We have inherited a health system that is broken beyond repair

We have inherited a health system that is broken beyond repair

I can truly say logging on to the National Commission on Certification of Physician Assistants website and seeing I’ve passed the boards was one of the happiest moments of my life. All of the hours invested learning to take great care of patients was worth that feeling. Like an entire generation of young new MD/DO/PA/NP graduates looking to make a positive impact in this world, I never felt more ready to begin my career.

I accepted a dream position working at an urgent care in Arizona. This clinic gave me the variety I needed to stay entertained, a very supportive staff, and the most helpful supervising physician a PA could ever ask for. However, nothing could have prepared me for the disappointment felt when I had a major paradigm shift; we have inherited a healthcare system that is broken beyond repair.

Though I expect accusations of pessimism, I have realized our American healthcare system is designed to keep you sick and poor. This was not done intentionally, but rather through years of greed, poor regulation, and the many variables that add to the skyrocketing cost of care. My realization began to blossom when a young skateboarder came into the urgent care complaining of a broken collarbone. Before I entered the exam room, I saw a pink form creeping out from chart. He was paying cash for this visit.

I walked in to the room and greeted by a college-age gentleman in obvious pain. After hearing his story about a routine day ending in injury, I asked him what made him so sure it was broken. He replied, “I could hear and feel the snap. I’m positive it’s broken.” When I suggested an x-ray, he began to politely argue the point of it.  He asked what difference it is going to make if I’m just going to put a sling on him anyway. Even though I explained why it’s not wise to skip the imaging, I knew without a doubt that his concern was about cost. Reluctantly he agreed. The result: displaced clavicle fracture, completely broken in three places.  What followed is what makes all of us as providers rendered powerless.

I began to educate him about the diagnosis and how my resources are somewhat limited in the clinic. I’m not an orthopedic specialist, but I’m confident this warrants a consult. I warned him that a worst-case scenario may be surgery and I would like him to be transferred to the local emergency room for further care. With a mixed expression of disbelief and hopelessness, he questioned my opinion and asked me call his father. Within minutes, I managed to find myself speaking with this boy’s father who was looking for answers. At one point he even asked, “Can’t you just pop it back into place yourself? We don’t have the money for the ER, much less surgery!”

Hearing his desperate attempt to avoid an emergency department visit, I grew angry. What healthcare system makes people feel they need to stay home suffering than seek the care they need? It is the one we’ve inherited.

New graduates today are the forefront of tomorrow’s healthcare model. No matter how much training you have had or hours spent studying, there is little that can be done about a patient who is refusing care. It made me ask myself “is this what I’m going to have to deal with the rest of my career?” I would like to think the particular patient in my story eventually made it to the hospital despite leaving against medical advice, but I am not sure.

My point is not to offer a solution to this healthcare crisis and our imploding system, but to make a predication that it will inevitably collapse. I don’t think it takes a healthcare provider to see it. With an aging population, comorbidities in epidemic proportions, and primary care providers dwindling everyday, this crisis is going to get worse before it gets better. I believe it is important all new graduates have this paradigm shift with themselves, because we’re not taught nearly enough in school about life. Healthcare is more than just a field. It is an industry. It stands to reason it is not immune to the same strife as the US banking industry, auto industry, or oil industry. There are going to be many changes in upcoming years and we have to be prepared to accept whatever may come and be part of the solution.

I expect all new grads to never lose sight on why they chose this path. There are too many older, miserable doctors (we’ve all met at least one) who are not remaining positive about this field. Despite the stresses and challenges that come with getting a new job and building a life for yourself, remember the moment you passed your boards and keep your positive outlook a priority for the future.

Zachary Leonard is a physician assistant.

Image credit: Shutterstock.com

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  • http://profiles.google.com/jlagnese james lagnese

    Third party payor has driven costs up a lot. If we insured our cars like we do ourselves, our car insurance would be a lot higher too. At one time insurance was protection against being bankrupt by an injury or illness. Now it’s meant to cover everything in many cases, drugs included. When someone else pays the bill, there will be more corruption.

