Confessions of a recovering doctor

Hi.

I’m Rob and I am a recovering doctor.  Yeah, I am recovering … doing a lot better, actually.  Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies.  I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better.  I am beginning to see how much better it will be to be on my own.

The key was when I realized that the system wasn’t going to change no matter how much I accommodated its unreasonable requests.  I felt that if I only did what it asked of me, however unreasonable, it would stop hurting me and, more importantly, my patients.  But I’ve come to see that all the promises to take care of me and my patients were written in sand, and that it couldn’t resist the temptation to cheat on me.  I tried to do what it asked of me, but as time went by I couldn’t take how dirty it made me feel.

I want to believe it was sincere when it told me it wanted to change.  I think at its core, it wants to help patients and doesn’t want to go on those spending binges.  But no matter how sincere the promises sounded, I was always left alone as it threw its money at every sexy treatment, procedure, or drug that walked by.  Then it would go off on tirades about how much I spent and that I didn’t do enough to keep to our budget.  It was always my fault.  I think it’s just easier to pass blame on others than it is to do the hard things necessary to really change.  To be honest, I think it was terrified at how much real change would hurt.

But I can’t sit around and wait for the system to change any more.  My patients were getting less and less of my time, and I was getting to the breaking point.  I know there are a lot of other doctors who are willing to do whatever the system asks, but I can’t sit around and watch it self-destruct.  It’s not what’s best for the system, for us doctors, and for our patients.  Sometimes the best thing you can do for someone is to let them self-destruct and pray that they finally take responsibility and learn the hard lessons.  I just hope that happens soon.

So what of my life?  Rebuilding everything from scratch has taken all of my energy, but I have much more of that energy when I know it will do good.  I can spend more time with my patients, answer their questions, and focus on them, not the system.  Even though I see how much more I could give my patients, how far their care is from where I want it to be, they are delighted with my attention and availability.  They are used to doctors giving them the leftover scraps of attention, not the bulk of it.  I hope they believe me when I say that my plans for them are much, much bigger than what I am giving at this time.

I’ve resisted the temptation to run to the arms of another for the sake of financial security.  My experience with the system shows that nobody pays you without expecting more in return.  Then I’d just end up compromising to keep the money flowing, and that is a kind of relationship I just got out of.  Instead, I am trying to do it the right way, keeping my focus on what is important: giving my patients the best care possible.  It’s not been real exciting – there hasn’t been much to write about, spending my creative energy on a building system that will actually improve care, not hinder it.  I’ve also had to pay much more attention to the little details: tracking where the money comes from and where it goes.  I’m not real good at that, so it’s been a steep learning curve, but it’s given me a sense of control I’ve not had for a very long time.

I can’t tell you how different it is, working in a job that actually rewards me for doing the right thing.  I am no longer penalized for healthy patients or an empty waiting room.  I am no longer paid less to spend more time with people or to handle their problems without forcing them to come in.  I don’t have to live in fear of the Medicare audit.  I can spend my time with my patients as they need it.  I had a guy come in wanting me to help him with his struggle over a decision about his elderly father.  We talked for nearly an hour, and I realized that I wasn’t at all frustrated by that fact.  There’s no CPT or E/M code for this kind of thing, but it was what my patient needed, and it is what he pays me for. He left with a look of appreciation we doctors seldom see.  It is incredibly freeing to not have to apologize for doing the right thing.

But I don’t want to brag.  I’m no saint, and the system I’ve built to this point is far from perfect.  I’ve still not taken a paycheck, and that can’t go on too much longer.  Things could still go wrong.  But my decision to no longer try to live in my dysfunctional and destructive relationship has been worth the pain and uncertainty.  I miss the patients I had to leave behind, and I am sad to hear about the care they are getting.  I hope I can build something good enough that lets me offer to them what my new patients have, something I’d given up on: hope for the future of health care.

That’s all I’ve got for now.  Thanks for listening.  One day at a time.

Live and let live.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).

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  • Steven Reznick

    Best of luck Rob. You made a wise decision!

  • Jasius

    Hey pardon my ignorance Dr. Lamberts (I’m new to Kevin MD) but what exactly did you switch to after leaving the insurance companies?

    I’m a premed student, and my greatest wish is to have that freedom to take extra time with patients as you described.

    • http://doctor-rob.org/ Dr. Rob

      I left my practice in October of last year and opened up my new one in February.

    • Adolfo E. Teran

      Dear Jasius, what Dr Rob did is brave. I would not mind doing the same thing or similar. I believe bringing back control to patients and their doctors about their care. It is frustrating and expensive to deal with health insurances private,state and federal. You can spend thousands of dollars and hours dealing with it. I wish you the best Jasius, I think there is light at the end of tunnel.

  • Noni

    Good luck to you!!

  • Suzi Q 38

    I like your “style.”
    I think more doctors should be brave enough to stand together and do this, not only for us patients, but for themselves, their sanity, and their principles.
    This may mean making less money, but at least you have more control over your practice.

    Good Luck to you. There are other doctors that are doing the same. Find them and discuss what is working for you.

  • Anthony D

    If you think healthcare is expensive now, wait till its FREE!

  • mmer

    What is the history of “meaningful use” and who has defined it? Did physicians drive this conversation, or did consultants and beaurocrats?

  • http://www.bobthepharmacist.com/ Bob Diamond R.Ph

    I saved my pharmacy from bankruptcy in Michigan in the early nineties by cutting out Blue Cross and Medicaid. I was able to sell it to Walgreen’s at a nice profit eight years later.

  • SBornfeld

    It appears you operate a capitation practice. As run by insurance companies, I feel it is a cynical way to decrease utilization and shift the insurance function onto the doctor.
    As run by the doctor, it is something else again, and (to my mind) much less likely to be abused.
    I would have some concerns, as it still in essence has you assuming the risks of servicing the needs of your patients for a fixed fee. I sincerely hope you make a go of it, and hope you’ll let us know how you make out.

  • Matthew Siedsma

    Rob, you don’t speak much on the patients you had to leave behind. I think we can all agree that to some extent what you’ve already done and what you are trying to do for the future is commendable. However I’m curious as to how you justify that in your mind when you acknowledge that this new approach has forced you to stop seeing (what I’m guessing) is a sizeable number of patients. Most of us agree the system is broken but if abandoning the system means abandoning patients, how much have we really accomplished for the public good?

  • michelleyehudamond

    Dr Rob has every right to do what is best for his sanity, and for his other patients @matthew. He was not treated well by those insurance companies. He was forced by those companies own actions to leave those patients behind to find other doctors who will take them. This is why the system is so broken. Dr.s can’t be expected to do their job at 100% when they are not given the opportunity to spend the time with their patients and give the proper care they need to give, or do certain procedures due to certain insurance companies dictating everything . This Dr is just saying he got fed up with not being able to do his job properly, so he gave up taking those patients with those government insurance plans. Now his life is much easier and he can actually do what he loves in the way he was trained.

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