I have had enough

[Travelwanted]

I have already given notice to do 1/2 time July 1, 2015 and plan to fully ER at end of 2015. However, I have just had it with medicine. And from what I see around me I am not alone.

From the new regulations and requirements by the gov't including pqrs, electronic medical records, etc, etc, etc and the continually dropping reimbursement rates I have been aware the glory days of medicine are gone. Most physicians I know STRONGLY agree with this.

However, to add to the chaos and stress is the new element of higher deductibles. We have a record number of people in collections along with the nasty, threatening calls about our services because they now owe money.

I do not claim to be perfect or even the best (I'm a pretty humble guy honestly - no God complex here), but have consistently received approval ratings in the top 1% of all physicians in our system. Yet, inevitably you cannot please all the people all the time no matter how hard you try. And, it has become so predictable that when a complaint does arise, there is ALWAYS a patient balance. Coincidence? I don't think so.

Without question, medicine is under attack from the legal system and the federal gov't. But now patients seem to be adding to the disappointments of practicing medicine. It used to be 99% of people were great and appreciative. Now that number is dropping. Sadly, for me, the non-financial rewards which once inspired me and carried me through many, many years of school and training are mostly gone.

Excuse the tirade, but I think major issues are ahead for healthcare. I'd like to say I am unusual in my attitude and pessimism but it is all around me. And, yes, med school enrollment is strong...for now, but I think it is due to a poor economy sending more to grad school since there were few jobs.

So, if you like your doc, take a moment to say thanks and let he/she know you appreciate their resilience.

 

[Walt34]

So, if you like your doc, take a moment to say thanks and let he/she know you appreciate their resilience.

I will do that.

A while back my dentist apologized for having to put my head in an uncomfortable position for a short period of time ("of course it's always the hardest place to reach") and I told him he didn't have to apologize. I told him I am so grateful that I didn't live in an era when dentistry consisted of a pair of pliers and a pint of Jack Daniel's.

Apparently it wasn't enough. Last week week we got a letter from him. The SOB is retiring.

 

[heeyy_joe]

I just thanked my doc for 8 years of good practice on me, then I fired him cause I'm moving to Florida. I will also add that I find the myriad of specialist my DW visiits to have very suspect bookkeeping practices, we are often over billed or double-billed.

Big Pharma, IMO, is a huge root cause of the problem. I also think we a headed for an excellent single payer system but we are going to have a decade of heartburn getting there.

If you have had enough I'm glad you are getting out. Change is hard, sometimes too hard for one that has been at it for thirty years or more.

 

[sheehs1]

Good post Travelwanted and while I always thanks my docs will make sure to say it more than once.

 

[Chuckanut]

I will thank my doctor the next time I see him.

I understand your situation. In my career in education, I went from enjoying teaching the students to dreading each new rule, change in curriculum, anything that might displease a parent, and various staffing issues. And, yes, my rich and powerful teacher's union did it's share to frustrate me along with school administrators, School of Education professors, and, of course, politicians.

 

[jerome len]

life is full of change Travelwanted. I've had the same Doc for 20 years and absolutely love her. years, ago, I had Doc friends from the UK, Canada and Bermuda. Most of them envied U.S. Docs because they made more money, had more prestige and overall, lived a better life. I'd hate to see any of this change and frankly don't have the answer. Looking ahead medicine will change......it has to.....but I wish it could be done without losing great Docs like mine. If you'r unhappy, get out......if you stay accept change....do your best and enjoy the income, prestige and appreciation from all your patients. All the very best to you!

 

[Mulligan]

I don't blame you, Dr. When I last went for my visit a year ago, my doctor spent half the visit time complaining about all the new changes. BTW, I asked his opinion, he didn't just start blurting it out. . I can see these high deductible plans could become a collecting problem. Used correctly they are great, but in the wrong hands, I could see the trouble you mentioned. Call me cold, but if I were in your line of business I would have to have the ladies at front of the office say. "I see you have a high deductible plan. Show me the money or no soup for you!"


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[CaliforniaMan]

I will remember to thank my doctors the next time I see them. Thanks for your post.

 

[Silver]

Changes in American healthcare are long overdue, and providers will be unfortunate casualties in the process of reform.

