Valerie Brooke, MD
Doctors Don't Like the System Either
One of my readers made a suggestion in response to my recent post Assembly Line Medicine, where I described the experience of seeing my primary care physician. I remarked how limited my time was with her and how so much of the visit was focused on data gathering in order to meet the needs of insurance companies and the meaningful use criteria standards set by the government. My reader suggested that I get another doctor, one that would take the time to really listen and get to know me.
I was shocked by this response and felt the immediate need to defend my doctor. I really like my physician and she does take time to listen to me and get to know me, no matter how many minutes she is able to spend with me. It’s not the doctor that is at fault, it’s the healthcare system. It dawned on me that many who don’t work in medicine don’t see the other side the therefore are unable see or understand that most doctors also don’t like how little time they spend with their patients.
Medicine is a business.
The more patients a physician sees, the more money the clinic or hospital can bill private insurance companies, Medicare/Medicaid, or the patients themselves if they are unfortunate enough to not have any health insurance. A certain percentage of any billing is expected to never be paid. Insurance companies, the federal government (for Medicare), or the state government (for Medicaid), set the payment amounts. Medicare and for sure Medicaid payments do not cover the cost of providing care to the patient, no matter the setting. Private insurance companies pay better, but these payments are also set by a contract between the healthcare system and the insurance company. Many times over the last several years I have lost the ability to provide care to some patients because their insurance company and our hospital system could not agree on a fair contract, one where the hospital makes enough money to cover their costs, one that the insurance company can also cover their own expenses and make a profit.
Medicine is a business.
A primary care physician in today’s world therefore needs to see a certain number of patients per day in order to cover the costs of running the business, including all the building and utility costs, the expected lost revenue due to bills not being paid, as well as paying all the employees and malpractice insurance. And unfortunately, in the way the payment system is set up, office visits where most of the time is spent counseling the patient say for example on making healthy lifestyle choices, pays way less than any procedure that is performed, like an injection in a joint. In the hospital environment, surgeons generate the most revenue because of the nature of surgery in itself and the perceived value that is placed upon it by insurance companies and Medicare/Medicaid.
I am blessed to work in a hospital environment where I have more say over how many patients I am able to see every day. My patients are sicker than someone seeing their doctor in an office environment, so that my billing generates more money for the hospital system. I find there is a very line between just the right amount and too many patients. And it varies day by day. If it’s a smooth day and no one is having a medical emergency, there aren’t any family psychosocial fires to put out, there aren’t any administrative meetings to attend, then I can say “yes” to one more patient admission. In the beginning of my career, I would never say no; to more patients, to more responsibility, to more administrative tasks, to more…whatever was asked me. But then I hit a bottom and got burnout out. Now I have set a limit, one which allows me to take the best care possible of my patients, give them my full attention, while not sacrificing my own physical, emotional, or spiritual health.
I am fortunate that I can set limits. My primary care physician cannot. And if I were to change physicians, because I have to stay in my own insurance network (unless I want to pay cash for my healthcare), the next physician will have the very same expectations as my current one does. So, the answer is not to change my physician. The answer is to change the system.