The Future Structure of American Medicine
An interesting article appeared today in the Opinion section of the Wall Street Journal (May 12, 2009) by Dr Scott Gottlieb that everyone should read. He called it “How ObamaCare will affect Your Doctor.” And let’s not kid ourselves about anything here: if it affects your doctor, then it will have an effect on you and your family.
Medicare has been a disaster for American physicians. It has piled regulation upon regulation onto doctors and made their professional lives very difficult and financially challenging to survive and care for their patients. Medicare payments are a fraction of what a physician should be paid. Gottlieb contends quite correctly that the government will provide Medicare as the model for health care. What can we expect?
First, we can expect further decreases in doctor’s pay. Too bad you say, well think about it. They will be forced to form larger groups to economize overhead and staffing costs. Short visits crammed together so they can see more patients in a day will be seen. Longer time periods will occur to get appointments and to schedule surgeries. Some will refuse low paying insurances and go out into cash only practices. Already they are told they have to move to computerized records. Where does that money come from? Not Uncle. Smart young people will see this and not go into medicine. You can’t borrow $200,000 to go to college and medical school and pay it back with the salaries they are going to see. More experienced older physicians will disappear into retirement, as they are now. We are now and will continue to face a shortage of physicians. You don’t want to live that way, so why should your doctor?
Payments will be made for quality of care and switched to primary care doctors. Performance-based pay is the key slogan now in health care. That is fine, but tells me how do we get young people to go into the other specialties if they don’t get paid fairly? Will a doctor now get docked if someone has the temerity to die under his care? I don’t want to be an oncologist for sure. Sounds silly, but that is where we are heading. Some specialties like Anesthesia or pain management, don’t affect outcomes per se. They are for service. How will you ensure fair payment if your guidelines are the above? Everyone wants to move away from service volume as a method of payment, but in some areas you cannot do it.
Compliance costs are soaring and are all shifted to the doctor. You have to hire staff to take of these issues or get fined and possibly thrown out of Medicare. Money is now actually diverted from care to more administrative issues. Remember all those computers and programs to get the records on line. They have to be bought and paid for.
So the debate begins and is to have a resolution by the end of the year with Congress passing new health care legislation. And these issues are just the tip of the iceberg.
May 14th, 2009 at 9:11 pm
I was born in 1927, I recall that when I was young, it was common for folk to want to be dOctors,Nurses, Teachers, POLICE AND OTHERS INCLUDING POLITICIANS FOR THE REASON THEY WANTED TO DO THINGS TO HELP THEIR FELLOW MAN, NOT FOR THE MONEY, WHICH WAS LOWER ON MOST OF THOSE JOBS THAN A TRADESMAN OF SOME FACTORY HELP. MONEY SHOULD BE SECONDARY IN ANY SOCIETY. WE WERE ALL PUT HERE TO BE OF SERVICE TO ONE ANOTHER. WE ALL ENJOY OUR LUXURIES, BUT MANY OF US STILL ENJOY AND ARE DEEPLY GRATIFIED TO BE THERE TO HELP WHENEVER WE CAN AND NOT EXPECT GREAT MONETARY REWARD. OUR REWARD IS OUR SENSE OF DOING GODS WORK. OUR REWARD WILL COME LATER.