A family physician chronicles his journey from an HMO to urgent care to practicing outside of the insurance system.

Steve Simmons notes that doctors out of residency rarely have any training in the business of medicine, including the all-important skill of coding.

“I needed to learn this’skill’ on the fly,” observes Dr. Simmons, “using a code book to translate each medical diagnosis into a five digit number, with an additional number serving as a cipher to explain the type of work I had done for a patient. This code book does not contain some diagnoses and many of its diagnostic codes inaccurately describe medical conditions, causing inevitable mistakes that led to non-payment.”

It is no wonder that the innumerable restrictions and pre-authorizations placed on, and required of, primary care doctors is a significant driver of physicians leaving generalist practice.

Medicare and Medicaid are not immune from the bureaucracy, as they too have onerous paperwork requirements that obstruct good patient care.

It’s no wonder why more doctors are finding satisfaction practicing outside of the insurance system, or in cash-only or concierge systems.