The following is a reader take by an anonymous primary care physician.
I am a primary care physician who is less than a decade removed from residency, and at a recent medical staff meeting, I witnessed the beginning of the end of primary care in this rural Midwestern town.
I work in a town of about 50,000 people roughly an hour outside of a major Midwestern city. There is one hospital in the entire county of over 100,000 people, which employs the vast majority of physicians in the area. Being a Healthcare Provider Shortage Area, they are able to offer some student loan forgiveness, but the warm fuzzies end there.
Physician retention has been a chronic problem. A malignant administration reveals itself almost before the ink is dry on signed contracts. They have recently forced increased unassigned call duties upon primary care doctors with no additional compensation. To our faces, administration promised us hospitalist coverage for not only our own patients, but also for the admissions for patients without physicians (a substantial percentage of the population).
The city itself has none of the charms of a small town and all the disadvantages of one. Having practiced in many parts of the state and country, the sense of entitlement, payor mix, tobacco abuse, sedentary lifestyles and obesity rates of our current patient population are nothing less than breathtaking. At best, it is a painful population to care for.
Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.
At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol.
After weathering repeated attempts to renegotiate our contracts in a blatantly deceptive fashion, our administration has dealt yet another demoralizing blow to the community’s primary care physicians. Subspecialists have an enormous return on the investment of “physician extenders” and do not surrender any of their autonomy. As a result of the awesome greed and narrow-mindedness of the proceduralists, primary care physicians will now have little recourse when the hospital offers insulting compensation packages.
What will motivate the system to improve the lives of doctors who have mortgages, children in school, and contractual “gotchas” when they can threaten to replace us all on the cheap?
Submit a reader take for consideration.
{ 24 comments… read them below or add one }
The answer is simple and you already know it, you have to be willing to say “no” and pack up the family and move to a new job and area. Generalist physicians are in demand almost everywhere. If you aren’t willing to move, then accept that a crappy job and low salary is the cost of staying put.
Another alternative for some of us is to drop third party payers and hospital affiliation. One of the major tools the hospital has to control us is the need to have hospital privileges to satisfy our third party payer contract requirements. However, based on your description of the area, it sounds like a cash practice may not work well there.
By your description of your community, I am struggling to understand why you value being there so much; evidently the lack of appeal is obvious to the would-be prospects as so few are biting at the hospital jobs offers. Having a relatively poorly-educated and chronically unhealthy population to serve is something I am amply familiar with in my town, (about an hour from the capital of this country, no less.) That can indeed be trying, as you see the full scope of the consequences of smoking, obesity and sedentary living, despite exhortation and having surprisingly good access to specialty care. Weighing three hundred pounds and walking with canes at age 50 just doesn’t turn heads, or minds like it once did.
Like others said, your best bet might be to move somewhere you would be happier. I have no doubt the headhunters already flood your mailbox with offers; they even flood mine, and I am a specialist.
Cash practices require patients with the ability and the will to pay cash. That is as much a cultural as it is a economic phenomenon. As you know, that isn’t going to work everywhere, particularly where the population is passive and expectant of their union insurance or Medicare to pick up every expense. But if you are not valued where you are, it is only going to come to you to find the community where your presence and service is valued, by the patients or the hospital.
(And BTW, I have given up seeing “non-profit” community hospitals as beneficent public institutions; many have become little more than quasi-profit-making entities without the corporate obligations to pay taxes or have accountability to shareholders. Like the Blues, their managers are often paid hugely, and they have long ago abandoned the shared sense of mission with their medical staff; doctors are merely occasional components to the business plan, whose needs are to be considered only when necessary.)
