Thursday, November 20, 2008

Can you blame them??

On Tuesday, CNN headlined an article "Half of primary-care doctors surveyed would leave medicine" (if they felt they had an alternative. ) And we learned a few weeks ago (in many major papers) that only 3% of medical school grads are going into primary care. Now, using logic, primary care should be pretty important. Not everyone needs a surgeon, or a neurologist, or an ob-gyn, but anyone with a body that might someday get sick, should have a primary care doctor. So if everyone needs a primary care doc, but 97% of med school graduates are going into other fields, and half the primary docs out there want to leave, what the heck good is it going to do to give everyone health insurance?!?!?
So before we go around mandating or dishing out health insurance to everyone, lets step back a sec.
Here are the cover articles from my (snail) mail on Monday morning:
American Medical News: "Medicare rated as poor performer during debut of pay-for-reporting"
Physician Practice Journal: "Finding lost treasure: Search for billing and coding gold"
Journal of Family Medicine: "10 Billing and Coding Tips"
I could easily spend 90 % of my "medical reading" time on figuring out how to get paid. There's got to be better stuff for me to learn. Why would people want to go into this job?? It has gotten much worse in the past 4 years, I think. (or i've just become more aware, but judging by the amount of articles about payment, I think the situation is crumbling)
When looking at the changes in the healthcare plan, we must ABSOLUTELY NOT lose sight of the fact that if we do not simplify this process it will not work. (Two ideas that are interesting right now are Sen Baucus' proposal, which highlights improvement in primary care with modifications of the current system, and the US National Health Insurance Act which supports a Single Payer system.)
I am all about the "new model of Family Medicine" the Patient Centered Medical Home. In essence it means that patients, who want to stay healthy or who are sick, have a Family Doc to call their own, that they can go to for advice, treatment, and coordination of care. Nothing new about it if you ask me. The "new model" calls for better payment though, which would be nice. But I cannot imagine how the laundry list of things to be paid for could make billing easier. So they came up with the idea of paying Family Docs based on the number of patients they care for, if they keep up a basic practice requirement. BEEN THERE, DONE THAT!!! We've spent 20 years proving that capitation doesn't work out for the docs.
I'm loving the fact that I could ignore the "how to get paid" articles. In the many articles I've read about "cash only" or "no insurance practices", none have ever indicated that they were a bad idea or didn't work. I am infinitley less stressed in the last 48 days. I feel for the first time in years that I have job security. I don't think that a cash only practice is the final answer, but until we get a system that works, maybe the "no-insurance" docs will be the ones to survive.

Tuesday, November 11, 2008


It has been an interesting mix of people that have decided to "stick with me" through this practice change. Some, despite having money to go on several cruises a year, have opted to save their money and transfer. (Which is fine). Others, with seemingly very little money, come in and pay, and often with a bit of pride about it. Many will come into the exam room and try to pay me directly (rather than the receptionist), and others will say to their spouse as they walk down the hall, "don't forget, we have to pay the lady". But they don't seem begrudging, or annoyed, I get a sense of pride from them, that they have opted to spend their limited resources on something important. It is as though, I feel sometimes, I am backed by a small, ragged, and sometimes sick little army in this battle against a failing healthcare system. And they are rallying. Its cool.
In the past week since the election, I can feel the energy and hope. Cape May County is strongly republican, and there are still some difficulties understanding that skin color is not relevant to leadership ability. But people will whisper to me behind their hand that they are secretly glad that Obama was elected, and that he will be a great president. (One person told me they even voted for him!) It is this optimism, I think, that at least this week, keeps me, and my small army going. Once more unto the breach!