuit was by a woman who claimed her chest pain was ignored in the ER-a very serious charge. However, there was no evidence of angina, coronary artery blockages, heart attacks (which show up by EKG patterns), heart failure, lung disease, or anything cardiac even on independent medical consultation by the legal firms' referral to cardiologists. If you have heart issues, you are not given food or drink in case there is a need for an emergency procedure, plus if you're having chest pain, eating stresses the heart. This woman had come to various ERs in the area (all of whom she was suing) 8 times on 3 days with the same complaint, raised hell when they wouldn't feed her anything she wanted, & walked out when food wasn't forthcoming. Not only that, but she had tried to hit nurses, doctors, even maintenance people. She cursed, broke things, attacked other patients…I'm sorry, but those lawsuits were frivolous. Had the judges for each case not thrown them out, an expensive trial would have ensued. IMNSHO people who do things like that should have to serve time or do a lot of volunteer work or at least be psychiatric admissions for 30 days to get them some kind of help. There should be consequences for that sort of baloney. It would greatly reduce the cost of malpractice insurance. Let the lawsuits be for those actually wronged.IMO insurance companies should be forbidden from paying bonuses to employees for denying payment. I would bet the cost of the bonuses & the appeals cost more than the care does in most cases. This is especially true when the person denying care is a high school graduate with a list of things to deny automatically pre-admission, someone who has about as much medical training as an elm tree. When they put a RN in that position, they not only give a bonus for denials, but punish them for approving too much, even when their training shows a much more in depth understanding of the medical necessity of a procedure. If they document their reasons for approval & an independent panel concludes they're right, there should be a bonus for avoiding lawsuits instead of a punishment for not finding some other entity at fault to pay what the insurer owes or denying a legitimate claim. I can't count the times I have had to have care for my arthritic knees & have had my insurer's employees, a different one every time, ask if I injured my knees in a car accident so they can make my car insurance pay. They are always ticked off when I tell them I fell at home in 1978, on a wet floor, dislocated my knee, & that it has been repeatedly injured since because it is a “trick knee" which makes me fall on it, reinjuring it, & that the stress put on the other knee compensating for the bad one has made it almost as bad as the injured knee. I have even been accused of lying to keep the “right person" from paying! That should be outlawed. I have several times had to go without needed treatment for months while the health insurer paid a fortune for someone to investigate my medical history to try to pin the injury, & payment, on another company. I have had my car & property insurers call me to ask why I said they were supposed to pay for the bad knees, & had risk management at my employer ask why I told the health insurer I fell at work so workmen's comp would pay, when I have done no such thing. I tell them they should know insurers well enough to know by now that they will pay 10 times the cost of care to find someone else to blame, even though I tell them it's an old injury from a fall on a wet floor at my apartment, that this is what I told them, that they have arranged me repeatedly & accused me of lying about how I was hurt, so is it any surprise that when I insisted it was a freak accident, they still insisted on trying to blame some other company! I have nearly lost my job several times over health insurers lying & spending a fortune to avoid paying out. This should not be allowed. Get injured in a car accident & your car insurance will sometines try to find someone else to pay…this from a friend who was rammed while stopped at a light, in his compact car, by a drunk in a huge pickup truck who was going 60 in a 35 zone, ran a red light & served into the oncoming traffic lane, causing my friend's entire back & neck, his head, & one shoulder to be severely damaged, along with both knees. There were tons of witnesses who saw it. The drunk was, of course, not insured since he obviously needed the money for booze (insert eye roll)…& “no fault" insurance is suppose to mean they pay you for injuries occurring from an accident involving your car, & the other person's insurance is supposed to pay them, regardless of who's at fault…but that only happens in a very few states of the many who CLAIM to have no fault insurance laws.Making those shenanigans illegal would help cut medical costs, which would allow doctors to take care of patients without such high costs. It would acknowledge the invaluable & irreplaceable PCP, allow lower fees for all stripes of physicians, & lower overall care costs.BTW, private insurers get their ideas for avoiding insurance payouts from Medicare, so Medicare for All will only make things worse. And Medicare disses the PCP more than any other entity & is one of many reasons for physician attrition rates, esp. PCPs.
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