I found this expression of raw emotion resonating to my core as well. I am a solo internist who has been following the demise of primary care for the last few years since I finished residency. This poster shines a light on the dirty secret of medicine that no other posts call out. The fact that the majority of problems in medicine and the poor postion physicinas find ourselves in these days is our own fault and the generation of physicians that preceded us. We have never done a decent job policing ourselves, nor have we ever looked out for our fellow physicians. We are a greedy bunch of ego driven people that care only for our own well being. This was driven into our soul during medical school as the only way to survive and it follows us the rest of our days. If we as physicians cannot respect one another then why should we expect Insurance, Big Pharma, governement, nurses or even our patients to respect us. We paint ourselves as a noble bunch with patients’ best interests at heart but are we all really that altruistic? If we are, then we deserve to be exalted but alas we are not and we deserve the admonishment, loathing that we currently receive. We deserve to be at the bottom because we have not lifted ourselves to the top. If physicians would stick together and fight for one another the way the nurses do we would have power. If we would not sit idly by as the corporations chew us up one by one or enslave us by offering us meager sums to feed their money hungry machines; then we would be free. But we have not shown that we deserve freedom because we have not used our power responsibly. As long as physicinas act with the every man for himself philosphy, then we are all doomed. And because I am a physician and because I know physicians just like the poster speaks of, I believe the end is near and we will all be made to unite against our will under a system of universal health care. We will all be slaves because we did not fight for one another or our profession. Maybe we’re getting exactly as we deserve. For those who disagree with my statements you are part of the problem. For those that agree with me the only answer is evolution.
“Malignant” non-profit hospitals are a dime-a-dozen (especially in rural areas where a hospital can very easily monopolize and abuse resources with little resistance). NO ONE in state or federal government anywhere is doing anything about them.
I’ve spend ten years fighting one in my hometown (long story - public service/loan repayment nightmare - told in excruciating detail on my blog).
I’ve blogged on ALL of it . . . “my take” on being threatened for voicing concerns about quality of care/physician behavior . . . on getting fired (for ignoring the threats to save a newborn’s life) . . . on suing the practice . . . on being sued (unsuccessfully for “libel” - because I told the truth to the government I served) . . . on being swindled at settlement (by in-your-face perjury, contempt & fraud).
I’ve fought back with everything I have. Since discovering the perjury, I’ve plead the case to law enforcement and politicians and journalists from Raleigh (NC) to Washington. And I’ve jumped through every hoop in the blogosphere to get my story “out there”. No one cares. Oversight is non-existant.
Yet I’ve barely gotten a sniffle (and certainly not a link) from Kevin - and the MSM media has shut this story down. This is a “Sixty-Minutes” kind of story. But the powers-that-be do not want the general public to know what is going on.
I’ve made ends meet for ten years as a Locum Tenens. It’s not the life I wanted - and I have yet to give up my house in my hometown.
You’re damned straight that generalists are needed everywhere. But you would not know it by the way they are getting treated - or paid - by some of these “malignant” hospitals.
Why is the solution always for the doctors to leave? Why can’t some of these EVIL, CLUELESS, GREEDY, OVERPAID suits be shown the door?
In my case, why can’t I get someone to cast some public attention on my case and help me put two of these lying cretins in a jail cell?
The reason I fought is because IT IS MY HOME.
I simply will not let the liars and thieves win.
It’s way past the time our MSM media and medical blogger-kings started looking at this kind of thing as a BIG problem. I see the same things everywhere I go - different people making the same mistakes. It has got to stop! Because it threatens the very survival of medicine in small towns.
A lawyer once commented to me that all doctors are whiners. An uncle of mine followed up with a message to all physicians - “get over it”. No one cares. No presidential candidate cares, no hospital or insurance adminstrator cares, no attorney cares, and he added, no patient cares. Is this news?
What would be news is if GPs found a new set of balls and changed the rules. I won’t get into how I changed the rules but, a very simple solution for this whining physician - grow some balls and MOVE! And while your at it, take all the other hospitalists and GPs in that town with you. Let the towns be served by nurses and the proceduralists. If it was me, I’d be on the first pickup truck out.
It’s really not as hard as you think. Pack the family, find a town with nice schools and move. The back of the NEJM and JAMA have dozens of well paying non hositle. Heck, I’ll even hire you.
As an fp working in nearly the same type of geographical setting, I’ve had a very different experience. Our local hospital decided to evolve into a regional center due to our relative geographic isolation. We primary care doctors identified poor outcomes for our patients at “the big city” hospital 1hr. away esp. in regards to cardiac interventions.
With the cooperation of our health systems’ board/administration we set forth “the building blocks” to get to an Open Heart Program.
