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:
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