[Tanyech] Walford is not alone in her struggle. Relatively low earnings, rising overhead and overwhelming patient loads are sending veteran primary care physicians into early retirement and driving medical students into better-paying specialties, creating what the New England Journal of Medicine recently called a crisis.
Primary care doctors “should be able to leave work thinking not of their income, or of unanswered phone calls, or of test results that they might have overlooked,” Boston physician and associate journal editor Thomas H. Lee wrote in the Nov. 12 issue. “They should go home thinking, ‘This is what I was meant to do.’ ”
But after five years, Walford couldn’t hang on any longer. She closed her office nine days ago.
“It’s sad,” said Walford, who has shoulder-length wavy black hair, a cherubic smile and a slight lilt that betrays her Jamaican roots. “I worked really hard. It’s a tragedy.”
The good news about the recent stock market tumble is that many of my primary care colleagues who would have taken early retirement are going to hang in there a little longer (the key term being “little”).
The paperwork is ridiculous. Then, they have coming down the pike “pay for performance” (P4P). It should be called “Pay less for failing to meet arbitrary criteria which require a full time actuarialist to try to document and meeting those criteria hasn’t even shown to improve health.” P4P is going to hit primary care really hard.
The best senior resident in my former hospital’s internal medicine program does not plan to practice medicine. He has got a good job as an airline steward. Apparently the pay is comparable, the hours vastly better, the liability non existent, and they prefer to have docs as stewards in case there is a medical emergency.
Some more about P4P: One of my Ob/Gyn colleagues had one insurance company doing early P4P. They had sent her a list of names of women that didn’t have listed a Pap smear in the past year. He had his staff pull the charts, several had died, several weren’t really his patients but he had interacted with them while covering for another Ob/Gyn during the year and a few that needed Pap smears had declined.
The P4P described by RobRoy [#1 & 3] sounds abusive.
But I’m curious how our anti-government commenters would propose to deal with it? The insurance companies are, after all, private firms.
Our primary health care doctor has just taken early retirement. He told us it was because of increasing government regulations, having to accept insurance payments that did not cover his expenses, endless paperwork, etc. I remember him as a young doctor just starting his practice, the joy in his face and carriage because he knew he was starting out to do what God had called him to do. He is near retirement age now, but not that near. We shall be the losers in this; he is a gifted doctor.
#4 We go back to the way that medicine used to be. The patient pays the physician for services. If the patient wishes to then collect from insurance and insurance pays for doctor visits so be it. If the patient wishes to have the criteria that insurance companies monitor (pap tests or smoking cessation lectures) let the patient pay for it, or pay for an insurance company that cares about it, and therefore charges for making sure it gets done. Frankly, since I am not sexually active, I don’t need pap tests and don’t get them myself. If I didn’t hang around folks who were likely to have flu, I wouldn’t get a flu shot either. Nor do I particularly wish my physician to lecture me about my weight (though I am aware that I could stand to lose 20 pounds). P4P is ridiculous. The only performance worth speaking of has to do with “how long did you live after that life threatening event?” These are areas that the US excells in. We have the highest 5 year cancer survival, and 20 year heart attack survival in the world. We have the best infant mortality (counting premies from moment of birth instead of counting from 9 months gestation the way other countries check on this) in the world.
P4P does not measure this, however. Neither does the WHO. The reason is that our better outcomes are achieved by ICUs and expensive technology, which the public health folks don’t wish to hear. Thus, the measures that they insist on using (like asking would you like to quit smoking) have to do with items that really don’t need a physician. Thus, countries that don’t invest in technology, and therefore can’t achieve our heart attack or stroke survival rates can manage to lecture their patients on obesity, and “look good” on “performance” criteria. This is akin to grading the performance of athletes on how often they stretch out before running, and whether they change their socks daily, rather than on how fast they actually run.
Ridiculous. Frankly, I think they should just let ordinary folks prescribe their own insulin, asthma medications and bp medications. Smart folks would do just fine. There are algorithms to follow. It is no harder than filing your own taxes. Folks with complex diseases and folks who are not smart can hire a physician, nurse or other provider, just as folks with complex tax returns hire accountants. I think we will eventually end with a system like the above anyway.
RE: “But I’m curious how our anti-government commenters would propose to deal with it?”
As flies to honey, so Irenaeus’s question lures us out of the woodwork.
I think the simple answer is more competition to the insurance companies. The government needs to radically reduce regulations on insurance companies — in particular the protection racket that allows the big ones to flourish.
For instance — insurance companies need to be allowed to choose whom they will cover in a risk pool. And HSA’s need to be further de-regulated. And the self-employed need to be given the same tax break as the big corporations for the health insurance — or the tax break taken away, of course. Regardless, the net effect would be for more and more — and specialized — companies entering the insurance market, and offering far more varied and targeted product offerings.
More and more people are choosing HSA’s and the net effect of that choice is to allow the consumer of the medical care to make the choices — not the insurance company.
I should add that insurance companies have fought tooth and nail all of those above points. They want increased regulation — lessens the pool of competitors. They hate HSAs [with the exception of a few] and only now occasionally offer them because they’ve been forced to by the market. HSAs ultimately are designed to move everyone to catastrophic care insurance — rather than “I need insurance for my dental checkup and my annual physical.”
More competition among insurance companies would eventually mean that some would advertise their decreased paperwork — just like Southwest Air advertises its ease and efficiency.
As it is, we have stagnant huge massive insurance companies who RULE THE ROOST when it comes to both patient care and doctor hassling. It’s a living nightmare for both the consumer and the provider.
Any time the ultimate consumer of a service or good is separated from the cost of that service or good you have an unbalanced market that is rife for becoming overblown, overcostly and overused.
Two good examples of this are our Health Care industry and College and University costs. In both, the actual consumer be they patients or students are divorced from the actual cost of the services they are procuring. In College tuition costs you have government aide picking up more and more of the bill and as a result you have college costs rising 2-3 times or more above the rate of inflation. In Healthcare you have insurance companies and the government picking up the tab after low co-pays. Healthcare is also rising at a rate several times above inflation.
The hard answer the country will probably never choose is to get government and insurance as it is now exists out of higher education and health care. This would introduce the law of supply and demand and would eventually balance the market. If one doctor on Main Street offers physicals for $175.00 another doctor could open down the street and offer the same service for $125.00. Eventually, costs would have to come down to what people could pay. The caveat is catastrophic insurance care coverage for medicine and scholarship money for higher education.
What is more likely to happen, however, is that the government will become THE insurer for all or most Americans and the “dream” (read nightmare) of socialized medicine will become a reality. Because the system really is broken… I just don’t know why we want to trust to people that had an active hand in breaking it in the first place to provide the fix.
P4P sounds like another scheme by insurance companies to not pay the doctors for the services they render. The health insurance industry is a scam, and is, I fear, the harbinger of how life would be under a single payer system.
Irenaeus,
That’s “Limited-Government” or ‘smaller-government”, not “Anti-Government”, thank you very much.
This is what happens when health care is ‘free.’
From the article:
[i]”I love medicine,” she said. “But they don’t tell you this stuff in medical school. They tell you there’s a shortage of doctors.”[/i]
Yep, every generation falls for this trick (me included when I was younger.) There is no such thing as a long-term labor shortage – only [i]a shortage at the prices currently being offered for the labor.[/i] I’m tired of hearing the same thing being said about teachers and nurses. All nonsense.