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Obama's Health Care Reform Inspires Little Confidence

There are some funny misconceptions about the life of a doctor. I have practiced internal medicine for 20 years. My two hours off for lunch are spent seeing patients in the hospital; my nights and weekends are spent doing paperwork (filling out Medicare forms justifying the use of Depends; those miserable forms form the Scooter Store; recertifying people for home oxygen, petitioning insurance companies to allow me to use certain medicines, or get a walker paid for, plus writing letters to patients, returning calls, etc etc). On average I spend about 20 hours a week doing this invisible stuff, and my workweek averages about 70 hours, 51 weeks a year. My call nights of course kick that up to maybe 90-100 hours, I don't know.

Meanwhile, my income (in nominal dollars) has risen a grand total of only 15% over the past decade. I make a decent wage, but at enormous personal cost, and I'm losing ground.

The fact is, primary care doctors, at least in my region of the US, lose money on Medcare and Medicaid patients. Simple irrefutable fact. So---we have to pass those costs on to the rest of you to stay upright. There are exceptions in specialty care---some quirks of the fee system allow for ridiculous charges e.g colonoscopy costing multiple thousands, but most primary care doctors feel embattled and many would quit if they could.

The fat cat doctor is largely a myth---at least in primary care. And herein lies the dilemma. It sounds fine, all of this talk of savings, but it has to be accompanied by reduced and more realistic expectations. I could see more people (with reduced unit costs per patient) if I didn'thave to fill out all of those @#$%% forms and push against various bureaucrats, and wargame my practice style to counter the malpractice attorneys who fish in these waters.

I have found that no one wants to do without---as long as someone else is paying for it. As the saying goes "Everyone wants to go to Heaven, but no one wants to die to get there". In this case, many/most people are more than happy to utilize the system e.g. have a brain MRI because they have had a headache (even when doctors try to dissuade them) but then act shocked when their premiums rise.

There needs to be less care, less doctors, greater acceptance of mortality and hardship. This isn't heartlessness---I love my practice and my patients. Compassion and understanding don't cost that much....but unfortuantely they don't generate clinic revenue, ROI, and don't pay for my nurse, typist, insurance compliance person, coding and billing specialist, quality compliance auditor, or my malpractice insurance. You get the picture.

--Written during a break in the action on call, 3 AM