Our system has 3 part time “VPMA’s”, a pediatrician, myself, and a gen. internist. This and our administration’s doggedness in building up Primary Care first with very fair/equitable integration/suppport has helped to lead our board of trustees through the trying times in that primary care is a losing “business”.
However, that fundamental fairness was rewarded with a loyal integrated AND independent medical staff. Some of our independent doctors work through our systems surgical center despite the fact they may leave money on the table.
I don’t believe for one moment that is just from the kindness of their hearts solely, they recognize that other competing ventures have failed due to the LOYAL PRIMARY CARE BASE (whether they are integrated our not) supports our local institution. Understanding that IF we all give a little the system flourishes.
We now have had an open heart program for 1year now with 120 or so done the first year. Our case mix index 3 years ago was 1.01. It now stands at 1.33. The experienced trio of CT surgeons we recruited away from “the big city” certainly make a great salary, but I begrudge them not as I see the value (qualitatively as well as quantitatively) they have instilled in our system
I exist in a setting where our board/administation/medical staff seems to align as best as we can. Our administration hopes to get an ehr package together so that our region can go to the 3rd party payers and demand payment for ALL the functions a Pri Care doctor does. Whether we will be successful is dubious as of yet but it still doesn’t deter us from trying. In a community where all major programmatic development goes thru a clinical planning committee that advises the system on how to allocate those resources, we have been challenged. My two cohorts as “medical directors” and many other pri care doctors take the time to sit with our specialists to do that planning, and our system attempts to value that time. Certainly, any “breech” of this trust by one of our parties can bring this down like a house of cards. We must eliminate our jealosy of what one doctor makes as long as it is compliant,ethical, delivers a service to our patients and doesn’t bankrupt the system. Alignment of goals/ managing the polarities that exist CAN be done, BUT we’re not alone in making this work.
As you can tell, WE all take ownership in our system!
it sounds like the problem is the administration and yet the author include the specialists when doling out the blame.
in my hospital, all i hear is the hospitalists whining. they get 26 weeks off a year and they complain because they don’t get ‘vacation’ they want caps on their admissions and service size. they want to work for the surgeons but not the generalists. they want the hospital to increase their subsidy. they want to make more money, even though they are making 2x what most outpatient docs here make. (i mean, everyone wants to make more money, but these discussions shouldn’t be in public and they seem to take the tack of telling everyone possible in hopes it will become a populist outcry and nurses, doctors, and social workers will unite in demanding the administration treat the hospitalists fairly)
Allow me to expound on a point: “No once cares.”
Then WHY, I ask you, should earnest young people sacrifice their youth to become physicians? Why not just over to the dark side (i.e. law or hospital administration)? You’d have a much better chance of not having your life uprooted or everything you’d ever worked for destroyed.
All it would take to stop a lot what is going on . . . to make some of these overpaid suits look over their shoulders . . . is some publicity (of the “60 Minutes” or “20/20″ variety) cast on some of these (many) egregious cases/situations.
If I’d had one-tenth of the press thrown at the Duke “Not-A-Rape” case, I’d be home and back in practice again. All I’m asking for is that the law work the way it is supposed to work . . . and for two crooks running a small town hospital to be held accountable. I think people might respond if they KNEW - I know they would based on recent events in my hometown.
But the lid is slammed shut by the Chamber of Commerce and the NC Hospital Association - and even doctors’ own state & national “advocacy” organizations. They don’t want the public to know these things are going on. It’s bad for business.
I’m not a GP, I am a (general Pediatrician). We are the lowest form of life on the physician totem pole until a disaster happens. I don’t really care what the specialists do or make - if someone would only treat me/us with some respect (all of the time - instead in the aftermath of cleaning up a mess).
I don’t think it’s “whining” when the things you’re trying to fix are about patient care. As a young (obviously naive) doctor ten years ago, I didn’t believe that it was okay to roll over and go back to sleep while a baby was dying under the bad care of someone else (which is what my “malignant” hospital wanted me to do). . . I didn’t believe it was okay for a chief of Obstetrics to openly carry on an extramarital with an LDRP nurse, get her pregnant, and then abort the baby in the privacy of their love nest (that’s public record - he didn’t even get slapped on the hand by the hospital until the Medical Board intervened) . . . I didn’t think it was okay for baby’s penises to be mutilated by botched circumcisions (because someone was too proud to ask for help) . . . or their scalps to be ripped off at delivery because someone was impatient and late to a party (wait, that was somewhere else). There’s more, but my fingers are tired and my soul is sick to re-live some of this stuff.