I believe we have done ourselves an injustice by making believe that access to health care is a right or entitlement when it's not. It's an expensive product that the consumer may or may not be able to afford. And I think it's that mixed message that makes people angry.

The very poor and very wealthy have good options for their health care in the USA. The rest of us....not so much.

Providers put a lot of themselves on the line because they believe they can help. But that energy burns out quickly.

 

[longranger]

Doctors currently receive about 7% of each health care dollar. Other health care professionals such as nurses etc.. also represent a single digit percent of healthcare costs yet professional services are the first place government and big business look to make cuts. Next are less glamorous but vitally important areas such as food workers, clerical staff, sanitation workers etc.. Next truly needed upgrades in equipment and infrastructure in many major hospitals and clinics is cancelled or delayed indefinitely.

The main growth areas in hospitals and doctors offices across the country are in IT services and low to mid level clerical staff to ensure compliance with regulatory agencies, credentialing, integrity of patient records and collections. Everyone on the front lines of providing healthcare is effected. The environment has become quite toxic for many. Still compared to many sectors of the economy those working in the healthcare industry make a good buck and have relative job security. Until things get considerably worse for patients those outside of the healthcare industry will continue to view the providers of care as the problem.

Meanwhile medical costs continue to spiral up. The US spends about twice as much on healthcare as most modern industrialized nations. It just does not make sense or does it?

Of course it makes sense. We currently have for lack of a better term a bastardized system of healthcare. Politicians refuse to do the obvious. Either go to a clean single payer system or allow medical care to sort itself out based on the principals of capitalism, supply and demand and charity.

HA. Not exactly what has occurred. First off with medicare, medicaid and the VA system nearly 60% of the population is effectively on a single payer system already. It is the remaining 40% or so of the population where things get really interesting. Those with insurance have seen ever higher premiums for reduced services and higher deductibles...AKA cost shifting. Then there are the unfortunate 40 million or so that ACA means to address.

It will take at least a decade for this madness to sort out. Why? Because so many different special interest groups continue to get rich off this system and the american public still is not ready to accept the notion of some sort of healthcare rationing.

Yes I am a Doctor. Have practiced a little over 30 years. Proud of it. Continue to work for now because I want to. Practice is not as much fun as it used to be but for me it is enjoyable enough to persevere. If the practice environment deteriorates much further I may decide to change my tune and pull the plug. That would be a sad way to end what has been a rewarding career. Sure hope that does not happen.

 

[urn2bfree]

When I announced my plans to retire early from my medical career the overwhelmingly dominant response from fellow physicians was envy. The mood amongst the physicians I know is not good, but most of them will not be retiring. Many have large debt burdens and have developed spendthrift lifestyles. Many find more than enough satisfaction in the good parts of the job to continue collecting what usually still is darn good money (and they deserve it- it is a very stressful, difficult job even without the added headaches mentioned in posts above).

I just passed the 7 month mark since I wore a stethoscope, and I tell my colleagues that I am afraid I have developed a new "medical condition" during that time--my face is a little sore from smiling so much.


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[donheff]

I will thank my doctor the next time I see him.

I understand your situation. In my career in education, I went from enjoying teaching the students to dreading each new rule, change in curriculum, anything that might displease a parent, and various staffing issues. And, yes, my rich and powerful teacher's union did it's share to frustrate me along with school administrators, School of Education professors, and, of course, politicians.

+1 Many of us, from corporate jobs, to government, to .... felt similar changes turning our work environments sour. That is not to say that your concerns and observations are not real, just that they are common to a lot of careers. Kids coming into the same jobs today will start out used to the current hassles and will tolerate them for many years. After a few decades many of them will start to burn out with frustrations relating to whatever is happening then.

Still worth striving to make changes for the better but also worth while planning a good exit strategy. I too will try to remember to thank my doc at my annual physical next week. Sounds like something we should do for a lot of service people.

 

[2B]

+1 Many of us, from corporate jobs, to government, to .... felt similar changes turning our work environments sour. That is not to say that your concerns and observations are not real, just that they are common to a lot of careers. Kids coming into the same jobs today will start out used to the current hassles and will tolerate them for many years. After a few decades many of them will start to burn out with frustrations relating to whatever is happening then.

