Skip to comments.Care by the Hour
Posted on 08/30/2006 12:22:11 AM PDT by neverdem
A PRIMARY care doctor Ive known since we were residents 30 years ago recently described for me his typical day as foisted on him by current economic realities. He rises at 4 a.m. to make a dent in his avalanche of paperwork before dashing off to make rounds at the hospital and arrive at his office before 8. For the next 10 to 11 hours, he races through a series of patients so long, he cannot talk to any one of them as much as he believes he should, and he constantly worries hell miss something. Worst of all, he admitted, he no longer enjoys practicing medicine.
Ten-plus years ago primary care was lauded as the potential rescuer of a health care system in chaos. Primary care doctors, it was hoped, would fix what had become an expensive, fragmented specialty system geared toward treating emergencies and episodes of acute illness. Thanks to new technologies and treatments, medicine had become a team effort, but the teams needed captains who would keep patients overall health in mind, and that role was to be filled by the primary care doctors: internists, family physicians, general practitioners and pediatricians. We would all know our doctors, and they would know us.
But unfortunately, primary care has not flourished, and the ranks of primary care doctors are thinning. As reported in a series of articles in The Annals of Internal Medicine in 2003, medical students are...
Ideally, the hourly rate would not be the same for all primary care physicians, but would be assessed on a sliding scale, predicated on a doctors level of education. Internists and pediatricians the primary care doctors who have had the most training would receive a higher rate than general practitioners and family physicians would.
(Excerpt) Read more at nytimes.com ...
My guess is that they're referring to Continuing Medical Education seminars, though I'm not sure.
I can say that this situation is going to get worse unless some drastic changes are made. I'm a med student working with a doc in Internal Medicine. The very first day we showed up at our preceptorship, he told me and my classmate to avoid primary care like the plague. He's a great doctor, very personable, and the kind of guy you'd want to see. He knows his stuff, and he's good for a laugh when it's needed and sympathy, as well. Always participating in medical pharmaceutical trials and keeping on top of things.
That said, his schedule is running him ragged. He sees 4 times the number of patients that a lot of doctors see in a day (who earn 2-3x more than he makes). I don't see the point, frankly. Specialize and move on. An extra 2 years of residency/fellowship are definitely worth it.
On top of this you're going to have a lot more women physicians arriving on the scene. Women who are traditionally a lot less willing to work long hours. Guess what that's going to do for the doctor shortage?
Well thank goodness this is what happens when you have socialists running the medical system. Now in America we have it great, insurance companies are driven by market forces to keep both the suppliers and consumers. I mean the doctors can just refuse to work with any company that doesn't pay his desired wage.
I guess the days of house calls and things done on a human level are really over. Sigh . . .
They are no longer part time psychologists with a bedside manner.
You do comedy as a side job, don't you? The insurance companies are a HUGE part of the problem in this country. Note the sentence in the article at the beginning about the mountain of paperwork the doctor has to deal with. That's courtesy of the insurance companies
The only thing the insurance companies work toward is to keep their profits up, and you, your doctor, and your health be damned. Not flaming you, just pointing out the experience I (and everyone you talk to, pretty much) have had with the insurance companies.
Sorry that was sarcasm.
Yes, that's right, three years after med school.
I have 11 years of practice as a primary care Internist, and 12 as a Gastroenterologist. My life is definitely easier, and better paid, than it was as a primary care doc. Of course, I earned that by staying on in training extra years beyond what primary care folks do, and by the fact that my work involves higher-risk procedures, using much more expensive tools, with higher malpractice cost. And my knowledge of my field is deeper and more current compared to a primary care doc, who must cover a larger area of medical knowledge and so cannot go as deeply into any one area.
Having been both types of doc, I can tell you that it's not that specialists are overpaid, it's that PCPs are grossly underpaid. But if you want to rectify the underpayment of PCPs by underpaying specialists (a truly socialist idea) then be prepared to wait six weeks for your heart disease or colon cancer to be treated, because who wants to do all the extra training only to be paid as if they hadn't?
Socialism can only level down, not up, making shortages, not plenty.
I might add that it's simplistic to reduce the matter to money alone. The hassle factor of primary care practice has to be experienced to be believed. And that hassle factor has nothing to do with the nature of a PCP's work. It is imposed by--you guessed it-- government. The commercial ensurers, as the article states, follow Medicare's lead because they can get away with it.
If I could drop Medicare and all commercial insurance, and escape the incredibly intrusive and useless paprwork and regulatory burden imposed by them, I could go to a cash-only basis, cut my fees in half, and still increase my income. I am absolutely convinced that if Medicare never happened, we'd still have excellent quality of medical care in this country,it would be cheaper, and primary care would retain its place of honor in the field of medicine. As it is today, excellence in primary care is punished.
Nice, informative post, thanks.
Being completely uninformed about the realities of medical practice, I find myself asking, ''OK, why can't you do this?'' Not being a smartass, here -- I'd really like to know. Some sort of regulation? Ethical rules? I haven't a clue.
Would you please elabourate a bit? In layman's language, please ;^)
My guess is the cash market is too small.
Short of calling every physician in the book, though, I wouldn't know how to do that. (shrug)
I wonder how he proposes to coerce docs to accept hourly pay? Probably by using government. If it was more efficient to pay docs hourly, one would think they could charge it themselves (as some do, cash only psychiatrists), or the HMOs etc.. would do it.
Benefits from the Social Security funds and Medicare have both been turned into a vast welfare program. If SS served only workers who've paid into the system, I don't think it would be in such trouble. Also, there's a lot of doctor fraud with Medicare and the SSA does not police this very well at all. Congress has created the SS mess, very deliberately.
There's a small group of doctors in southern Oregon who've gone to cash-only, don't accept insurance of any kind, and the last I heard, they were saying they have begun to love their work again and are making better money.
Afraid I'm not in Oregon, however, so I'm looking for more local information.
I think yoiu are mostly right...it's up to the doctors to make their own profits, and they should never have expceted the isnurance companies to "care", as that is not the latters' job.
Amen...Primary care IS punished, adn I encourage all the med students who train with me to avoid it like the plague! After 4-1/2 years of slapping myself in the head with the frozen fish, trying to make a go of it in an office that plays the stupid insurance game, I had had enough. I had been moonlighting > 100 hours per month in the Er to pay my bills, and just went there full-time, signing my half of the office over to my partner whom I could not convince to go cash-only. FP's and internists should do clinic-based, primary care work only if they are cash-only and free of insurance and hospital i.e. Medicare/Medicaid involvement.