Cost and Degrading of Medical Practice: Overlooking, Underestimating Overhead
Currently, President Obama is attempting to improve medical care in the United States and reduce its costs. He apparently has spoken to a number of individuals representing the many components of the healthcare system to understand their views of the current system and what should be done to make the system better.I wonder if these presidential discussions dealt with the issue of the financial and even emotional overhead and its effect on medical practice which faces most practicing physicians in one way or another and can influence costs and effectiveness of medical care. Today, I posted a visitor comment on my “I Hate Doctors: Chapter 2” blog thread which I think could easily represent the views of many physicians in practice. Read what was written and I’ll be back at the end.
I hate doctors too... I am one and hate myself for ever going down this path. I spent 10 of the best years of my life training to be a physician (after college). I studied hard to be top of my class, worked 120 hours a week for 5 years during residency, and now have hundreds of thousands of dollars of debt from school loans. Now I've been in practice for nearly 10 years and I wish somebody would have been straight with me about the PRACTICE of medicine. Truths... If I don't see at least 6 patients an hour, I lose money. Overhead is ridiculous. Malpractice premiums are $80,0000 a year (and that's lower than a few years ago, thanks to tort reform - and I've never been sued). In my practice, overhead is about $70,000 a month per physician. So what, physicians make lots of money - yeah, so they can pay staff to file appeals on each claim sent to an insurance company (ever try to get through to an insurance company? no different for a physician's office). You want 15 minutes per visit? you pay my overhead. You think the $29 dollars per medicare visit pays all the staff you see in the office? No pressure to see patients quickly. If I did care about patients I wouldn't have time to show it... (that's a joke - ha, ha)
Time constraints aside, at least 15% of my patients are drug seekers. always nice at the end of the visit for the "can I get some dilaudid?" question. Most patients don't listen to my recommendations and come back 4-6 weeks later with the same symptoms. "Therapy? I use my shoulder all the time at work. I don't need therapy." Oh good, then why are you here? You can obviously diagnose and treat yourself.
If you can't read between the lines, I am completely disgruntled with medicine. I understand why patients hate doctors. Unfortunately with todays system, there isn't enough time to SHOW that I care. Don't think I don't care. Do you think I like seeing the same patient over and over, without them improving? I'm sick of medicine. I'm sick of patients thinking that they are my only patient. Please call me in the middle of the night for the same problem you had the last 3 days. I can only hope the rest of my 8,000 patients call me tonight too. I don't like sleeping. I don't like seeing my kids at night. I love filling out insurance, fmla, disability, etc. forms. I love dictating for 3 hours after seeing patients for 10 hours. I love my patients lying to me, trying to get pain medications. I love patients talking on their cell phone, ignoring me when I come in the room. I love patients not paying their co-pays. I love patients threatening to sue if I don't see them that day.
I love my patients. I love being a doctor.
So what does this all say and mean? How would you respond to this physician and the obviously sarcastic ending to the comment? In my own experience, much of what this doctor writes about is true. Physicians are faced with profound financial and emotional investments. Will all of this be taken into consideration when new medical legislation is written? Here is some of my thoughts, perhaps impractical. With regard to the financial overhead, why can’t the government regulate the overhead costs of running an office? Why should the government place the burden of the costs of medical practice along with the income limitations solely on the physician? That is what has been happening ever since Medicare was created in 1965. Shouldn’t the government set limits to what licensed physicians have to pay out to their staff, for the rent, for their equipment and supplies and for insurance? Share the burden for the interest of better care for all citizens. If this is done, I am sure that the emotional overhead will be mitigated and doctors will have more time to spend with their patients, more men and women will find becoming a physician more inviting and will reduce the load of patients each doctor must see and treat. And, well, if patients would become more patient and understanding of the limits of physicians and the medical care system, much aggravation would be reduced on both sides. Do you think they are thinking about all this in Washington these days? ..Maurice.