Monday, September 22, 2008

How are doctors faring in this economy?

Today, a front page article of the Wall Street Journal spoke about how people are cutting down on healthcare spending in the wake of this shaky economy. The article noted that for the first time in 10 years, the amount of money spent on prescription medications had dropped. However, it wasn't clear from the article if this drop was due to falling demand or due to the fact the insurers are more and more forcing people and/or their doctors to choose lower-priced drug substitutes for the brand-name pharmaceuticals they take or prescribe. The article assumed that the drop in prescription spending was due to patients skipping a month here and there on their costly prescriptions. I'm not saying this isn't true, but there may be another explanation. After all, I get incessant faxes, mailings, crazy insurance people calling me, airplane trailer announcements, and the list goes on, to remind me that the drug my patient is on has a cheaper (forget about effectiveness) alternative.

The other major problem, that being in Manhattan I don't have to think about so much, is that people are choosing not to drive because of the cost of gasoline. So an Internist in Tennessee in this article noted that his summer volume was down 10% from the year prior. The assumption is that people are just not driving to see their doctor for minor stuff, because the cost does not outweigh the benefit. Sorry country doc, it seems that people are more willing to stick out their illness. Well, the article also reported that remote doctors were having a more difficult time getting their patients to specialists that may be a 40 minute drive away. Again, the culprit -- rising gas prices. Really, it's about the rising cost of living that has now outpaced most employee's rise in salary. I spoke about oil's effect on the cost of healthcare in this country in a prior post; see What I didn't consider there is that people would simply self-select and not spend money on healthcare if they already have to spend too much money on gasoline and electricity. Maybe rising oil prices will cut the cost of healthcare?

No, I don't think so! Less access means that instead of presenting with elevated cholesterol and maybe some decreased exercise tolerance, people will not present until they're rushing to the emergency room with crushing substernal chest pain. The cost of treating that high cholesterol just rose as they are wheeled away to the cardiac cath lab with $1000 medications dripping into their veins to get that blocked artery unclogged after a highly expensive visit to the emergency department. The cost of delaying healthcare is immense!

Then, of course, boo hoo to the laboratory giant, Laboratory Corporation. Their self pay patient volume is down. When everybody talks about controlling the cost of medical care, no one ever mentions lowering the cost of laboratory testing. Tests for a typical comprehensive exam can run over $1000, whereas the cost of the doctor's visit and expertise averages $350 in Manhattan. The doctor's time is cheaper than the automated laboratory results. Amazing!

So, I'm curious, how are the doctors out there faring in this economy? Is healthcare as recession proof as people have said? Post your comments and share with the rest of us.


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