Sunday, June 24, 2012

Why Are Solo Docs Selling Out?


1.   THEY DON'T TRUST THEMSELVES.
     Solo docs get tricked into thinking someone else can do it better.  Doctors are sensitive. This is good because they need to register the little messages patients are always transmitting below the radar.  But they are too sensitive to the corporate messages, which amount to advertising and can be subtle or in-your-face.  The corporate propaganda has this theme:  Let us handle the business of medicine so you can do what you do best, doctoring.  Aren't you tired of late nights and burnout?  Come with us and we'll guarantee you a high quality of life.                      
2.   THERE ARE TOO MANY AUDITS. 
      Doctors feel offended by daily auditing of their medical records by insurance companies whose intention is to intimidate doctors into under-coding for their work and offering their patients fewer services so that insurance companies can increase their profits.

3.   MEDICARE IS BANKRUPT.
      Because they are threatened, year after year, by large Medicare pay-cuts and are made to feel personally responsible for the mismanagement of all the money tax-paying individuals have entrusted with the Medicare program.  Starting in July or August of every year doctors are warned that they will have to accept lower pay, despite the escalating costs of running a practice.   This year the projected Medicare pay cut was 29.5%.  Every medical journal seemed to make it a top story.  Then, as has happened every year this decade, in March or April we were told, "Congress Averts Doomsday but Medicare Pay-cut Still Looms."  Is there even a sigh of relief in these headlines?  Medicare and Medicaid face $320 billion in cuts over the next ten years.  (What if your boss told you he probably couldn't sign your paychecks much longer?)   For some reason doctors think their corporate employers will fare better in this environment, and they sell out in order to shut out the din of threats.

4.   INSURANCE COMPANIES REJECT CLAIMS.
     All insurance companies regularly decline to pay for services performed by the doctor, and the procedure for appealing the decisions is preposterous.  It involves an interchange of forms and electronic responses;  human beings seem to be absent from decision-making by insurance companies;  explanations for non-payment are on the order of "the documentation doesn't support the need for service;" and insurance companies spend 100% of their time eroding the doctor's stamina, whereas the doctor is spending most of that time seeing patients. 

5.   DOCTORS NEED TIME FOR THEMSELVES.
      Doctors have inherited a long tradition of self-sacrifice, working long hours and ignoring their bodies and souls.  They are still not very good at making time for their families and friends.  They think corporations can solve this problem for them.

6.   PATIENTS HAVE UNREASONABLE EXPECTATIONS.
      Patients have also inherited the tradition of expecting doctors to sacrifice themselves and have unwittingly acted as partners in the doctors' self-destruction, for example by calling and saying things like, "You shouldn't be up at 10 pm taking care of patients...but could you tell me what's wrong with me before you go?"  Doctors think the corporations will bully patients into better behavior.

7.   HAVING A CALLING IS HARD.
       Every job--especially a job that is a calling--requires a measure of self-sacrifice, and doctors don't want to admit this.

8.   MEDICINE IS OVERREGULATED.
      The federal government, heavily influenced by lobbyists who stand to rake in big profits for their corporate employers when Congress acts on their behalf (from which profits the corporations will make tidy behind-the-scenes campaign contributions),  is mandating changes in doctors' office that don't make sense for doctors or patients.  First it was the use of tens of thousands of numerical codes to explain to insurance company computers how a doctor diagnoses and treats each patient;  then it was expensive billing software requiring constant maintenance; then it was HIPAA compliance;  then it was OSHA, CLIA, AHCA agency regulations;  then it was E-prescribing software, often duplicating handwritten prescriptions and doubling the doctor's work; then it was quality-control reporting;  and now it is electronic health records (price: $30,000 to $150,000, plus one to two years of transition costs).  These mandates don't improve efficiency in most offices.  They get in the way of patient care, and they don't  acknowledge the deeply personal methodology of doctoring.  Coding a visit,  for example, is akin to synopsizing Wagner's Tristan and Isolde to five lines, converting it to numerical codes, and attaching a dollar value to it.  While some translation must occur now that patients don't pay for their own services, what  really happens in the exam room is lost in this process.

9.   INSURANCE COMPANIES SEEM TO OWN EVERYONE.
      Doctors are afraid to bow out of the insurance system, thinking they won't have enough patients.  Because patients think insurance really is a "benefit" and are afraid to bow out too, paying their own way, saving premiums, staying healthy.

10.  PATIENTS HAVE BEEN MADE SUSPICIOUS.
       Patients are incited by insurance companies to report their doctors when they think there is "over-billing."  Most doctors don't over-bill and are not criminals, but patients are led to believe otherwise.

11.  MALPRACTICE LAWSUITS ARE PAINFUL.
       The threat of malpractice lawsuits still hovers over doctoring, not because so many doctors commit malpractice (they don't) but because, as a lawyer once told me, "when the economy is down people look for any way to make money."  Malpractice suits feel demoralizing to doctors, but they are easier to bear if they can be shared with a big corporate daddy.

12.  THE FEDERAL GOVERNMENT CONDUCTS RAIDS, WHICH ARE TERRIFYING.
        The federal government is criminalizing medicine, raiding and impugning innocent doctors like me with the intent of amassing money through intimidation, to keep the big machinery of a bankrupt government going a little bit longer.  The government is more apt to attack a doctor who works alone and is vulnerable than one who is ensconced in another kind of machinery with layers of protective armor, the corporation.

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