I’d like to post a dissenting view to my primary care op-ed last week. The writer gave permission to have it published here. I appreciate the feedback:
Your article in USA Today was quite instructive of the way the medical community thinks and why we are in trouble.Your description of “fee for service” and how it is affecting the medical community reveals the incredible naiveté of doctors and other medical employees. This fee system is, indeed, how business in general works. Different prices for different products is what is termed “product mix” in the real business world. Every company is subject to this phenomenon Some products are incredibly profitable and some barely cover overhead, or are loss leaders. And many of the “consults” or services that I provided as a manufacturer of foodservice equipment earned absolutely no fees. Unlike you, I could not charge for my “professional time”. I hoped that it would bring in profitable business and prepared my presentations and dialogues to bring about this result ,but had many failures or missed opportunities. The last two doctors I saw (for a skin condition and for gall stones) both came up with no diagnosis or proposed solution yet each charged me their “fee” of $110 and $230, respectively
The “indiscriminate cut of reimbursements” from the government is quite comparable to what we term “the marketplace”. Everyone expects to pay less and less for better and better products and services. Witness Costco, Wal-Mart, Sam’s and the appliance industry in general. Rather than griping about cuts from the government (and I hear it constantly from my doctors), doctors and the medical industry should be working feverishly on ways to reduce expense and cost. The only reason I have a fax in my house is for doctors. Every other industry accepts scans and PDF files on a computer. My insurance agent, financial advisors, my drug store, my mechanic… all of the services that I use and purchase are computerized. Only my doctors (my orthopedic surgeon excepted) have paper files and shelf after shelf of records that require intense labor (read cost) to maintain and use.
Time management is severely lacking in the medical community. Time is money and doctors have no respect for others’ time, and apparently their own. My wife recently had foot surgery. We were told to report to the hospital three hours before the procedure. When the nurse at the hospital asked why we were there so early we explained that the doctor’s scheduler informed us that the doctors usually run ahead of schedule and this way they would not have to wait if they got ahead. This itself is rather arrogant (don’t make the doctors wait when a customer can do the waiting for them) but was made even more ridiculous when the nurse told us she had been there since ‘94 and had never seen this surgical group run ahead. Doctors should have courses in time management in their medical training. We all have different skills from different disciplines but we all need to manage our time to be efficient and affective. If doctors use their time better then they will do more and make more…just like the rest of society. I wished that I could have charged more for certainly products that I produced but the marketplace just wouldn’t pay for them. So, I had to change my “product mix” and increase my company’s efficiency. Hint for doctors!!
Office expenses are rising everywhere. Cross training, better use of technology and modern equipment all make a great difference in how those costs can be contained or how productivity can be increased. And I constantly hear from my doctors about liability insurance; and you point it out in your article. EVERY business has to buy expensive liability insurance. We paid hundreds of thousands of dollars for our insurance. We were routinely sued by consumers who misused our equipment or who blamed our equipment for problems. It’s a part of doing business. Only doctors seems to believe that they are exclusive in this area. Perhaps in their arrogance doctors think they should not be sued or blamed for incompetence or mistakes. We all make them and we all have to take responsibility for them.
Medicine is a business. Doctors still think they are special because they took an oath. Usually implying that the rest of us are reprobates for not taking oaths. Ethics are ethics whether you take an oath or not. It’s a business and not a calling. People with a calling don’t bitch and complain about their fees and insurance reimbursements and Medicare cuts.
Most doctors make a good living. Just do your job as well as you can and stop complaining.
Thanks for listening and I hope that changes are made to improve the medical industry. It might be severely broken but we still need it. By the way, I pay $14,820 a year for health insurance.
Update:
A reminder that any comments that contain profanity or personal attacks will be deleted.
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The commenter does seem to forget that physicians are required to treat patients in the hospital whether they can pay or not. If every restaurant had to feed everyone, there would be no restaurants left.
I do agree, however, that no one is forcing you to accept third party contracts. I hear pharmacists complain about reimbursement rates as well. However, some of the most successful retail pharmacists I know are the ones that dropped all third party plans and went to straight cash payment. They do half the work and make twice as much money. That option is available to physicians as well.
It’s all very easy to simply say “don’t sign the contracts” with medicare.
People just don’t seem to understand how difficult it is to get away from Medicare.
It’s not really a matter of simply not signing a contract with them.
If you are a licensed physician, you are by default signed up with medicare, whether you like it or not.
(Also, If you are a U.S. citizen over the age of 64, you are by default a medicare patient, whether you like it or not.)
It is possible to get out of medicare, but it is a lot of hoops to jump through to do so, and even then, they still have their tentacles all over your practice and will prosecute you for fraud if you make a simple clerical error involving any patient who has medicare and comes into your practice (even though you have opted out of the medicare program).
Anyway, I personally think all physicians should immediately drop out of the medicare program altogether.
That way, every U.S. citizen over the age of 64 can just go suck eggs.
