Monday, October 21, 2013

Money And Medicine

A female colleague, a general surgeon, confessed to me that 'some months I don't get a paycheck'. Business is bad, and the cases are down by half. So the group has to keep the office running, all the expenses paid first, and the physicians who own the group get paid with 'what's left'.

But I have to pay my nanny! Sometimes I wonder why I keep doing this? I love my work but you know???

It's true.

With insurance companies reducing reimbursements to follow Medicare rates (In anesthesia they are twenty cents on the dollar of what we are 'worth' and 'bill' for our services, the worse disparity in all of medicine), physicians are taking the hit.*

A leading gynecology practice hired a new graduate. To stay competitive and keep this new hire, the rest of the group took a cut in pay to keep them in the group. The new hire earns MORE than the senior partners!

In the O.R., we want lots of cases that are quick and turn over really fast. That is how we get 'ahead'. A long slow case on a really sick patient? You lose money. So does the hospital. Even though the bills are  sky high super expensive and frightening.

Now we don't even put foley catheters into patients that earlier for all my career we used to. Why? Because we stopped needing to monitor urine output during the case due to some great new technology? NOPE. Because Medicare won't pay at all for the ANY of the services rendered if the patient develops a urinary tract infection from the foley.  That's right. An important monitor for kidney perfusion and patient comfort is no longer used because of a rule that someone in government made. How can anyone hold their pee for more than three hours? I don't know! But I give a lot less fluid just to make sure the bladder doesn't over distend. Instead of volume, I give small boluses of pressors. If a foley is used, for whatever reason, it has to be out in less than twenty-four hours or insurance won't pay.

You see, to be a physician, you incur a lot of debt while you are in school. This creates loan payments that are astronomical! I knew of a couple who had private school undergrad and medical school, who lived in Palo Alto, which is not a cheap place to live. Their combined loan payments were greater than the mortgage! And I know of another couple in Southern California who are in the same situation--Dr. and Dr.

Why would I ever bring this up?

Do I want to complain?

What is the POINT?

The point is that Truth is Stranger than Fiction.

  • people become doctors to have 'delayed reward' and contribute to society
  • people go into debt for their education
  • between malpractice insurance (some OB GYN's pay over seventy thousand a year for it) and the cost of private practice, and taxes, many do not make the kind of money anticipated
  • this is no accident--this 'squeeze' affects everyone--the 'system' has it so we are 'just getting by'
  • the only ones who win in this system are the insurance companies and the big health care organizations.

Here is an eloquent article titled, 'Who Makes More--A Professor or a Fry Cook?' which goes into the details of how this strange twist of fate ended up as 'reality'.

Note--this Tenured professor works sixty hour weeks, compared to the forty hour week at the fast food place.

Note--Physicians work eighty hour work weeks to one-hundred twenty hour work weeks.

Instead of Separation, this is the time to look past the paycheck to the system, and figure out where all that money has been going. If it's not to the patient, and not to the doctor, and not to the nurse or the pharmacist, where does it go? How much is the cost of business for the organization? And how much gets 'siphoned off' somewhere by someone who does not have our best interest at heart?

Aloha and Mahalos,

Reiki Doc

* in 2010 September all reimbursements from private insurance for OB anesthesia services were cut in half. This was a one-sided decision by the insurance companies to reduce it to Medi-Cal rates. The offer was 'take it or leave it'. We needed to work. So we didn't fight the change....