Tuesday, April 04, 2006

I don't claim to be the expert, but.....

Go ahead and ask me your medical practice questions. I may be able to answer them. And if I can't, I'll refer you out. Of course, who I refer you to depends on your insurance. Oh, can you imagine that? What if you needed insurance to see anybody (car repair, lawyer, photocopier), and if they weren't on your plan you would have to pay out of pocket? Oh wait, that's sounding like communism. Well, apparently the insurance industry has increased our freedom of choice. NOT!

Look at the Oxford Liberty plan, for example. There's a euphamism: Liberty! What liberty? There is none in the Oxford Liberty plan. In fact, it's sometimes so difficult to find a doctor that accepts it, that it seems like just the opposite. Then try getting a referral.

Oh, forgive me, yes I know. Insurance has helped a lot of people receive medical care, but unfortunately, access and good medical care are not necessarily equivalent. Would people enroll in the Oxford Liberty plan if they knew how difficult it was to get a referral? Or to find a doctor who accepts the plan? I don't know, because it's those same people that have allowed something like this to evolve.

Now we're heading towards a physician shortage. Yes, call me a doomsday naysayer or whatever you like! This is what the buzz is all about nowadays. The medical profession is becoming less and less attractive as a profession to our young, intelligent hopefuls of the future. After all, who wants to study/work hard for over 10 years, acquire thousands in school loan debts, then watch their insurance payments fall year after year while they're working themselves to the hilt trying to see more patients to make ends meet during their prime years, hoping to own a home, hoping to have a family and perhaps retire by the age of 90? That is, if they don't die of a heart attack! Yeah, well you think that doctors make too much money? You should consider all of the sacrifices they make, and the fact that by the time they emerge from their training they've already lost an entire decade of their working life.

Bitter? Nah! I'm in the game because I started out with a certain set of ideals. But I also want to be able to support my family and give my children a hopeful future. It's funny how people would never think twice of ordering a meal at a restaurant and pay for it, but they may question an insurance deductible. This feeling of entitlement, and lack of appreciation is what is leading us to a healthcare crisis by the year2020.

The solution: have people own up to their care. Instead of spending thousands on insurance plans, have plans that cost less, but cover costly tests, like CT scans and hospitalizations as well as preventive screenings. Doctors should drop insurance plans in mass. Then, perhaps they will listen. The insurers have all the power now because they've somehow convinced all the docs to enroll. If no docs wanted to enroll, or only enrolled in plans that participated in an enhanced fee schedule through an IPA so that quality care can once again be administered, then perhaps the insurance plans would start thinking twice about their greedy, profit-seeking methods.

Before there's a crisis, doctor's should make a pre-emptive strike. Drop your insurance plans one by one, starting with the most troublesome, weakest payers. If insurance plans faced the threat of losing multiple providers (then consequently insured patrons) for even as little as 3 months of repeat infractions with no corrections, they might think carefully about their methods. They have all the power now, and they're the reason that this country will face a physician shortage by the year 2020.

Maybe I'm wrong. But if I'm right, you better be damn sure I'll be referring back to this posting in 14 years. For now, I'll continue to think that I will create the ideal practice situation for myself, in spite of everyone else's actions.


Blogger Family Doctor said...

I'm glad to see you posting again. I enjoy reading your blog! I wonder what the climate will be like in 2 years, when I'm out on my own... I'm a Family Medicine intern right now, and almost done with the busiest year of my life. I'm certainly helping for some fair reimbursement! Please see my blog...

4:35 PM EDT  
Blogger Medicine Man said...

It's a different world out there, once you're out of residency, and the insurance environment/ skyrocketing malpractice premiums are making it hard for the solo-practitioner to exist without having a varied practice. Learn and use procedures as part of your care. It will enhance your relationship with your patients, and help in the billing, which is deficient in non-procedure medicine.

4:03 PM EDT  
Anonymous Anonymous said...

You sound so angry. If you think that you have money problems, why not try talking to an NHS doctor in the UK. He/she works just as hard as you do, and makes even less. So if you think it is socialized medicine that would solve your money worries, think again. Their is a tighter budget, young people aren't being lured at the prospect of making thousands, they become doctors because they want to help. Why is there so much complaining going on with you? Don't you realize you actually have it better then doctors in other countries??? Take a vacation--to England and see for yourself.

8:23 PM EST  
Anonymous Anonymous said...

Given that only two out of every five applicants to medical school are accepted, I think that we'll be OK for the time being. Even if 20% are completely unqualified, that still leaves us with twice as many applicants as matriculants.

11:35 PM EST  
Blogger Medicine Man said...

to anonymi (sp? is that a word?)
Question for you? Who pays for medical education in England???

Angry, yes, I am at the limitation to health care that insurance companies have created. They try to tell us how we can dish out tests and which medications to prescribe.

I do see patients from the UK who have moved to the city where I practice, and you know what, they're shocked at: 1) how much time I spend with them, 2) how thorough I am when they visit me. I don't just deal with the problem at hand and rush them out the door without a full evaluation (which they report to me is the standard of care with these so-called "idealistic" docs in the UK system, which sounded pretty jaded to me from my own patient's descriptions), I address all possible health issues in their lives. If that's what a non-socialized system of healthcare has created, I'll take that, but I will still complain about its deficiencies. Those patients, btw, had no confidence in their previous UK doctor experiences. Good care does not happen in a 5 minute visit.

What I'm talking about here is the insurance companies nickle and diming physicians to the point that they have to decrease their time spent with patients in order to make probably less money than before to pay ever RISING cost of malpractice insurance, staff, and living expenses in this country. This is driving less youth to choose medicine as a profession. And yes, will result in a physician shortage, because it's not just about how many new physicians are being created, it's also about how many physicians are deciding to retire early or leave medicine after a few years in practice because it's just too damn frustrating to practice corporate-driven or big-brother medicine.

1:43 AM EST  
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