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Health reform is not a threat, it’s an opportunity

| Physician | September 8, 2012

Doctors are …

Start by entering those two words into the search line of your web browser and look at the list of the top ten searches.  What words come to mind next?  This is the list from my browser:

Doctors are stupid, arrogant, evil, dangerous, idiots, overpaid, useless, underpaid, rich, greedy.

This list is disappointing.  Is this representative of public opinion of what doctors are?  As one physician, I realize there is not much I can do to improve this perception.  All I can do is do my best to take good care of patients, and learn from my mistakes.

I deal with many different doctors professionally every day through my primary care practice and as the Chief of Staff of a small community hospital, as well as on a more personal level as my patients and through physician meetings dealing with physician health concerns.  The list I come up with is quite different.

Doctors are terrified, stuck, retiring, trying, not valued, struggling, worried, hopeful, angry, human.

Personally, I too have felt disillusioned as a physician in today’s healthcare climate.  But when the Supreme Court ruled on the ACA, I made a decision that I am going to be a part of it.  I want to move forward, adapt, and continue to be able to provide quality care for my community.  In speaking with other doctors, I realized that I am not alone in my fears of the future, and that I have colleagues that also want to be the best physicians they can be.  We can help each other do this.

I have heard that the Chinese symbol for crisis also represents opportunity.  I encourage my colleagues to embrace the changes, network with your peers, learn about Accountable Care Organizations, Independent Physician Associations, and other models and take action now to have a voice in your future.

This is an exciting time.  This is an opportunity.

Patrick W. Hisel is a family physician who can be reached at Patrick Hisel for Congress.

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Tagged as: Health reform, Hospital, Primary care

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  • http://www.facebook.com/brad.tangen Brad Tangen

    Fine. But decisions are being taken away from both doctors and patients to be made by bureaucrats.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Insurance does this already.

    • http://twitter.com/Liberty_Doc Patrick Hisel

      I agree with you 100%. But doctors still get to make some decisions. Many are exercising their choice to retire and I want them to know that there are still other choices out there that they can stay in practice and continue helping people.

  • Dan Lottsfeldt, M.S.

    The focus needs to stay on patient care, not the providers. The health care and physician community are about to get 30-40 milllion new patients (customers). How can that be a bad thing?

    To say the U.S. has the best health care in the world is a misnomer. Too many think the measure of quality health care is just having the best trained physicians in the world with the most advanced procedures and technology. There is an equally important measure. This entails the delivery system that provides this top level care. The U.S. health care system certainly has the first, but not the second.

    Why is it when the rich and famous people from around the world come to the U.S. for treatment, they go to Johns Hopkins, the Mayo Clinic, UC-San Francisco, etc.? There is a reason they don’t go to rural Mississippi or Wyoming. It is a sad paradox.

    • http://www.facebook.com/LaserSurgeon Peter Benson

      30-40 million new customers sounds like a good thing until you look at how doctors are going to be paid for treating them. They will be put on the Medicare fee schedule; the one that has been frozen for 12 years and does not cover the cost of care. Plus Obama has propose cutting it by another 15% in addition to the 32% cut scheduled for Dec 31,2012. Now throw in the proposal to pay doctors based on perceived quality instead of production and the half of doctors rated below average will have no choice but to shut the doors.

      • http://profiles.google.com/andeevb Andee Bateman

        Percieved quality needs to be outcome based, not customer service based. Sometimes the answer is “No, Mr. Jones, you cannot take your oxygen tank outside to smoke.” These surveys are all the rage for bedside care and its wreaking havoc for hospitals who place it directly on the RNs. Bugs abound and need to be worked out. As for the cuts, make a note that those cuts were primarily to insurers and hosptials who recieved bloated payments along with the premiums they only spent 50% of on patient care. As that money was cut from the profit side of insurance companies, it will be re added to actually compensate for care. As more patient care is compensated, the subsidies to hospitals and insurance co’s will balance out.

    • http://twitter.com/Liberty_Doc Patrick Hisel

      The focus is on patients. The best patient encounters occur when the doctor is at his or her best. Good doctors are happy doctors. By pointing out the list of negative adjectives I am trying to acknowledge obstacles of general perception that all doctors are bound to face at some point. The two tiered rich/poor healthcare system you present is not disputed by me. But, my hope is that doctors in rural Mississippi and Wyoming can coalesce into alignments that strive to offer the best possible care for their communities, and still be rewarding both financially and emotionally for the physicians. It is going to be a personal decision each physician will answer for themselves, and the model of healthcare delivery will differ by geography and population demographic.

      Here is an excellent article in Medical Economics about changing healthcare delivery systems: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=785800

    • doc99

      The focus needs to return to the Doctor-Patient Relationship – a bond threatened by the overt intrusiveness of the Orwellian-named PPACA.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I don’t get this…. Is running for Congress on a Libertarian platform to “get rid of Obamacare” part of the “opportunity”?

    • http://twitter.com/Liberty_Doc Patrick Hisel

      Yes, I see your point. Mine is a solo FP practice model that cannot survive as it is now in Obamacare. The healthcare reform caused many emotions and many actions in doctors like me. Some docs dug in their heels, complained, and resisited. Others bought EMRs and paid for consultants to try and adapt. Others stuck their head in the sand and have done nothing. Still others have slowed down, retired, or are taking steps to retire in a couple of years. Some went to work for hospitals or larger groups to try and achieve some security. My response was to run for Congress in protest.