Hey, nothing personal grandma, that’s just business.
“The same basic asset protection strategies that every other business owner employs apply to you. “
Sorry, but they do not. Professional malpractice claims are exempted from the ordinary asset protection strategies used by most businesses in my state. Incorporating does not help. Home protected–sorry buddy, in my state only if it is less than $30,000 dollars–in other words a 10 year old mobile home on stilts in a swamp.
“change product mix” . . . .
In medicine that is done by denying care to whole classes of patients –those who most need care, instead offering cosmetic feel good services that are unneeded. It is why you can’t find a dermatologist to manage a real skin disease or a psychiatrist to treat the seriously mentally ill, why it is easy to get a heart cath but hard to get a thorough exam by a cardiologist, why it is easier to get ineffective back surgery than good advice as to whether you really need it-because more and more people are taking that advice. Be careful what you advise.
Doctors are poor businessmen and whine way too much–but be glad of it because if every one of them woke up tomorrow cured of the whine flu and emdowed with good business acumen which they applied proactively, the American people would rue the day.
I am a good businessman. I decided years ago that I wouldn’t lift a finger until assured of a fair payment with near 100% collection with minimal expense and liability. The best way to do that was to completely remove myself from the mainstream of providing any kind of truly needed care. When I or my loved ones get sick, I thank God that most doctors are worse businessmen than I.
“Professional malpractice claims are exempted from the ordinary asset protection strategies used by most businesses in my state. Incorporating does not help. Home protected–sorry buddy, in my state only if it is less than $30,000 dollars–in other words a 10 year old mobile home on stilts in a swamp.”
What state is that?
“Doctors are poor businessmen and whine way too much–but be glad of it because if every one of them woke up tomorrow cured of the whine flu and emdowed with good business acumen which they applied proactively, the American people would rue the day.”
Nonsense. Just like with any other profession, there would always be some who would still work for the govt, or for the insurance companies, because they liked the hours, or the security, or didn’t want the hassle of running an office.
You guys aren’t as unique as you think in terms of motivations.
“Nonsense. Just like with any other profession, there would always be some who would still work for the govt, or for the insurance companies, because they liked the hours, or the security, or didn’t want the hassle of running an office.”
Maybe you will get your wish. Medicine run like the DMV (or VA). Doctors working 9-5 with a one hour lunch break, no weekends, nights, holidays.
It seems as though this opinion piece has been taken out to the proverbial “woodshed” if you get my drift. I hope you did not post this weak sh!t to make yourself look good Kevin because I found many of these arguments flat out naive and uninformed.
This is the dissenting commenter replying to Whitecoat. He seems a bit abrasive and somewhat personal but that’s his right. No, I’m not an economist as he sarcastically states. Just a business man who worked very hard in a business.
One of my comments was that doctors seem arrogant. Whitecoat seems to bear that out. There is a long list of items that he seems to think pertain ONLY to doctors.
1) Medical school loans of $250,000. I had to borrow $1.3mm to get my business going. And the bank then wanted 10% in warrents. Doctors always talk about their loans. Most business people I know say nothing about the huge debt we incur to own a business.
2)He points out that doctors have “no pay” customers. EVERY business has no pay customers. It’s called a bad debt reserve on the books. We had it as did all of our competitors.
3)I didn’t just buy and resell products that could be changed instantly for a better product mix. I manufactured complex electronic products for major chains around the world. I had to deal with the bad as well as the good. I had a complete engineering staff to develop products for potential customers and markets. As with just about every manufacturer, we always tried to develop what was needed but failed as well and rarely recovered these costs. But, there were other successes that paid the bills. Just like doctors, we got paid for some things and not for others.
PS to you and others who implied that that I thought the doctors’ charges (in my example) were not justified or paid. I did pay them and they were justified, if not a bit high for the time spent – less than 5 minutes in each case.
4)A partner and I owned our “corporation”. It was an S corporation with personal liability. When you arrogantly refer to our company easily passing on liability costs you do a severe injustice to many people. My 401(k), my house, my savings, my daughters’ college bonds (everything I possessed) all were committed to the company as collateral. Why would you believe that only doctors would lose these things with malpractice suits. Arrogance!!!! Doctors are not the only ones, as you ridiculously believe, who pay huge sums for liability insurance and take huge responsibility. If I had three judgements against me I would have been out of business. Sweep them under the rug? Not if I were to remain ethical. Other people do the right thing besides doctors. It’s called personal character – not some oath. And then you have the gall to state that if the corporation goes bankrupt, SO WHAT!!! I’ll tell you what happens – the 325 people that I employed would have been out of jobs and benefits. SO WHAT!! You need to look around at the rest of the world.
I may not understand the root of the medical issues with this country but, unlike our medical doctors, I do understand that all people who try to do important things expose themselves to huge risks, whether it be savings, homes, family, employment or good reputation. I took all of those risks and resent being told that only doctors experience these types of dangers. I worked 70 hours a week and spent weeks away from home with customers around the world. Running a business is not a 9-5 job.