The willingness of someone to tolerate hassles at a job deminish rapidly when someone develops the financial ability to not have to tolerate them. I don't think that the "next generation" will be any different in this regard. I know that if my job wasn't so lucrative and so easy without any meaningful hassles I would have been gone years ago. My only complaint is having to come in every work day.

 

[Travelwanted]

Thanks for all the kind replies.

I agree it is not isolated to medicine. Any field that involves high levels of stress can lead to rapid burn-out.

I also agree that for the next generation of docs, it will be the norm and they will deal with it. Just as when I entered, the old timers said "medicine ain't what it used to be".

And absolutely agree with 2B. Thankfully, money is not my master, just a means to an end.

 

[Mulligan]

Thanks for all the kind replies.

I agree it is not isolated to medicine. Any field that involves high levels of stress can lead to rapid burn-out.

I also agree that for the next generation of docs, it will be the norm and they will deal with it. Just as when I entered, the old timers said "medicine ain't what it used to be".

And absolutely agree with 2B. Thankfully, money is not my master, just a means to an end.

But I see it could be more problematic in the medical field than maybe other professions. The road barriers to entry are already daunting.... Around 10 years of schooling ( and I'm sure there isn't the time for partying that was made available to me in my chosen career path) and high schooling debt load prior to getting a job..... So let's make things better by putting the squeeze on the doctors salary and increase their paperwork. I'm sure this will motivate the youngsters to all get into the profession... I was a reasonably good student back in the day, but there was no way I would have went into the medical field as a doctor. 8-12 years of schooling...my brain hurts now just thinking about it....kinesiology and anatomy alone were too much work for me back in my schooling days!


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[Jay_Gatsby]

First, to the OP, thank you for choosing to be and serving as a physician. It is often a thankless job where you are expected to work miracles. If you fail to do so, you've committed malpractice.

Second, medicine has changed so dramatically over the past 30 years it's frightening, with the pace accelerating due to the current regulatory environment. However, I do wonder whether a byproduct of what we're witnessing is simply an unrecognized swinging back of the pendulum. In the early-to-mid 20th century, doctors focused on practicing medicine, with far less concern about regulatory compliance, insurance paperwork and collections. Perhaps recent medical school graduates will find themselves outsourcing such obligations to large hospitals or other healthcare organizations (often going on salary in the process) and again focusing on practicing medicine.

The simple fact is that medical school doesn't teach doctors how to deal with regulations, insurance companies, collections and other bureaucratic aspects of running a medical practice. Personally, I would rather focus more on my health problem than on such things. Perhaps doctors will end up making less gross revenue (and net pay), but I think many would be willing to make this trade off if they get to spend the vast majority of their time doing what they were trained to do.

 

[Travelwanted]

First, to the OP, thank you for choosing to be and serving as a physician. It is often a thankless job where you are expected to work miracles. If you fail to do so, you've committed malpractice.

Second, medicine has changed so dramatically over the past 30 years it's frightening, with the pace accelerating due to the current regulatory environment. However, I do wonder whether a byproduct of what we're witnessing is simply an unrecognized swinging back of the pendulum. In the early-to-mid 20th century, doctors focused on practicing medicine, with far less concern about regulatory compliance, insurance paperwork and collections. Perhaps recent medical school graduates will find themselves outsourcing such obligations to large hospitals or other healthcare organizations (often going on salary in the process) and again focusing on practicing medicine.

The simple fact is that medical school doesn't teach doctors how to deal with regulations, insurance companies, collections and other bureaucratic aspects of running a medical practice. Personally, I would rather focus more on my health problem than on such things. Perhaps doctors will end up making less gross revenue (and net pay), but I think many would be willing to make this trade off if they get to spend the vast majority of their time doing what they were trained to do.

Thanks for the kind words.

I agree that I would take less pay for less headaches. Less gov't intervention and less threat of legal action would allow us to do what drove us to our profession: care for patients. As I said it is the NON-financial rewards that inspired my path (12 years btw) that are now fading for me.

Your second sentence strikes a cord with me. It is exactly the problem. Maybe the answer is we fight back and sue those patients for emotional distress!

 

[longranger]

Jay_Gatsby you have nicely highlighted some of the most frustrating aspects of practice for todays healthcare workers. I agree that many doctors would take less money for an environment where they were not expected to do tremendous volumes of paperwork with no direct relationship to providing excellent healthcare.