  • Maskeladden

    Great article and I completely agree with you. Our health care system is no longer about care, but about business. Dental is similar, being so insanely expensive people would rather skip having a checkup. And prices only seem to go up, regardless of the dollar, economy, recessions, position of other industries etc. Why is that? Because they can is what I suspect, and because health care will always be a necessity.

  • Charles Cawley

    Healthcare is essential for an efficient economy. Whether it be private and business run or state run the fundamental need is for good management. If private and it makes too much money but it is run well, the solution is not difficult.

    If public and run well no solution is needed. The fundamental problem is that no one has investigated exactly why public management often so bad and there is a growing call to find out why private management seems to be going the same way.

    There is no logical reason why bad management is a speciality of public control. The core of the problem is management control. Perhaps the disgraceful failure of virtually all MBa courses and across general management training give us a clue.

    To control management and prevent waste and inefficiency you need to understand and control business and office politics. This is about the control of information flow and ensuring the best informed decisions are taken. It is about short circuiting ignorance at every level of management. Rather than moan and dismiss this reality, it should be studied, revealed and harnessed for the good. The key to management discipline is good information and that means good political control. This can be taught.

    US business, like UK business, is immature and almost childish in its approach to dealing with the realities of business politics. They desperately need to grow up. Once this happens, the prospects for both the UK NHS and the US healthcare will transform. If it is not done, what is broken, now, shall be pulversied in the future…. private or state controlled.

    This is about competitive edge and efficiency.

  • Ajit Balkawade

    I am an Indian who had lived in the US during times, when Sicko released. I found myself in tears after watching the documentary and wished there was something I could do. All I hope to offer here is some perspective: India started off as a mixed economy, where private and state hospitals deliver parallel services. So the rich can get the quick and great service and poor always have an option to turn to. Our service may not be liked or appreciated even by most Indians. As compared to our population and infrastructure, corruption, their views seem plausible to me. But I am sure American can deliver a lot better and I will never understand why it does not.

    • Charles Cawley

      At the risk of being dull, bad management could be the reason, I have gone on about is in a post just below but here’s the point: “US business, like UK business, is immature and almost childish in its approach to dealing with the realities of business politics. They desperately need to grow up. Once this happens, the prospects for both the UK NHS and the US healthcare will transform.”

  • http://www.facebook.com/dale.douglas.524 Dale Douglas

    Well, of course.
    Also, our bridges and roads are falling apart.
    Our power infrastructure is 19th century.
    Basically, the Boomers screwed up the country by nickel-and-diming everything. The question now is only how to get out.

  • Jess

    I went to an urgent care because I had injured my foot. I went there with my insurance card and ID like they told me. I asked if they took my insurance and they said yes, I paid my co-pay and in the exam room I went. After an x-ray and several blood tests later I have no result to my foot problem and I now need to seek additional medical advice.

    I just got a bill in the mail for over $500 in medical bills because my insurance told me I didn’t have prior authorization. It isn’t just the uninsured that have problems, my insurance didn’t cover a penny of that visit.

    I feel cheated by the urgent care that told me I was going to be covered and cheated by the insurance company for not paying for something I didn’t feel was ER worthy.

    The worst part about this all, I have just paid over $800 for a root canal and now I have over $500 more to pay for another medical issue that was not even fixed. My employer pays about $500 per month for my medical costs and they have probably paid $10,000 already without me using a cent of that. They can’t over the urgent care???

    I hope the system crashes so that we have some hope to rebuild it!

  • Howard Bolling

    Of course the system is going to collapse, soon. With costs rising at a rate that predicts doubling in less than ten years, most people will simply not be able to afford it, whether or not it’s buffered by a payer’s risk pool.

