If you live in a small town or rural area of the United States, you may have noticed that family doctors are becoming an endangered species. Private and public health insurance reimbursement rates are so low that survival as a solo practitioner (without the economies of scale of a large group practice or hospital system) is next to impossible. Some primary care physicians are staying afloat by refusing to accept insurance – this allows them the freedom to practice medicine that is in the patient’s best interest, rather than tied to reimbursement requirements.
I joined such a practice a few years ago. We make house calls, answer our own phones, solve at least a third of our patients’ problems via phone (we don’t have to make our patients come into the office so that we can bill their insurer for the work we do), and have low overhead because we don’t need to hire a coding and billing team to get our invoices paid. Our patients love the convenience of same day office visits, electronic prescription refills, and us coming to their house or place of business as needed.
Using health insurance to pay for primary care is like buying car insurance for your windshield wipers. The bureaucracy involved raises costs to a ridiculously unreasonable level. I wish that more Americans would decide to pay cash for primary care and buy a high deductible health plan to cover catastrophic events. But until they do, economic pressures will force primary care physicians into hospital systems and large group practices. My friend and fellow blogger Dr. Doug Farrago likens this process to being “assimilated by the Borg.”
Doug offered a challenge to his readers – to customize the definition of Star Trek’s Borg species to today’s healthcare players. I gave it my best shot. Do you have a better version?
Who are the Borg:
The Borg are a collection of alien species that have turned into cybernetic organisms functioning as drones of the collective or the hive. A pseudo-race, dwelling in the Star Trek universe, the Borg take other species by force into the collective and connect them to “the hive mind”; the act is called assimilation and entails violence, abductions, and injections of cybernetic implants. The Borg’s ultimate goal is “achieving perfection”.
My attempt to customize the definition:
Hospitalists are a collection of primary care physicians that have turned into cybernetic organisms functioning as drones of the collective or hive. Hive collective administrators (HCAs), in association with partnered alien species drawn from the insurance industry and government, take other primary care physicians by economic force and connect them to “the hive mind”; the act is called assimilation and entails crippling reimbursement cuts, massive increases in documentation requirements, oppressive professional liability insurance rates, punitive bureaucratic legislation, and threat of imprisonment for failure to adhere to laws that HCA- partnered species interpret however they wish. The HCAs’ ultimate goal is “achieving perfect dependency” first for the drones, then for their patients, so that HCAs and their alien partners will become all powerful – dictating how neighboring species live, breathe, and conduct their affairs. Resistance is futile.
To learn more about my insurance-free medical practice, please click here. We can unplug you from the Borg ship!
With regard to physicians’ support for medical malpractice reform, the times they are a changin’. These iconic words of Bob Dylan, who has now reached the 8th decade of life, apply to the medical liability crisis that traditionally has been a unifying issue for physicians.
The New York Times reported that physicians in Maine are going soft on this issue, but I suspect this conversion is not limited to the Pine Tree State. Heretofore, it was assumed that physicians as a group loathed the medical malpractice system and demanded tort reform. The system, we argued, was unfair, arbitrary, and expensive. It missed most cases of true medical negligence. It lit the fuse that exploded the practice of defensive medicine. Rising premiums drove good doctors out of town or out of practice.
What happened? The medical malpractice system is as unfair as ever. Tort reform proposals are still regarded as experimental by the reigning Democrats in congress and in the White House. The reason that this issue has slipped in priority for physicians is because Read more »
*This blog post was originally published at MD Whistleblower*
Sometimes having no end of job prospects, more than one in four new doctors regret going into medicine by their graduation, according to a recruitment firm survey.
Recruiters Merritt, Hawkins asked new doctors if they would study medicine if they had it all to do over again, and 28% said they would select another field, up from 18% in a similar survey in 2008.
Still, the newly minted physicians have plenty to do while they mull other options. About 78% of newly minted physicians received at least 50 job solicitations during their training, and 47% received 100 or more contacts from recruiters.
Despite the heavy rotation of recruiters, residents Read more »
*This blog post was originally published at ACP Internist*
I’ve been at it a long time, and one thing (of many things) that I still have not gotten down is scheduling. I seem to have a method to my own madness, but somehow I imagine it’s not how other people do this. I’ve heard other shrinks say, “I’m booked for the next 4 weeks” or say they aren’t taking any new patients. Some people put a “no new patients” message on their answering machine. Wait, so no appointments for 4 weeks? What if a patient calls and needs to be seen very soon? Like this week? If you can’t wait, go to the ER? I thought the point of having a private doc was that you didn’t have to go to the ER unless something couldn’t be handled safely as an outpatient. And if you tell the world that you don’t take new patients, then don’t people stop referring to you? It seems to me that patients will come in and announce, “I’m doing better and want to come less often,” “I’m moving,” “I’m done,” or they will cancel an appointment, not call back, and not be heard from again for weeks or months. Sometimes it all happens on very short notice and life can be very unpredictable.
In my pre-shrink days, I thought that psychiatry worked such that patients came every week (or twice a week, or whatever) and had their own slots. Tuesday at 1, that’s me! So a psychiatrist had every slot full with patients this way, and could be “full,” until a patient finished and stopped coming, and then another soul was let in to the Tuesday at 1 slot. Gosh that would be nice, but it doesn’t seem to work that way. Read more »
*This blog post was originally published at Shrink Rap*
Close your eyes and think of a doctor. Do you see a Marcus Welby type? A middle-aged, smiling and friendly gentleman who makes house calls? Is his cozy office staffed by a long time nurse and receptionist who knows you well and handles everything for you? If that is what you envision, either you haven’t been to the doctor lately or you are in a concierge practice where you pay a large upfront fee for this type of practice. Whether you live in a big city or a rural community, small practices are dissolving as fast as Alka Selzer. Hospitals and health systems are recruiting the physicians, buying their assets (unfortunately not worth much) and running the offices.
Doctors are leaving small practices and going into the protection of larger groups and corporations because of economic changes that have made it harder and harder for small practices to survive. The need for computer systems, increasing regulations, insurance consolidation, skyrocketing overhead and salaries coupled with low reimbursement has signaled the extinction of the Marcus Welby practice. Some older doctors are finishing out their years and will shutter their offices when they retire. Young to middle age physicians are selling out to large groups and new physicians would never even consider this type of practice. They are looking for an employed model from the outset.
Every doctor I know who is currently in private practice is Read more »
*This blog post was originally published at ACP Internist*