Wednesday, June 13, 2012

10 Reasons for Not Being a Solo Doctor in America

1.  The processes for getting paid each week keep changing, have become unnecessarily complex, and are not reliable;  therefore whether or not you get a paycheck (and for what) is not under your control.

2.  You need to learn a new language for sending out bills.  It is called "coding" and, while inherently logical, it requires that you attach numbers to everything you do.  This makes no sense when applied to a humanistic enterprise.  People and people-based services cannot be reduced to codes.

3.  Surprise!  You are working for insurance companies and pharmaceutical companies, not for patients.  Your job seems to be to help them get richer.  The things you might do for patients are, ultimately, "extra."

4.  There are regulatory agencies dictating nearly everything you do, including the appearance of your signature, the temperature of your refrigerators, the computer software you use, whether or not you can talk to patients about things like abortion, how you talk about death, who you hire, and whether you need malpractice insurance or not.

5.. There is a constant, real threat of being investigated by governmental agencies (like the FBI) staffed by individuals who can advance their careers by making a case that you are breaking the law.  This threat has increased since laws were relaxed to allow for arrests explained by "the war on terrorism" and "the war on drugs,"  and now allow government forces to storm your office, steal your medical supplies, charts and operating capital, and cross-examine your staff and patients in the middle of office hours...without having to provide an affidavit or explanation of any sort for up to seven years.  Even a court of law is no use when FBI agents decide that you, a solo doctor, are a threat to the nation.
6.  It is easy to break the law without even knowing it, or to be made to seem to break the law, because the rules for seeing patients, writing down what you do, and submitting requests for payment are contained in government documents that are thousands of pages long, contain many self-contradictions, and are obfuscatory.

7.  There are no representatives at the government and insurance company levels who understand the business they regulate (doctoring), or who can give clear instructions about what medical services are or are not payable, or who can be located in their respective, labyrinthine offices for questioning a second time when their advice or instructions are found to be wrong.

8.  Your patients and your staff are constantly being encouraged, petitioned and even rewarded for identifying and reporting you for things they think you might be doing wrong, and to regard these things as criminal.  These same people, patients and staff, continue to expect you to treat them with utmost humanism and courtesy, and to save their lives if need be, and to pay them, provide benefits, and guarantee a calm and secure workplace.

9(a).  You live with expectations from a bygone era, such as that you will be available day and night, you will sacrifice your personal life out of dedication to your profession, and you will treat people without needing to know whether or not you will get paid.  9(b).  You live with expectations from the modern era, such as that you will have a balanced life, get enough rest, take time off to avoid burnout, be a model of health, participate in community events, and meet the emotional needs of your partner and family.

10.  You are required to write down every detail of everything you do or say with every patient, as well as the reasons for doing and saying what you do, as well as your thought processes leading up to these reasons, however deeply entrenched in long and specialized training, as well as your hunches;  your handwriting must always be legible;  and you are required to do this in language that is simple enough to be understood by coding experts or average Americans.   But you must not be angry or surprised when you do not get paid for work you did, if "coding specialists" hired to read your documentation and to find reasons not to pay you say they can't understand what you wrote or why you did what you did with a patient. 

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