Please be careful before assuming things like "far less concern about regulatory compliance" etc... The frustration of physicians stems not from apathy. It stems from the assumption that they will perform the clerical and administrative funtions that you mention with no reimbursement while maintaining or increasing productivity to offset cuts in reimbursment.

 

[Jay_Gatsby]

Jay_Gatsby you have nicely highlighted some of the most frustrating aspects of practice for todays healthcare workers. I agree that many doctors would take less money for an environment where they were not expected to do tremendous volumes of paperwork with no direct relationship to providing excellent healthcare.

Please be careful before assuming things like "far less concern about regulatory compliance" etc... The frustration of physicians stems not from apathy. It stems from the assumption that they will perform the clerical and administrative functions that you mention with no reimbursement while maintaining or increasing productivity to offset cuts in reimbursement.

Apologies, but I think you may have misunderstood the context of my statement. I was referring to the practice of medicine 50-100 years ago. Back then, there wasn't nearly as much regulation or insurance headaches to deal with, so physicians were able to focus on their patients. While I can appreciate the benefits of regulatory oversight on patient safety and insurance to spread the risk, physicians shouldn't be the ones having to deal with these burdens on top of actually practicing medicine.

 

[longranger]

Apologies from me for not understanding the context of your statement. I also agree that the regulatory and beauracratic functions serve an important role in patient safety and quality healthcare. Insurance IMHO is a net negative for medical care. Spreading risk does not justify the costs of administering insurance and insurance company profits. At the end of the day insurance provides little to benefit individual patients.

 

[robertf57]

I think a transition to a single payer system will be a near impossibility. We already see groups of practitioners and hospital systems opting out of Medicare and Medicaid. In my region, "Concierge Practices" are growing; where physicians provide consultation and care management on a subscription basis and do not deal directly with insurers at all. I only see the schism between those with resources and their healthcare and those at the lower socioeconomic end widening.

The genesis of our predicament lies with the removal of the patient from the payment-decision function. We have created a moral hazard situation because the costs of decisions are not borne by the decision maker (patients and their families). This happens all the time in end of life care where family members demand everything be done despite near futility. The US is the only healthcare system I know of that accepts this wasteful paradigm.

We also have bastardized the primary principle of insurance: the transfer of the cost of a possible loss, shared among a cohort of similarly at risk entities; into a payment plan for expected expenditures. This removal of the patient from the decision making and generations schooled under the idea that healthcare is a right that is paid for by a nebulous insurance company or the government has spurred demand and corrupted market forces.

On top of all this you have the regulation and payment mandates of federal programs which only add to the costs while returning nothing to the patient. Don't get me started about observation days and denials!

 

[travelover]

.....................At the end of the day insurance provides little to benefit individual patients.

One advantage to me as a patient is that the insurance company negotiates a much lower rate for a standard procedure than I would pay as an uninsured patient walking in from the street.

 

[Chuckanut]

I am not unsympathetic to the problems of the OP.

However, the problems with providing healthcare in the USA have been obviously coming for decades. Why do other countries have lifespans equal to or better than our while spending far less of their GDP than we do? Inquiring minds wonder?

The medical profession, like many (education and law come to mind), could have done themsevles a service by addressing these issues earlier, rather than waiting until the pain was so great the any remedy was deemed better than the status quo.

 

[Jay_Gatsby]

I am not unsympathetic to the problems of the OP.

However, the problems with providing healthcare in the USA have been obviously coming for decades. Why do other countries have lifespans equal to or better than our while spending far less of their GDP than we do? Inquiring minds wonder?

Not to derail the thread, but part of the answer to this question is, in some countries, a healthier lifestyle with less food consumption, less chemicals in such food, more exercise, lots of red wine (okay, science has now started to question this ), etc....

As for getting between a patient and his/her doctor, cost will be a determinative factor as long as a 3rd party (whether the government or an insurance company) is paying for the medical care.

 

[modhatter]

I think it would be most interesting to hear a perspective from a doctor who after working for a system like Britain's NHS or Canada's to then be offered a position in the US with our fee structure. I wonder if the higher income would offset the added headache of paperwork, and dealing with countless insurance policies, and malpractice. In the end. I wonder which system a doctor would chose, having an adequate dose of both.