Our medical system does not work. And we must all be willing to try new and different approaches rather than just sarcastically and arrogantly pointing out what other people don’t know since they are not “doctors”.
Mr. Businessman:
How many of your employees borrowed $250,000 to pay for their educations before they came to work for you? How much did you borrow for your education? Did you have to borrow and then wait until your mid-30s before you could earn a living? What you don’t get is that is personal borrowing for the education. That isn’t what you have to borrow to open a practice. The practice loan–something you seem to confuse with school loans–can easily cost several hundreds of thousands more, which banks do not give on any better terms than you got for your warranted startup funding. (In fact, since there is no warrant-based equity, the interest is higher.)
Sure, you have “no-pay” customers. But those are customers of yours by choice. You can demand cash terms for six months and extend credit where worthy, and some of that could go bad anyway, but you can always turn away a customer’s request for credit you deem not credit worthy. In medicine, especially where emergency duties are involved at a hospital, that kind of scrutiny and risk avoidance is prohibited. By law. Does the law say who you have to extend credit to? Doubtful.
Who sets your prices? Sure, a big reseller will try to gouge you, but does the government tell you how much you are allowed to sell your machines for? Do they tell you that you have to sell them even if you lose money by doing so? Do they try to tell you that if you don’t sell them at their fixed price that you can’t sell those machines to better customers who might pay with cash rather than with credit? Do you have the freedom to offer your cash-paying customers the best deal over those who pay after delivery? Doctors don’t.
Do you really think we believe that bankruptcy for you means firing all your workers? Maybe in Chapter 7 liquidation it might, but not in reorganization. Your stockholders might want your head on a pike, though.
You don’t seem to understand “the root of the medical issues in this country” so you might stop being so arrogant yourself by suggesting that every doctor who points out what you seem not to understand is doing so out of “arrogance.” You say White Coat takes this personally, but so do you.
70 hours a week. Sounds tough. I topped out at 135–no kidding–on my feet, working, as a surgery intern. That is illegal now, supposedly. Weeks away from home? Where did you sleep, at a hotel? With room service? Try a tent sometime, in the Middle East. And think how it might be to work 70 hours a week, every week, your whole career.
There is a lot wrong with the medical system in this country, and the patients, not just the doctors are a big part of that problem.
Squeal about arrogance all you want, but it won’t get you anything. All I hear in that is denial of personal responsibility.
The big pain is coming yet–you be sure of it–and there will be plenty of hurtin’ to go around, for the arrogant, the ignorant and everyone in-between.
“All I hear in that is denial of personal responsibility.”
That’s mostly what your post consists of.
I have stated elsewhere that doctors have created this mess due to their monopolistic ways. Period. They entered into what amounts to collusion with the insurance companies and government to create a systems that does not work.
I am an analyst with years of experience in many different fields. Guess what? Medicine is the worst run field of all. Your efficiencies all suck because you refuse to enter the 20th – let alone the 21st century in tech and management techniques. Do you realize the money savings that could ensue with an initial cash layout in reorganizing the medical system? The AMA sold all of you out by their practices – but this is part and parcel of the past 30 years of all of US business and policy. Basically, an attitude of “eat the young for the benefit of the old.”
As to being forced into taking insurance, and, being forced into treating patients in the hospital? Well, the best dentists and doctors I have ever had I paid cash for – sometimes they went back to taking insurance, but often they retired. If you don’t want to be forced to take a patient, don’t practice at a hospital with an ER. They exist. I agree that the ER law is an unfunded mandate and should either be funded or abolished.
Really, most of the complaining and whining some physicians engage in just make no sense. They are doing nothing tangible to initiate meaningful change.
Bad management is not an excuse for continued failure. You will either change your business management styles or your profession is doomed.
And, no, I don’t mean MBA style management. That is a sure fire way to the poor house for all but a select few. Go talk to successful entrepreneurs in other industries. Every industry has something to teach one another. Yes, there are unique things to each industry, but they share a lot more than even they realize. Do you think there aren’t unfunded mandates in other industries? How about the 911 requirement for telecom companies? (Oh, and lives depend on that one, btw.) That is a major profit drain – and often can break the smaller carriers. (Yes, COA is black magic that makes insurance codes look like 2nd grade reading. I’ve seen both.)
The medical professionals who will survive and thrive in the future are those who will leave the 19th century practices behind and skip forward to the 21st century.
As to the poster who claimed grandma doesn’t have email? The fastest growing demographic for computer usage is the elderly. And they use email much more heavily than teenage girls use MySpace.
I seriously am beginning to think that many physicians are very out of touch with their patient’s reality.
As to HIPAA – it should just be repealed. It is, like Sarbannes-Oxley, nothing more than a “make the consultants and lawyers rich” scheme. After all, they wrote it.
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