Excellent article on healthcare from a physician's view:

I found this on the Emory University listserv..its long but if you care to read it, its excellent and well written.


Million Med March

I'm tired, mad as hell and just not going to take it anymore.

I'm tired that I cannot practice medicine the way medicine is meant to be practiced: with care, quality and timeliness. Economically I feel handicapped as most of the health care dollar goes for administrative costs to health insurance companies, and a large part going to the salaries and bonuses of the executives of these companies, money meant for patient care. It disgusts me that so much money goes to pay medic al malpractice premiums and tails, and that our livelihoods are at risks as attorneys consider us lottery tickets, using their clients as entry fees. It bothers me that pharmaceutical companies now look for diseases on which to use their patented chemicals, rather than looking to improve patient care with lower cost, but equally effective medications.



Little of the health care dollar even goes to pharmacies and hospitals, much less to physicians. Now the current administration wants to decrease payments to these three, in order to 'save' the health care system. We already have enough capable people leaving our profession, or declining the arduous journey to become an American trained physician; not to mention the huge number of physicians who discourage their own children from following in their footsteps. How sad when we don't want our own progeny to follow us all because we are treated like thieves, or worse, as children who cannot govern ourselves. And don't get me started on the AMA or the specialty colleges, who rarely stand up for the regular, non-ivory tower doctors that roll up their sleeves and care for patients on a daily, fee-for-service basis. The attitude in our county towards physicians does nothing but create a loss of quality, well trained, American- trained physicians.



Doctors get far less of the healthcare dollar than do pharmacies or hospitals, yet without us they would be out of a job. What is the joke: hospitals would be great places to work if it wasn't for all those doctors? There are around 1 million doctors in the country, yet there are over 25 million people in the health care industry. Each physician supports about 25 people… few actually treat or care (for) about patients. Once we actually get reimbursed, we have our medical school loans and ever rising business costs to pay for with our ever decreasing dollars.

 

Our patients suffer as physicians must see more patients every year just to make the same amount (or often less) money than last year; physician burnout is a well documented and a worrisome trend in our profession. This affects our ability to treat patients properly. Then, adding the paperwork and increased regulations put upon us by the state and federal governments, we have even less time to treat patients,read journals, go to seminars or get sleep. Quality of care suffers.



On top of everything else we need to deal with malignant hospital administrators and medical staff members or nursing staff members who can, just for untoward facial grimaces, suspend us and report us to the National Practitioner Data Bank, thus irrevocably ruining our careers, well before any investigation or fair hearing needs to be called. We worked our butts off to get top grades in college, to get into medical school, then residency programs where we often worked 80, 100 or even 120 hours a week, for what? So we could give up nights, weekends, holidays, birthdays, anniversaries and even miss the birth of our children to practice that vocation to which we were drawn. And how are we treated? We are considered the most vile criminals, cheats and depraved practitioners with no sense of integrity or consciousness, only out to harm those we have struggled so long to serve. If we are so bad, so vile and so depraved, shouldn't we let our patients get treated by witch doctors with voodoo medicine. But of course, that is already being practiced in US hospitals.



I really don't need to feel guilty that the profession I have chosen also puts food on my table, clothes my wife and kids, and allows my children to get a college education (not premed of course.) Yet what am I to do when 25% to 50% of my procedures, which are 'authorized' by insurance companies, are not reimbursed because, although authorized, they are now determined to be uncovered benefits. Sometimes we have to sell vitamins and other services to make up for the loss of payments.

 

Quality of care suffers with less time to see patients and less reimbursement received when we do see patients. We cannot do pro bono work as we have in the past as we have to see an ever increasing number of patients. This extra work is forced upon us when insurance companies, especially Medicare and Medicaid, constantly refuse to pay us in a timely fashion for our time and efforts. And, then once we do see patients our clinical acumen is stifled as we must follow a cookbook approach to patient care.



When healthcare insurance companies siphon money away from patient care and into the hands of the their executives, to support a life style that demands sometimes more than $30 million/year, this decreases money to medical schools for training and research that might create advances in medical care that actually benefit patients. Insurance companies have no incentive to provide better care if it in turn might make patients live longer. Medicine is going corporate, and we, physicians are just flipping burgers so corporations have an improved bottom line.


I am going to Washington, DC . At noon, on Thursday, October 1 2009. I will be on the mall with a few other physicians. We simply decided that we will not work that day and perhaps the day before and maybe even the day afterward. We are not 'organizing' anything other than a vacation from the stress of work, so we can enjoy our nation's capital and perhaps even say hello to our congressmen or members of the administration. Perhaps we will show the country that physicians are worth more than a $5 co-pay; that physicians are more important than a mid-level healthcare worker; and that our profession is needed, our services are required and our practice is a calling to be respected, not a trade that is to be negotiated to the lowest bidder.



I want our services adequately reimbursed so that we may spend more time with our patients, and I want less paperwork. I want less money going into the hands of insurance companies administrative costs, less money going into the hands of pharmacy companies for the development of drugs that are either unsafe or targeted for 'diseases' they seem to invent. I want brand named drugs that are as affordable in the US as in Canada or Mexico . I want medical malpractice reform, with caps on all damages, so that we can practice without the fear of needless and unwarranted lawsuits that only benefit the attorneys. I want the National Practitioner Data Bank reformed so entries are made AFTER all administrative remedies have been executed, so due process is given to all physicians and that all entries are reviewed by an independent board of physicians without any ties to the accusing hospital, nor state or local medical societies, prior to submission. And I want compensation for services that pay us enough to allow us to continue formal and informal continuing education, and that pays us enough to manage our practices and allow us a living that compensates us for our years of study and training.