I wasn’t interested in the money - that wasn’t the issue for me at all. But it was for someone else.
These things are NOT okay. Just leaving without doing anything about it does NOT help anyone (even the doctor who leaves - because if you do care it ALWAYS eats at you that you gave up and gave in). And it’s just plain WRONG.
Anon #3 is right on the money. We do not police our own. And we gave away any power we had long ago. The public thinks we’re rich bastards and bitches and that we (1) do not care and (2) can afford to be screwed.
I supposed that “the market fixes itself” is a valid argument: Physicians leave - care declines - the public rises up to make a change. But that takes YEARS. In the meantime, what happens to patients left behind. It would not take very much in terms of national/state regulation & oversight to put a stop to a lot of what has been going on.
“No one cares.” Someone should. And I’m tired of hearing everyone else (lawyers, politicians, journalists, business leaders, and even patients) “whine” about what is wrong with healthcare until they do.
And by the way, the anonymous posts are great. But if you want to really change anything, you can’t stay anonymous.
I work in OKC. The largest not-for-your-profit hospital is Integris Inc. The CEO, Stanley Hupfeld, pays himself $5 million/yr. As just one of many examples of egregious behavior, he put a giant photo of himself in the newspaper saying ‘thank you’ to the nurses for nursing week. It wouldn’t seem a big jump of logic to save the tax payer subsidized advertising dollars and give it to the nurses as just compensation.
Kudos to Mary Johnson and Concierge Doc….
You as a physician have more power than you recognize. This community obviously needs leaders like you.
You have developed the current pessimistic mindset of many physicians. As Mary stated you need to develop a mutual attitude of trust and ambition between specialists and primary care doctors.
In such a small town you should be a familar face to the residents, and are in a position to guide and lead this “typical” small town.
Obviously other physicians struggle with the same challenges you face in this small town. I am sure the specialists have similar but differentchallenges practicing in a small town. (are they itinerant with many satellite offices?)
The points made by anonymous are good ones, but lose their integrity when made anonymously. Your opinions are meaningless if not backed by your good name. Did you apply to medical school, internship and/or residency anonymously??
I think most of our angst has been expressed in this blog and the comments.
Mary Johnson, I will link to your blog, from mine, http://www.healthtrain.blogspot.com and if you like I would welcome a guest post from you.
Agree that you should pack up and move, life is too short and you will not be able to change the hospital administration. Just consider it a little lesson and move on. Please update us down the road
A useful link: http://www.guidestar.org
Requires registration, which is free.
Whatever your rural hospital is, look it up. The tax filings of the nonprofit with be there. Listed will be the highest-paid officers and employees. You can find what the “leaders”, acministrators, and sometimes the high-ranking physicians are paid.
If you are employed doctors, seems to me your options are to strike, or to leave. If the town is as bad as you describe, for Pete’s sake…..leave.
And more to the point, as alluded to here…..leave before the system there finds a way to tarnish your reputation.
You don’t see as much of this with lawyers, because the lawyers assume they will be corrupt, and have organized their profession accordingly.
Medicine is set-up with the assumption that physicians will all be saints. You have learned otherwise, the hard way.
Live is too short to be a coward. I’ve got to sleep at night.
Like I said, if some press attention and REAL blogging buzz got cast on some of these horrible situations - where “non-profit” executives have raped and plundered the medical landscapes (especially in small towns) . . . and have destroyed careers/lives . . . if some laws could get tweaked and changed to make it easier for doctors to stand/be REAL patient advocates & community leaders . . . MORE doctors could SAY NO! AND STAY.
I’m signing my name and I need help. I need 60 Minutes. I need 20/20. I need CNN. And I’m asking for it - no I’m BEGGING FOR IT - right here.
I’d like to see medical blogging become more than an ECHO chamber.
