Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Money will be lost in health care. This is true no matter how we describe it.

Edwin Leap, MD
Policy
December 3, 2018
4 Shares
Share
Tweet
Share

Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime?

I mean, we’re constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced “left without being seen” scores are connected to the money we make.

Medicine now is far less about the wonder of the body, the ravages of disease, the delight of the diagnosis and the thrill of healing.

Medicine, now, is clicks and time-stamps, clipboards and strategies, through-put, input, out-put, put-out, burned out.

I don’t know about all of the house of medicine. But I do know this.  When we, in the emergency departments of the U.S., see everyone at all hours, regardless of payment, then money will be lost.  This is true no matter how we describe it, no matter how we twist the truth to cover up reality with good feelings.

And thus, patients who actually do have a payer source will be squeezed tighter.  And every metric will be ratcheted down to try and make up for the very unrealistic ideas that we can:

  1. see everyone, anytime, regardless of the validity or reasonableness of their complaint.
  2. see everyone, anytime, regardless of the fact that many of their problems are social dysfunction, medical non-compliance with things already done to them for free, drug seeking or the desperate need for a work excuse
  3. see everyone, anytime, regardless of whether or not we will make any money for the transaction

No matter what you do with the rules and time expectations, the satisfaction scores, the consulting schemes, the computer programs or anything else, eventually you’re faced with the reality that you’re giving away care.  Sometimes to those who really need it. Often to those who don’t.

Worse, this occurs in fixed spaces, in hospitals where there is no more money for staff or space.  In a setting where there is no fixed number of patients and no fixed end to the need (or desire) for resources.

When reality meets business (and political) theory, then frustration and anger develop. Patients get angry because of cost (in money or time), or because they were told “no.” (I’m just joking there. Who gets told no in an age of customer satisfaction?)

Physicians and nurses get frustrated because the game is fixed. It cannot be won.  Do better?  More is expected.  Do worse?  More is expected, but the threat of firing looms.  So that a new group of physicians and nurses can try, for a while, to continue to do the impossible.

And administrators become frustrated, and angry.  Because however hard we try to make it work, it can’t.  Eventually, something breaks.

This can’t go on.

But we just keep on pretending it will.

Sigh.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan. 

Image credit: Shutterstock.com

Prev

The insanity of American health care prices played out in this one, real oncology appointment

December 3, 2018 Kevin 2
…
Next

A physician's letter to his wife

December 3, 2018 Kevin 1
…

Tagged as: Emergency Medicine

Post navigation

< Previous Post
The insanity of American health care prices played out in this one, real oncology appointment
Next Post >
A physician's letter to his wife

More by Edwin Leap, MD

  • Hospitals at a breaking point: Lack of staff and resources leave ERs in chaos

    Edwin Leap, MD
  • Trapped in a cauldron of suffering, medical staff are weary

    Edwin Leap, MD
  • Vaccine hesitancy is complex

    Edwin Leap, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • It takes more than marching to make Black lives matter in health care

    Torie S. Sepah, MD
  • Why health care delivery is an exceptionally different industry: Why does it matter?

    Joe Mandato and Ryan Van Wert, MD

More in Policy

  • Physician well-being: Overcoming administrative hurdles

    Pat Rich
  • Health care’s hidden problem: hospital primary care losses

    Christopher Habig, MBA
  • From fishing licenses to gun control

    Mitch Bruss, MD
  • How the NFL offers a window into health care solutions for our country

    Renee Hsia, MD
  • Unlocking the potential of allied health roles for a thriving health care system

    Eric Stastny, MHA
  • Efficient staffing partners for health systems

    Patrick Dotts
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • The synergy of AI and human intelligence in transforming health care

      Harvey Castro, MD, MBA | Tech
    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • Coping with grief in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Navigating physician shortages in rural communities

      Stacy Wentworth, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • How to select the right mutual funds for your goals

      Amarish Dave, DO | Finance
    • America’s pain management nightmare: How the DEA shaped the opioid epidemic

      L. Joseph Parker, MD | Physician
    • The middleman dilemma in health care

      Anonymous | Physician
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • ASCT Tops CAR T-Cell Therapy for Relapsed LBCL in Complete Remission
  • 'New Gold Standard' for Previously Untreated CLL
  • Emicizumab Safe, Effective, in Infants With Hemophilia A
  • Add-On Inavolisib Ups PFS in PIK3CA-Mutated Breast Cancer
  • Lovo-Cel 'Life-Changing, Transformative' in Sickle Cell Disease

Meeting Coverage

  • ASCT Tops CAR T-Cell Therapy for Relapsed LBCL in Complete Remission
  • 'New Gold Standard' for Previously Untreated CLL
  • Emicizumab Safe, Effective, in Infants With Hemophilia A
  • Add-On Inavolisib Ups PFS in PIK3CA-Mutated Breast Cancer
  • Lovo-Cel 'Life-Changing, Transformative' in Sickle Cell Disease
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • The synergy of AI and human intelligence in transforming health care

      Harvey Castro, MD, MBA | Tech
    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • Coping with grief in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Navigating physician shortages in rural communities

      Stacy Wentworth, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • How to select the right mutual funds for your goals

      Amarish Dave, DO | Finance
    • America’s pain management nightmare: How the DEA shaped the opioid epidemic

      L. Joseph Parker, MD | Physician
    • The middleman dilemma in health care

      Anonymous | Physician
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Money will be lost in health care. This is true no matter how we describe it.
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...