As an employed physician specialist working in an underserved community, I am thrilled with the Affordable Care Act (ACA). I was initially a skeptic of the program because of the cost to taxpayers, but I have since witnessed first hand the tremendous benefits. People with limited resources and real problems can now get help without suffering financial harm. Those with chronic diseases, malignant skin tumors and even hearing loss can receive the care they deserve. Skepticism I once had for the ACA is all but gone now that I have witnessed for myself the joy and thankfulness experienced by fellow Americans getting a break from the financial despair that often goes hand-in-hand with illness and injury.
Offering affordable insurance to all people regardless of their ability to pay is not only good from a health care standpoint, it goes hand-in-hand with the Planetree philosophy of how sick people should be cared for. The Planetree designation is given only to those hospitals that strictly adhere to the principals of patient-centered care. Founded by a patient in 1978 and named after the sycamore, or plane tree that Hippocrates sat under when he taught medicine, Planetree’s philosophy is based on a simple premise: care should be organized first and foremost around the needs of patients. “Amen!” I say.
I am also proud to say that my employer has the distinction of being a Planetree hospital. Honestly, this is what drove me to take a position with them in the first place. Core components of the Planetree philosophy include tenets that promote human beings caring for other human beings, the creation of a healing environment for patients, their families, and even staff members. Although the ACA has not proven to be the panacea in health care reform, it does provide another healing dimension for patients by relieving the anxiety associated with out of control medical bills and for that I am truly grateful. In my humble opinion, this too follows the Planetree premise of promoting a healing environment.
But while I am thrilled for those who are rescued by this excellent program, I now have the burden of looking for another job. That’s right. In July of this year my employer gave me six months to bring up my numbers and improve the practice financials or as it was succinctly spelled out, “We like you, but something will have to change.” You see my employer does such a good job of ensuring that its providers see patients regardless of their ability to pay that the resulting reimbursements can neither support nor justify my mid-range salary. Even when I work harder and see more patients it doesn’t translate into more dollars for the hospital.
And when my employer questions why I am not converting more office visits into surgical procedures and hence a boost for the bottom line, I simply tell the truth and say, “Not everyone in this town needs surgery.” I get that ordering unnecessary tests and performing unneeded procedures might improve my current employment situation, but that would be unethical and horrible for the patients. Primum non nocere or “Above all, do no harm” comes to mind. By the way, I’m happy to say that my employer has never suggested that I resort to this. Perhaps some combination of poor research into the community demographics for my specialty coupled with bad payer mix resulting in low reimbursement rates have led to the insecure environment I now find myself in. Regardless of the reasons, people that need my services will undoubtedly go without in the very near future.
So for all of the folks sleeping better at night because of Affordable Care, let me be the first to tell you that I am super excited for you. And most of all, I don’t blame you in the least. You deserve to be treated with dignity and respect. After all, each of us is one unfortunate circumstance away from hard times.
As for me: Don’t worry I have plenty of choices. Should my employer feel so inclined, I may be able to take a hefty cut in pay and continue to serve the community I have grown to love and respect. Or perhaps I will be sent packing to look for a new place to live where fewer low-income residents exist to muddy the waters of my financial future — a less fulfilling choice by far. Lastly, given my present job uncertainty and mounting disillusionment with the politics of health care — not people, I have considered quitting medicine altogether for a safer and more secure career. Perhaps the Secret Service will give me a shot.
The author is an anonymous physician.
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