And thanks, Gary. From the bottom of my broken heart.
Most of us have a zone of comfort and will act only if pushed. My push came when my Administration unilaterally told me they were taking over my practice and hiring me as an employee. That had been expected but when they offered me 31 cents on the dollar and told me to take it or leave it, I left. Best thing I’ve ever done. Much happier and making twice as much now in a better location.
Side note: I’ve posted a few times and always anonymously. Some people are vulnerable to retaliation but that is not my reason, I’ve tried to post with my name and just not been able to run the gauntlet of the sign-on process.. So I don’t think one should think comments by “anonymous” lack integrity, it just is much easier to post that way.
Im with the other posters who recommend leaving-all of you, PCPs and hospitalists. There are lots of other jobs out there, you just have to be sensible, methodical, and determine what you want. That hospital will probably be better off if you leave, because then maybe real change will happen there (then again, maybe not ..).
Good luck!
I’m back.
It’s not just primary care. The profession is in deep trouble and has been excluded from a lot of important decision-making.
Comment at http://executivephysician.blogspot.com/2008/05/accountability.html
As a first-year med student who came to med school with the absolute intention of going into primary care and working with the urban underserved, I read these kinds of posts, and their attendant comments, more and more and with an ever-increasing sense of despair. Anonymous (5:30p) is exactly right; for all the sound and fury about primary care and “service” that was trumpeted during the application, interview, and admissions process, and then again during orientation, it is abundantly clear that neither are valued. Among my classmates, Family Medicine has a reputation as a refuge for the bottom 10th of the class and seems to be met with a contempt only slightly less venomous that that held for Osteopathic schools. Medicine seems to fare somewhat better, but only because of the microsubspecialists who lecture to our class. You can’t swing a dead cat without hitting somebody who wants to be an orthopod. What’s more, despite all the early enjoinders to join the great primary care revolution, barely a peep since orientation some nine months ago. 5:30 is spot on: there is a lot of talk about being part of the health care delivery “team,” working with your classmates as a “team,” and medicine being an enterprise built around the “team,” it is painfully obvious that each and every one of us is on our own. As a team.
Even those of us who are not interested in high-powered specialties are subsumed by the crush of the clamor for the golden ring. From all the “How to Get Accepted to Medical School” books I read and all the conversations with admissions counselors, physicians, faculty and so on at schools all over the country, I expected that some “New Day of Medicine” had dawned, and with it had come a new focus on primary care, preventive medicine and service to the community and that the gunners and the procedure-chasers had been winnowed down to a rebuked minority. Oops. Guess not. Once again, Anon 5:30 is right, the every-doc-for-him(her)self-spirit is WD, WN and in NAD. What’s more, it’s sucklng greedily at the warm teat of medical education. It feels like booking a resort based on the pictures of the glorious room, sun-drenched beaches and succulent buffet in the brochure, only to find yourself sleeping on a straw cot in a corrugated tin shack eight miles from the coast during the fifth bloody coup in as many months.
Something will be done soon, though, because the students in my class and those after us will be the ones caring for the baby-boomers. And if there is one thing that the history of the last forty years or so has shown, it’s that when the baby-boomers really want something for themselves, they make it happen, consequences be damned. I just hope that the fix they employ to ensure they get the care they want in their now-dawning “Golden Years” doesn’t leave the rest of us on life support when it’s over.
As a family practitioner, I would like topp offer the following responses:
1) Telling an unhappy primary care doctor to pack up and move is akin to blaming the victim. In many cases, years have been spent building a practice and roots have been laid down.
2) As far as displeasure with local specialists, we should respond with our referral patterns. Just don’t use them. I tell my patients not to go to Dr. So-and-so, saying, “he does not treat other doctors well, and if he doesn’t treat doctors well, I have no reason to believe he treats patients well.”
So your are saying victims of abuse should stay with the abuser. That makes sense.
Anon 9:11 AM FP:
I suppose it’s “blaming the victim” but nothing will get done unless the doc leaves. Cut your losses.
And rural underserved areas are the worst for this sort of thing. They’re monopolies, and the only way you can make a living there is to get governmental dispensation to charge more than a doctor just hanging out a shingle. Then pretend you’re Mother Teresa because your clinic is treating the poor and no one else will.