      Now the objective has changed for me because the ACA was ruled on by the SCOTUS and the reality is that whoever is elected president, healthcare reform is here to stay. I still think it is unaffordable and unsustainable and that eventually it will financially break this country, but as John Maynard Keynes said, “the markets can remain irrational for longer than you or I can remain solvent.” So the objective for me and other independent physicians is to figure out a way to keep our practices solvent and keep taking care of patients in our community because more doctors are leaving and more patients are coming. As physicians it will require more work, but we will probably be fine. But it is about the patients and their access to healthcare. This post is meant for doctors to validate their frustrations and even despondency. That yes, it is an intrusion and it is not free-market, but it is reality. And I hope to encourage them to adapt, do the dance that CMS and the ACA makes us do and STILL find a way to take good care of people.

      • doc99

        I find it curious that a Libertarian would quote Keynes when Hayek wrote the book.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        This is a very strange conversation indeed. I am a liberal, and I don’t think the CMS dance is a reality just yet, regardless of the courts ruling, and I think that doctors should do more than just validate their frustration and then proceed on a path that I personally doubt very much will lead to taking good care of people. I do understand that folks need to make a living, and that here and there one could find an arrangement that may be a lesser evil for a while, but I somehow feel it is incumbent on doctors to stand up and fight on behalf of their patients before the CMS dance wipes out all independent practice and turns all physicians into powerless employed shift workers.

      • southerndoc1

        I have absolutely no idea what you are saying.

  • Fubao MH

    The value of being a doctor is to help patients. But nowadays it comes with a high price tag.

    • http://profiles.google.com/andeevb Andee Bateman

      which will go down as more and more uncompensated care is corrected by the ACA. It really is a regulation of payment more than anything else. Are you not tired of working for free? The author notes the addition of 30-40 million new ‘customers’ but the truth is, we would have treated them anyway. Now their care will be paid for.

  • Diane Smith

    why do nurses leave nursing and where do they go to be successful?

    • http://profiles.google.com/andeevb Andee Bateman

      Many leave the bedside to work as ‘advisors’ in managed care. Here, its United Healthcare or Wellpoint where they work the phones. Some go to public school systems for the retirements, and many more just go back to school. The entrance reqs for grad school are becoming more stringent, I have noticed. No longer can anyone that can get a student loan get in an FNP program. If they don’t have the chops, then its Ed or Admin. Advance practice programs have tightened and I think its in anticipation of big changes coming to nursing in 2015. Meanwhile, wages have dropped, ratios have gone up, hours and OT are cut. That’s just my experience in Indiana.

  • http://euonymous.wordpress.com euonymous

    Overall I think you’re seeing doctors under stress because the whole economy is under stress. Add that to the rapid advance of medical technologies, the advertising of prescription drugs direct to the public, the increasing hassle and administrative overhead of the insurance companies, and it’s no surprise that doctors are frustrated. This is not what medical professionals signed up for. The doctor is the face of the healthcare system to the average person. America’s frustrations with healthcare in general are being overlaid onto the image of the physician, which is unfair. Until we move to some form of universal healthcare, I don’t see things getting much better. How can they?

    • buzzkillersmith

      Excellent post. The whole country is under stress, as is the HC system, and people are lashing out to some extent, although I am still well-treated by my pts. Now what they say out of the office might be another thing altogether.
      I would add that the increasing number of the elderly has contributed immensely to our workload. An elderly patient, well managed, can take me 4 or more times as much time and effort for the same or less money. Their paper trail can be almost unbelievable to someone outside medicine. In 1989, when I started, I had 4 seniors per day. Now it can easily be 10 or more. Of course seniors need and deserve health care, but the system has yet to come to grips with how to get them health care without grinding up primary care docs. I don’t know the answer here, but I do think this change, although not often discussed, has contributed to the primary care shortage.

      • http://euonymous.wordpress.com euonymous

        Good point. When we were all young and chipper, we saw the doctor typically for a very single, specific problem. Doc, this hurts. Doc, my x is doing y. But as the population ages, the older patient has possibly interacting meds that might come from more than one physician, an accumulating set of aches and pains, and the general physical changes that come with age. Doc, my body isn’t as good as it once was, fix it, ok? You are so right that the increasing number of older patients is bound to be more demanding. If EMR becomes standardized practice, it may help, but nothing will solve the problem of patients who simply demand/need more of the doctor’s attention. I don’t know the answer here, either. There wouldn’t appear to be a technical solution. And the economics of the system do not encourage a humane coping with the individual elders. I still have the feeling that universal healthcare could be engineered to accommodate both the simple and the more complex patients. I don’t think our current – insurance driven – structure can be made to accommodate the growing elderly population and still keep people relatively happy. I am encouraged that more studies are coming out saying that acupuncture helps with pain (which, of course, it surely does). I also have a sneaking suspicion that if the US elderly population had more access to acupuncture, and possibly other things I’m not familiar with, both elders and Western trained doctors would be able to cope better.

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