Tuesday, April 21, 2009

Doctors in the Poor House

by Insurance Guru

I was reading some letters to the Editor in a recent AARP magazine. Hey, it's my Dad's. Really! The letters were discussing "Disappearing Doctors" and laid the blame at the feet of Medicare reimbursement and byzantine insurance rules. Boy, that makes me cranky. Yes, I know about rising malpractice insurance, increased office costs, lower reimbursements, rules, regulations, paper work, etc, etc, etc...

What I don't understand is why these letter writers believe their profession should be immune to the life the rest of us are facing. I'm an average Jane out here in the world trying to get by. I face rising insurance rates, stagnant paychecks, increased costs, rules, regulations and paper work. I'm still trying to get it all together for the tax man.

Being in the Insurance Industry, I get daily e-mails telling me how to "Increase My Medical Office Accounts Receivables!" or "Avoid OIG Billing Audits!" or "Best Billing Practices for Diabetic Patients!". The subjects and e-mails are endless. There is an entire industry out there that is devoted to "show me the money" for physicians. Add to that the American Medical Association which has a yearly 18 million dollar budget to lobby Capitol Hill. That's just one group, there's another for Chiropractors, Hospitals and on and on.

I guess a lot of physicians aren't just like me. I drive a 2004 Ford, live in a small house, my kids go to public schools and we shop at Wal-mart and Target with coupons. In order to further economize, I got rid of the cable movie channels, magazine subscriptions and weekday newspaper. I take care of my own yard, house repairs and dog grooming. My 401K plan now literally means 401 dollars. I haven't checked yet, but I don't think there's a lobbyist out there on my behalf.

Physicians are highly trained and a valued part of our communities, but it can't be just about the cash and status. If it is, than maybe we are better off without the physicians that have chosen to leave. I want my doctor to want to help me and is willing to work as hard as the rest of us to pay the bills by doing the best we can with what we have.
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Jay said...

Well, I won't shop at WalMart, and my car is a minivan, but otherwise I'm pretty much like you. I find it greatly irritating to listen to docs complain about shrinking incomes. I've yet to see a doctor on the street corner holding a sign that says "will diagnose for food".

insuranceguru said...

Thanks for the comment Jay, DM and I have been expecting firebombs and pitchforks from this post. It's a relief to know that there are others that feel this way.
You know, I'm looking for a new PCP. Maybe I'll find my next one on the street corner?

Gail Rae said...

No firebombs and pitchforks from me, either. I hadn't actually thought about this. I have the AARP newsletter you're talking about (I don't have to borrow it, I qualify for it by age) and noticed the article but haven't been reading the newsletter, lately. It's "Omigosh, can you believe this," style has begun to irritate me. I will certainly read the article, since you've mentioned it, but I can tell you, right now, except for not yet having gotten rid of the movie channels (I'm sure that will come) and not having a 401K, my life is an echo of yours.
Yes, I can see reasons for us to be disturbed to the point of complaint about some of the reasons why all our lives are so drastically and quickly losing economic value but, hey, we're all in the same boat...not a good idea to rock it by insisting on a "safe zone" at one end of the boat for certain members of society (I'll bet physicians aren't the only professionals, right now, who feel unduly economically castigated) who believe they should be privileged beyond national, make that global, economic circumstances.
Thanks for writing about this, IG.

Gail Rae said...

Oh. I guess it's letters, not an article. Well, I'll read those.

Liz said...

Reasons why MD's should make good money:

1. The amount of debt they accumulate in order to actually becoming an MD.

2. The sacrifice of 8+ years of their lives to become a trained MD.

3. The sacrifice of who knows how much longer to repay their student loans and other debt acquired while studying to become an MD.

4. The risk that on any given day, entirely without malice, a doctor may make a mistake that causes harm to a patient that could result not just in loss of sleep/peace from having to live with having caused someone harm, but could also result in the loss of their livlihood.

Maybe, if the government undertakes to pay for and train all MD's, then maybe doctors would be willing to work for much less money.

I'm an RN, not a doctor. I'm not married to a doctor nor are there any doctors in my immediate family.

Good doctors do work hard and sacrifice, they should be well compensated for the risks they undertake to do so.

insuranceguru said...

Hi Gail - yeah, AARP is getting a little out of control with the bulk of their articles these days. It's a great place for me to keep up on Medicare issues though. They leave no lobbyist unturned making their point known.

insuranceguru said...

Hi Liz,
I agree with your thoughts but I think that your statements also apply to Engineers, Scientists, Teachers, Lawyers ect.

Debt, length of schooling or pressure to do a good job should not be factors in excluding a profession from economic realities.

Liz said...

I'm actually OK with doctors not becoming wealthy doing their jobs.

But I still think it's only fair they be well compensated according to the amount of personal sacrifice and risk they incur.

Engineers and teachers simply don't run the same risk of killing someone inadvertently during the daily course of their jobs (OK, maybe engineers do but they also have time to study their designs to maximize safety (as long as they're not undercutting safety for bigger profits), not something all MD's have....say in the ER with someone bleeding out right in front of them.