I just finished medical school and am starting my psychiatry residency in NYC in July. I used to be a social worker in NYC, and don’t get this ‘we don’t have a voice’ way of thinking.
I partially agree with the med student poster about baby boomers getting their minds on things and doing it… but i think its going to take a collective set of cojones for them to do it. I mean, they’ve been standing in this steaming pile of a mess for a while, watching it decline, their generation watched it and some helped it happen and made some nice money off of it… I dont know if they can change it, but I wont discount the possibility. I think by the time medicine finally hits ‘bottom’ they’ll be retiring and will have a foot out the door. I think change is up to us, the new grads. This generation of people in their 20’s think differently and have a completely different relationship to ‘the rules’ and authority- some of which I agree with, and some of which I don’t.
Bottom line: Docs have to realize that they can stand up and practice medicine fearlessly.
Some people might want to pack up and thats their prerogative, but MORE MD’s MUST KNOW that they have the option to stand up for whats right, and that there’s power in numbers.
You may have a voice, but it does not matter if no one is listening.
The newspapers/MSM are not telling these stories - journalism these days (even “citizen journalism”) is ALL about keeping the fat-cats at the Chambers of Commerce (i.e. big fish in small ponds) happy . . . and putting on a pretty face for the next newbie the hospital can sucker. And I’ve had the crap beaten out of me in the Greensboro NC blogosphere (considered by many to be so “progressive”). I’ve lost count of the times I’ve been told to “move on” and get over it . . . and something is wrong with me if I don’t.
I offer fair warning to the brave new warrior in psychiatry, if your voice gets too loud, it can always be silenced with bad-faith peer review (fueled by the snakes climbing on the cadeuses that always live in an administrator’s pocket). Then it’s not just your reputation that is trashed it’s your career. I have seen this happen to a number of people. It’s ugly. It’s effective. It’s about total destruction.
Our medical and legal regulatory systems are a joke - I mean, the sad fact is that Medical Boards EVERYWHERE are slow and sluggish to act on anything except sex, drugs and alcohol. We do not effectively police our own.
In my own situation, I’ve reported perjury/contempt and fraud on the part of two way-overpaid “non-profit” executives to every state and federal agency under the sun. Cut and dried. No question. Not to mention the complete desecration of the “mission” of state and federal programs to bring doctors to rural areas and keep them there. But I’ve got a local DA that is pandering to the mill-town powers-that-be (who are on the board of the hospital that screwed me), a State Bar that is covering the tails of its own - and a gutless North Carolina Attorney general (remember the Nifong debacle?) who still says he has no jurisdiction over what a “non-profit” in North Carolina does.
It’s ludicrous. He absolutely has jurisdiction - by virtue of my service to the state. And if he maintains that he doesn’t the power, then he/the state should be doing something to get it. In order to fix anything, hospital exectutives and their lawyers MUST to the same moral/ethical standards as doctors. They are not. “Non-profit” hospitals can do whatever they want to whomever they want - right and wrong are irrelevant. They hide behind the “good of the many” when it’s really about the good of the few and well-connected.
You hear all the time that JCAHO can shut hospitals down - for the very kind of things that I reported and that were done to me. It’s a load of hooey. Everytime those clowns show up for another dog & pony show I have to roll my eyes. Tell me, when’s the last time you saw JCAHO shut anybody down for anything? It’s all wink and nod.
Our “advocacy” organizations sold us out long ago. What use have I got for their expensive “advocacy” if they cannot do something/anything for the individual (which they all say they can’t).
I needed a union. The AMA ain’t it.
In my younger days I thought might would stand up for right, but I was tragically mistaken and I have paid for it with ten years of my life - thirteen if you count the time I spent in my “rural” hometown trying to build a life and a practice I could be proud of.
I practiced and spoke and advocated fearlessly . . . and I wound up spending years paralyzed in fear - of loosing everything . . . looking over my shoulders for the next legal dirty trick . . . constantly on the road . . . barely able to make ends meet. I have only recently gotten back on a bit of an even keel - emotionally and financially.