Richard Chudacoff, MD, FACOG

Las Vegas International Center for Advanced Gynecologic Care

 

good stuff

 

That's so true.

I used to work for a large healthcare company. When I started with them, their focus was on acquiring non-ubran hospitals about to go bankrupt. They'd come in, refurb them, refresh the technology, and run them at a modest profit. After a few years, they started buying larger hospitals. Sadly, shortly after going public their focus changed from ensuring healthcare to making profit.

 

That's the way capitalism is supposed to work. You know, the profit motive. To hell with all that liberal/socialist/hippy do-gooder shit.

 

I think a lot of the public resentment towards us physicians is most people really do not make an effort to understand how it is to walk in someone else's shoes.

They think that the bill they get from the hospital all goes to line my pockets; that the "$300 cast" (as I saw from a previous thread) goes to paying for my Mercedes or yacht. I'm not going to lie to you. I make a damn good living doing what I do. But if you're not going to get mad at the guy who claws through the ranks to get himself to where he is in life, then check your standard before you get mad at me for doing the same. And, still, I drive a Honda Civic and have no yacht. Or even a small boat, for that matter.

I think that Dr. Chudacoff reflects how most of us feel. We're just too busy trying to fix people, fill out paperwork, or dodging lawsuits to be able to do anything about it.

My dad was also a doctor. When I graduated from college, he tried his best to dissuade me from following in his footsteps. But, no, I wanted to fix kids.

As a resident, I started out getting paid $30k/year and worked an average of 110 hours/week. This is no exaggeration. My pay slowly increased until I graduated 5 years later to $50k/year and only 80 hours/week.

I'm still paying student loans from college and med school even though I graduated in 2001. It's been hard to even start paying off $75,000 (a low amount compared to some of my colleagues) with how much it costs to live here in California until I actually got my current "real job".

My malpractice as a surgeon with no pending lawsuits and no past lawsuits or legal action runs about $40k/year. That's a good rate.

I take care of kids with disabilities on a regular basis and get a discounted rate for doing it from the State of California. Even so, I haven't been paid from them since February. You should see how the staff there looks at me when I tell them I'm thinking of stopping because I'm not getting paid. And yet, if they don't get paid for 2 weeks, they start threatening to leave.

All I want to do is fix broken bones for kids. And ride motorcycles. I'm not out to get your money. I don't even look at what insurance the kids have when they come in - they're all the same to me. I just want to be able to do my job without someone looking over my shoulder, questioning the validity of my medical decisions and my motives so that they can save a couple bucks.

Probably too much to ask, huh?

 

FWIW, not too many people here are disputing the doctors' salary. Mindewe, for some idiotic reason, the ones making the most money are the plastic surgeons...

 

Let's clear up some of the whiney shit though. Only half of them worked their asses off and got good grades. The other half was below average.

The shit he says nurses do to doctors(report them, etc.) and ruin their careers gets done to the nurses too by doctors that think they know everything. There are a lot of arrogant fucking doctors that won't listen to anyone around them because it might bruise their egos.

Stop whining about burnout. You make 6 and 7 figure salaries for a reason... you chose to do something that very few can handle. There's a reason for that salary. Don't like it, do something else.

Now, the rest of the stuff is pretty damn spot on from what I've seen.

 

Get out of California.

 

Hah.... get out of California? What? And miss sweet riding weather almost all year round? Yeah right!

I will agree with you that there are quite a few arrogant doctors. More than a few. There's a lot. And they bug me as much as they bug you and the people they work with. And, honestly, most of us don't have time (even the arrogant ones) to report nurses. I've never done it, but it seems like it's the one way that some nurses (of course not all) can "get back" at the doctors. I, for one, just prefer if you tell me I'm wrong and then tell me how to fix it.

I guess he was feeling a little "burnt out". I don't know that I ever would feel that way, as frustrating as the system is. But he's not complaining about the emergency calls and the staying up in the middle of the night. That's part of our jobs. He's complaining about all that other b/s. It's like complaining about the traffic, but not the drive.

Plus, very few of us make 7 figures... Pretty much just the plastics guys.

 

Yeah, capitalism has been known to come back and bit us in the butt.

 

LOL. You sound like a couple of good friends of mine that retired from medicine within the last decade or so. One friend and neighbor, was Dr. Henry McDonald, an orthopedic surgeon who practiced medicine for 53 years before retiring. His main reason for retirement was to get away from HMOs. That was also true for Dr. Joe Lewis. He was a Pediatrician that fought with HMOs constantly to get paid for his services. He finally told them to fuck off and handed his practice over to his partner.

I have a nephew and his wife that are in their residencies at present in Penn. She's an OB/GYN and he's a surgeon. Both will be finished with their residencies within a year. In my conversations with both of them we have discussed HMOs and how it was before HMOs came onto the scene. They agree that they would not survive today's rules if they had lived under the old rules where a Dr made the decisions with his patient.

Doctors have my sympathies. Apparently, it isn't as much fun as it used to be.