Sunday, September 16, 2007

WHOSE FAULT IS IT, ANYWAY?

There is a certain kind of blog poster that has been angering me. It’s the nuts on KevinMD that make the claim over and over that somehow I, and all doctors like me, are responsible for creating this system where insurance companies bilk doctors and patients, and that, after years of “doctor abuse” and “doctor fraud”, I am just now getting what I deserve.

What a complete load of garbage.

Just to clue all of these brilliant thinkers in, I completed residency training FIVE YEARS AGO!!! So the idea that somehow I am responsible for the current system is total crap. Does anyone think doctors made any substantial monetary gains in the last FIVE years? Or even the last FIFTEEN???

When I entered medical school, I had ideas about being a respected professional who could offer opinions and diagnoses to ease suffering, cure disease, and as my father told me “You won’t get rich, but you’ll never go hungry”. Well, truer words were never spoken my friends. I am not rich, and for the most part, I haven’t missed a meal (except on call of course). But I did manage to amass over ONE HUNDRED AND FIFTY THOUSAND DOLLARS IN DEBT!!!

So when I was slogging through Gross Anatomy and Physiology, according to the “just desserts” crowd, I should have KNOWN that HMO’s and insurances were perpetrating dwindling reimbursement on doctors and that Medicare was dropping their payments. I should have KNOWN that doctors in the 70’s and 80’s were doing unscrupulous things like putting pacemakers in dead people and charging for them (a fact told to me by an esteemed medical director who saw these things happen and did nothing to prevent it). I should have KNOWN to study these things just as hard as the Biochemistry and Microbiology and Pathology I thought I would need to be a good doctor.

After four years of school and three years of mind-numbing residency, I was, of course, desperate to find a job that would help me pay down this debt I had acquired. So I took the first job offered that paid well (I felt). According to the “just desserts” crowd I should have rejected all insurances, Medicare, etc, and just took cash only or raised my fees.

Well then, I just have one question… WHERE THE HELL AM I GOING TO FIND PATIENTS???

The people who make these statements are just clueless. And they blame doctors like myself for the way the system is. Just as you would blame me for slavery during the Civil War or I would blame Germans today for the Holocaust. It’s such a tired argument and serves no purpose, except to make the “just desserts” crowd feel better about blaming doctors for high health costs. They forgot that doctors become competent only through studying and hard work. The best doctors aren’t the most business savvy ones. They should ask themselves which doctor they want to see: the one who’s practice is booming because they’re making money hand-over-fist, or the one who paid attention in Path.

6 comments:

Al said...

When I was in dental school I remember instructors talking about how the profession had been "ruined" by insurance. That was more than 10 years ago. My experience is that this has become more true for physicians than dentists (so far). I know that I can only see so many patients and still do a job that lets me sleep at night. In dentistry we're constantly pushed to try to attract high end cosmetics while it's obvious that many folks without a lot of means go without any dental treatment. Some days I feel particularly libertarian and rant about patients valuing my service and paying for it. It helps me to remember that a great many of my patients who really like me probably would seek only emergency care if they didn't have "insurance." It's a rock and a hard place.

Pharmer Jane said...

People will always want to blame someone else for the high costs of health care. Many of the problems come from over-consumption of resources. The cost of services rendered to people who cannot pay, or simply refuse to pay, also must be passed on to everyone else.

The general population has also been very sheltered from the actual costs of health care because of insurance. They really seem to have no idea that their small copays are just a small part of the cost. I often see it in practice. If the generic costs $5, and the brand costs $10, there are many people who will want the brand name, because "it only costs me a little more, and the brand is better". They are completely oblivious to the fact that it can cost the insurance company another $100 for them to have the brand. Then people rationalize "I pay so much for my premiums, I want to get my money's worth." With the current system, there is no incentive for people to voluntarily restrict their own medical care consumption.

Anonymous said...

I hear ya, but try to remember that blog comments, by default, tend to be posted by people who feel really strongly about the subject. So the conversation is skewed a priori.

I don't really care whose fault it is that the system is so messed up. I just want it fixed, and I am willing to make some concessions in order for that to happen.

We're all oh-so-busy pointing fingers at each other. We all think the other guy should be the one to make the concessions, and what we get is a giant stalemate that's going nowhere.

Aislinn Kottwitz said...

Walk the Path

Abram said...

Thanks for the article, very effective information.
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Anonymous said...

Wait, aren't good doctors supposed to train the mid level practitioners before they work? I guess doctors didn't get the memo that were your responsibility and most of you in primary care hire us anyways. Don't hire a dumb mid level. Dumbies