It has been quite sometime since I’ve been able to blog. You see, the attitudes expressed on this site sometimes push the envelope, and a few in particular have pushed a few buttons at the hospital. I’ve been pretty open about end of life issues, medicare waste, idiotic medical practices, negative trends in healthcare, and support for nursing staff I feel have been unjustly treated. Some of what I’ve posted was intended to needle a few, some was intended to entertain (me). This was all good, that is until I was found out.
I laid low for a long time hoping that the heat would let up, and it did. I few specialist services who I’ve knocked for providing expensive futile care seemed to lighten up. Then of course healthcare reform fired up again–after we thought it was dead.
Medicare has stopped paying consultant fees (a big part of my job), cardiologists and other specialists are flocking to hospital administrators asking to be bought out and employed because insurance won’t pay for many of their office tests, hospital census has dropped through the floor (despite the ER mandates to “fill those beds”), and my boss has gotten paranoid about decreased demand for our services.
What this all boils down too is that my organization is cutting staff and, in part because of my activism, my contract will not be renewed. I’m not sweating it too much–doctors tend to be always needed, somewhere.
The message here is this. When you short reimbursement and increase overhead in healthcare, you force physicians and medical services to focus more on the financial bottom line instead of the patient. We start practicing badly just to maintain cash flow to keep our services afloat (ie low/no threshold to admit/treat, provision of unnecessary services–like a surgeon consulting a hospitalist group just so he wont be bothered by phone calls in the middle of the night, increasing volume of services but decreasing time and quality of those services, refusing to care for uninsured, Medicare and Medicaid…).
I think this is why I’m looking for a new job today. Now a days, physicians in a group do not have the luxury to be idealistic. If I was a business man trying to keep my practice alive in a climate of increasing overhead and decreasing reimbursement, I would hire those willing to 1) bring in the bucks, 2) don’t screw up, 3) don’t rock the boat. I would fire squeaky wheels. Too bad I didn’t think about this a few months back when I commented to my boss that we have become part of the healthcare problem because of the way we’ve been forced to practice.
I wish I could shake up the people in Washington, the lawyers, the everyday people who think that ongoing changes in healthcare are good for medicine. Don’t you see that the practice of medicine has been bastardized/corrupted–not by greedy physicians, but by forces that for years have distracted us from the patient. Now comes the new healthcare reform, something we need but done totally wrong, not even addressing the issues that are harming our system.
Shortly after the passage of the healthcare bill, I not only heard about my contract but I also learned of a colleague who has decided to retire. Two other internists, both of whom having just opened their practices within the past 3 years, both unique in this area where most doctors already refuse to see Medicaid and Medicare patients, are closing their practice to government insurance programs.
If it wasn’t so tragic, it would be funny. While many in Washington toast each other, the practice of medicine has taken a major blow. Some say the true intent is to force its collapse so that true universal/state run care can be enacted. I used to think this an over-the-top belief; now I’m not sure.
Thanks for bearing with my middle of the night, exhausted after work, rant–the first in a long time. Perhaps there will be more, maybe I’ll get back on that population piece–It’s not like I need to worry about my job any more.
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