    It doesn’t have to be this way, though. We can use our heads, and our technology, to radically decrease the cost of care, while improving outcomes. ACOs and other quality-based business models are a step in the right direction. Patient Centered Medical Home (PCMH) programs are another. The explosion of mHealth has barely begun, and you can bet that the private market will create some unbelievable opportunities in that area. Wellpoint has a Watson that is being trained for preauthorizations, and that’s just the tip of the cognitive computing iceberg that will help alleviate the primary care shortage by placing reliable diagnostic abilities into the arena of LPNs and other highly skilled, but non-MD, health professionals.

    Our body of medical knowledge doubles every five years. Moore’s Law is holding true in technology. Instead of wailing and gnashing our teeth over the broken system, we need to look for opportunities to “connect the dots,” advocate for rapid adoption of tools that can improve outcomes, especially for the most ill (most costly), and create a medical care culture that concentrates on sustainable improvements and engaged patients.

  • Homeless

    Clearly this man should have skin in the game. Why should he get free healthcare? He didn’t buy insurance with a HSA. That’s the best way because he will demand things he doesn’t need if he doesn’t have to pay for it.

  • JPedersenB

    Bravo, you are absolutely correct. I am afraid that no one will agree to ANY changes until the whole system implodes. The costs are just unbelievable! We need to rein in compensation for hospital and insurance executives, suspend relentless hospital expansions, equalize (as well as lower) all medical service costs and change the basic philosophy of medicine that everyone is basically sick until proven healthy. Just my point of view…

    • JPedersenB

      We also need reforms to the tort law. It is hard to feel confident about a physician’s decisions when you are wondering if they are made for your benefit or to protect the doctor!

  • http://twitter.com/lvsara Sara Allred

    This is great and thank you for caring still!!

  • Docbart

    Have you heard about Obamacare? It is designed precisely to eliminate this problem. I know many are unwilling to accept the idea of anything good coming from “the gummint”, especially from the Dems, but there it is.
    Good luck in your career, don’t despair.

  • Kat

    I agree with the other commentator about reforms in tort law also being essential to system overhaul. All too often we are practicing defensive medicine and not medicine in the best interest of the patient due to hospital policies that place covering their behinds first. I know that other countries (New Zealand I believe) have a system where health care mistakes have a certain specified payout. This payout is significantly smaller than what one may possibly receive in a settlement but the point is anyone is able to get it. In contrast, in the US, one has to go to court spend funds and likely not win a settlement. However, those few that do win are given a larger payout therefore incentivising all others to attempt the same aka sue.

  • Rob Burnside

    I’m reminded of a quote attributed to Henry Ford: “Think you can; think you can’t. Either way, you’ll be right.”

  • petromccrum

    I agree. The current system is so dysfunctional I don’t believe it can be fixed.
    Everyone suffers because of the system, not only patients, medical personnel as well. Obamacare is only making the system much worse, by adding additional costs, additional paperwork, and additional patients and NOT addressing one problem!

  • buzzkiller

    My community has Stentor. Here you could have called the ortho, had him look at the film, and he would have told you what to do, gratis. True, if the clavicle were severely displaced, he might have needed to reduce it, and that would cost.

    Arizona medicine is a mess, known to be so. Come to Washington state. Not perfect, but better than urgent care in AZ.

  • querywoman

    Our current health insurance does not insurance the very young, and I will loosely define that as ages 18 to 25, before young people start getting jobs with insurance.
    Did you not have a county hospital or a church hospital to refer him? Even if not, emergency rooms are required to provide care in emergencies, regardless of the ability to pay. Medical bills are an unsecured debt, and many people do not pay them. Fear keeps people from getting medical care.
    This is the way the politicians and medical profession have let it be for now!
    I was a public welfare worker for years, and have placed many high school students on Medicaid. But Medicaid was not an option for college-age students in my area. I live in a large municipality with a county health district and used to attend a large downtown church. I know where church clinics and a mosque clinic are.
    Are you familiar with resources in your area?
    I live in Texas, the bottom-ranked state in social services, and I can find an answer for most social and medical needs, except dental.

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