Just got off the phone with one of my physician clients. I think he may have just wanted to talk to somebody. I’m a pretty good listener.
His complaints basically boiled down to three: the state of Illinois is paying him one cent on the dollar, he’s doing a lot of pro bono work, and the practice of medicine is becoming increasingly bureaucratized, to the detriment of patient care.
He ain’t seen nothin’ yet.
What do the fed’s pay him?
I would be interested in seeing Steve’s comment on this.
I’m afraid we’re nearing a meltdown in the healthcare system. Nobody seems happy with it.
As I see things there are several things that are in tension: who decides the standards of practice, who pays, and how much it costs. I’d rather see a system in which the standards of practice are determined fairly traditionally i.e. mostly by physicians, healthcare is paid for from tax dollars, and the relation between what people in healthcare earn and what other people in our society earn is closer to historic norms than it is now.
But YMMV. We certainly can’t maintain the system as it is now. Too many people aren’t receiving the healthcare that they need. Too many physicians are far too overworked and unhappy with their practices. Paying for it all will require tax revenues to go far above historic norms which is going to be tough on the rest of the economy.
Um. We could try the price mechanism, and make insurance, insurance, not maintenance.
But I’d be a crazy assed fool, wouldn’t I?
But eventually we’ll get it right…..
My take is that eventually he’ll do something else. You can’t operate a business that way. As for the larger system, I’m with Dave….
Herb Simon once stated something rather obvious, but is so very appropriate,
“That which cannot be sustained, wont.”
Our health care system cannot be sustained, ergo it wont be sustained. There are two broad ways to deal with it:
1. Be proactive and try to change things before they “meltdown” as Dave put it.
2. Do nothing and the problem will solve itself….via a meltdown.
There is absolutely no political will to do 1. Thus, 2 is the only option left in town.
I am somewhat sympathetic. Salaries have been far outpaced by practice costs. The poor economy means more people who cannot pay. (Not sure how he gets to a penny on the dollar.) There are a lot of real cuts coming because the ACA that are affecting people.
However, I think the biggest issue is just how medicine has changed. Physicians used to be unchallenged in their environment. Especially in a smaller hospital, you were a demi-god. You were never questioned. You could throw temper tantrums and get your way. Little paper work. No one tracked your results. The nurses did what you told them. Heck, when I was young, the nurses used to stand when you entered the nursing station.
Now, everything you do is tracked and measured. Patient satisfaction (happiness) is rated almost as important as actual outcomes. Every pipsqueak service line manager, usually a 35-40 y/o nurse with a masters who wants to be CEO someday, wants to tell you how to practice. You have checklists you never had before. You are asked to follow protocols. No longer do you decide by yourself what you do.
Thing is, not all of this is bad. Not sure why it was ok to abuse nurses just because you were a doc. Protocols and guidelines have, for the most part, greatly improved outcomes. It is just irritating to have others telling you to do these things. And, while we have lost a lot of autonomy, we have often failed to fill the leadership gap when we could have.
It actually still pays well, it just feels more like work, with too many people making decisions that used to belong just to docs.
Steve
“Thing is, not all of this is bad…..”
I agree that accountability is not a bad thing, as well as a re-balancing of a physician’s Demi-God ego you referenced. However, like most things in business or life, the pendulum of change seems to wildly swing from either one side or the other, but rarely in the middle, where it usually does the most good.
In the cases of the medical profession, all the paper work, check lists, endless and sometimes mindless protocols take up so much time and energy, distracting from the actual hands-on practice of medicine and patient care. It can also give the patient a sense of one-sided power over the medical establishment in that any deemed omission or perceived slight in medical care can be leveraged into a law suit. Tort reform would definitely offer some checks and balances to what has sometimes become a fiscally and legally beleaguered profession. I also think that accountability and responsible health care should be something equally shared by not only doctors/nurses but also by the consumers.
@steve
… The nurses did what you told them. Heck, when I was young, the nurses used to stand when you entered the nursing station.
At Charity Hospital in New Orleans, the nurses ran the place, and you really did not want to tangle with them. This was years ago, but it probably has not changed much.
steve,
Interesting stuff, thanks. Sounds like doctors are going through a culture change as much as anything else. In some ways it reminds me of pilots.
From my experience, TB, nurses still run the places. As a caregiver, I’ve seen how hard it is to find or speak to a doctor. “Ask the Nurse” is where it’s at, even in ICU.
They watch from hour to hour, and know when there are changes of health status. They take vital signs, and observe appetites and skin colors.
Personally, I love nurses. They have helped me, too. My eldest sister-in-law just retired from nursing just outside of Dallas. She’s been my buddy since I was six.
She was in the cardiac arena. I need to answer her email now.
Hell, my sister-in-law let me scratch up her station wagon and took me for my driving test when I was 16.
@Andy- Holy Sh@t! Exactly. That was starting when I was in. To be fair, some specialties have seen more changes that others and have been whacked pretty hard. Not knowing this guy’s specialty, he may have some real complaints. However, most of the time, this is doctor whining. I dont tolerate that very well. Do something or dont do something. Dont whine.
@jan- Yes, re-reading I dont think I made it clear that the paperwork volume has increased for most of us. The state (seldom federal regs for me or OR stuff in general) makes some silly rules. We are in the process of figuring out what mid-levels, the new term, are capable of doing, which is threatening to some docs, sometimes with justification. I wouldnt want to totally discount this guy’s complaints, but I have sat through many hours of doc complaining how they only make $400 k now, while being handed instruments by a tech who makes $9/hr.
The kind of sad part is that I dont think a lot of docs have accepted the inevitable. Whether it is the ACA, or the magic of the markets, salaries are going down.
Steve
My sister is an NP for an oncologist (outpatient), and my impression is that she acts much as the primary treating physician and her doctor plays more of a diagnostic and management role. When my sister rotates to smaller clinics away from the main office , I don’t think the doctor is necessarily there all of the time. I think she receives a lot of job satisfaction from patient interaction that doctors are becoming more removed from. She works far fewer hours (30 hours) and has less headaches than doctors. She also gave a lecture at Mayo’s on a course of treatment variation they employed. This area may lend itself more to the dentist model than others.
My dentist clients are bitching, too. A lot of ordinary care is being delayed or forgone. Here in Illinois the state is, curtailing dental care compensable via Medicare sharply. That’s likely to have serious dental and even medical implications down the road. Penny wise, pound foolish.
It seems like I tell that to my 7 year-old son at least a few times daily. One consequence of having my own kids is that my tolerance for adult whining is really low.