While most college grads (who aren't born rich or get scholarships) have student debt, MD's incur an inordinate amount.

We're not all suffering during this economy....many people who aren't doctors are doing just fine.
Why so interested in seeing MD's specifically taking a hit?

insuranceguru said...

Hi Liz,
Thanks so much for taking the time to check back!

Pehaps I am picking on doctor's but then again they have very powerful lobbies and associations with which they can successfully pressure organizations for reimbursement. I just don't see other professionals out there writing Letters to the Editor.

I disagree that Engineers, Teachers, Scientists, etc. don't have the same impact when it comes to critical decisions.

Not that long ago many lives were lost in Minneapolis after a bridge collapse. Teachers are responsible for our children's education, social and learning skills. Scientists make decisions and inform us of climate changes, volcanic activity, hurricanes, medical discoveries... that list is endless. When I don't do my job accurately, thousands of lives are impacted.

Perhaps these jobs don't carry the immediate risk that you see with an ER Physician but we all create lasting impacts that cascade to thousand. Risk and personal sacrifice are a part of doing a good job - any job.

Gail Rae said...

Just stopped by to say, I subscribed to this post for e-delivered comments and am really enjoying this discussion. I have nothing more to add, yet...but I love the way it's bouncing back and forth! Great thoughts, great responses!

dethmama said...

@ Gail Rae... I have to agree. This post has been good source for civilized exchange of opinion. Good job, I.G.!

Anonymous said...

I am a newly-minted, fellowship-trained hospice physician and from my point of view, I would just like to get a job for less than 60 hours per week, no more than 1-2 nights of call per week, and enough to pay the $4000-5000 per month I owe on my student loans. We drive an 11 yr old Ford Taurus given to us by our supportive, struggling friends--and are grateful to be so blessed. We live in a small apartment. My daughter attends public school. At this point, my family (in-laws included) have made many sacrifices for me to be the first doctor in generations. I owe so much to my family and friends that I will never be able to repay. All so that I can do work that I find incredibly rewarding and wonderful, but that I don't know that I can afford to do. Personally, I may have to return to my primary specialty, at least temporarily or part time, to allow me to give some of my patients the care they desperately need. It sucks to have the uncertainty that, after all the sacrifices, there is not even any sort of guarantee that I will be able to afford to do what I worked to learn to do.
The system is broken in ways that cause good people to be reluctant to participate. I don't hear doctors saying they need to be exempt, what I am saying, and other docs I talk with, is that we just want some of the same working conditions that other people take for granted or, at least, adequate compensation to make up for some of the debt, risk, hours, etc. that we put up with. It is not that we want to be exempt, we just don't want anyone to get caught up in this system, including patients. Personally, I think nurses, and our other colleagues, need to band together with us to demand a better, safer, more reliable system.

insuranceguru said...

Thank you very much for your comments Dr. Anon! I agree that the system that trains and turns out MD's in this country is very much broken but I sincerely hope that you will find a way to practice the medicine that you love.

However, anyone that chooses to become a physician knows there will be enormous student debt, insane hours and a workload intended to temper a physician's skills. These couldn't have come as a surprise.

Newly-minted doctors, teachers, cube farmers... we all have to work twice as hard to learn our trades and prove ourselves to those that depend on us to do our jobs.

These are tough times to be a newly-minted anything. Uncertain employment, financial pressure, insolvency, bailouts... we are all in this lifeboat regardless.

After 20 plus years in my profession, I had hoped to not work 60 hours a week but we have fewer people to do more work. Everyone now faces an uncertain future.

Tracy Twyman said...

Thank you for this post. It's hard not to hate most doctors. The majority of my doctor visits (which have been very few because I can't afford them) were simply to get the doctor to give me the treatment I already knew I needed for the ailment I already knew I had. But because the government makes it criminal to treat yourself, I instead have to suffer for months so that I can save up the money to go to a doctor's office and spend hundreds of dollars to get treated like crap so that I can ask for his permission to buy a particular pill or cream or ointment. Or, more often than not, I don't even see the doctor, just the nurse. When I do see a doctor, every single time without exception, he makes small talk with me about his latest vacation, or the one he's about to go on. I don't necessarily begrudge them their wealth, but I don't think they are entitled to it any more than any other profession, and I don't think I should be required by law to enrich them every time I need a Vicodin or an anti-biotic. Nor should I have to pay a stupid insurance company hundreds of dollars a month just to get their permission to see the doctor, like a mafioso demanding protection money. If all I need is a handful of Vicodin, I shouldn't have to pay the doctor to get his permission, or the insurance company to get their permission. I'm an adult. Let me take care of myself.

insuranceguru said...

Hi Tracy- thanks for taking the time to share your thoughts. I absolutely agree that our health care system makes it nearly impossible to have a nice quick to the point doctor visit... and how dare the patient come in already knowing what they need! Wouldn't it be great to have a 15 minute doctor visit that cost 40 bucks and you leave with the meds for the same problem you've had off and on for 25 years?