To this day I cannot wrap my head around what happened to me. On WHAT planet does it make sense that a doctor would be fired for saving a baby’s life? And on WHAT planet is it okay for the guilty parties (executives and doctors) to skip merrily on with their lives?
Our planet.
There’s much that needs to be fixed. I’m not a newbie anymore and I am jaded/cynical beyond my years. But I still believe it can be done. It IS going to take cahoones - and more people speaking out and signing their names.
It MUST start with the new generation hearing more about what has happend to those who came and fought-the-good-fight before - i.e. medical schools and residency programs taking real steps to educate their charges about the real world. I MUST start with MSM doing something to shine light on these stories and what is really going on in medicine - especially “rural medicine”.
It ain’t pretty.
The last piece that “60 Minutes” did on the National Health Service Corps (in which I served), was a total pile of white-washed fluff. They only want to tell the success stories.
My story is about a total failure of the system to work.
I’m telling the medical blogosphere and the MSM, if you’re gonna pull back the veil and “fix” medicine, then pull back the ^%$#@* veil. Shake out the fluff and get to the dust mites.
Again, nothing you said Dr. Johnson tells me otherwise. If you want to be a martyr, that’s different. It sounds like you’ve done everything you can, and you’ve gone above and beyond what an average physician would do to try to save your honorable and dutibound services for the patients in your town.
Getting PR for your story is necessary. But your sincere frustrations are read by others as typical doctor whine. Try to change your angle, your pitch to the media.
Press Release: Can you imagine this, Community XZY hospital has voted to replace all doctors with nurse practitioners.
Or hospital XZ patients see nurses in a new role - replacing physician’s to fulfill shortage.
Change your angle and you may get a better response from the media.
Or be a martyr, or just move.
Regarding the anger towards specialists - in honesty their is no anger, just some dare I say mild envy and jealousy. Dr. Johnson is justing that the specialists choose to protect their own economic interests. Heck, if insurance’s ever pay highly for GPs to coordinate a medical home, while NP’s actual see the patients, us PCPs/GP/peds would hire as many NPs as we can. That’s just simple econ 101, nothing personal against any subspecialist.
I went “above and beyond” when I went in that night ten years aog and cleaned up somebody’s else’s mess. I thought the government I served would have my back.
I’ve been in the blogosphere for over three years. I’ve gotten all kinds of advice about my “angle” and my “pitch”.
It’s not an “angle” I’m “pitching”. It’s the sad, sorry truth about a medical and legal oversight system that absolutely, fundamentally does not work.
It’s not about being a “martyr” either. I am PISSED OFF . . . about the despicable way I was treated . . . about the way patients/parents caught-in-the-middle were mislead and lied to . . . about the way my community has been manipulated and played for profit . . . about the care I, myself, received at this hospital . . . about the fact that my Mom still lives in Asheboro, and if she got sick tomorrow the LAST place I’d want her to go is my hometown hospital.
All of that and the fact that my home is my home. I’m not leaving.
It’s time to stop making excuses for the bad guys, stop blaming the victim, STOP RUNNING, stop hiding behind anonymous monikers and FIX what’s wrong. I don’t call that a “whine”. I call it an imperative.
I suppose that (the way today’s media works) it’s regrettable that I’m not a Hollywood hottie with a good agent (like Dennis Quaid who today testified before Congress).
Dr. Johnson has no beef against the subspecialists. Dr. Johnson’s beef is with a “rural” hospital that covered up bad care (indeed, in this case she was the specialist) . . . and retaliated against her for (1)intervening to stop it, (2) and reporting it. That’s not “Econ 101″. It’s dirty pool.
Many, many people want universal healthcare in this country. What happened to me STARTED while I was in government service (remember Walter Reed?). I have accused a “non-profit” (subsidized by public money) of some pretty serious things. NOTHING HAS BEEN DONE - BY THE FEDS OR THE STATE OF NORTH CAROLINA - TO RECTIFY THE SITUATION OR TO HOLD THE HOSPITAL ACCOUNTABLE. The government that is supposed to protect and serve does not care.
Yet we’re supposed to build a solid healthcare system upon that rotten foundation?
Hey, maybe that’s a pitch.