A Pessimistic View of the Health Care System
A regular reader who is a medical resident writes the following:
Regarding the changes taking place in health care, from a physician’s perspective I think that our pay will be cut, the patient loads will be much higher, we will continue to face frivolous lawsuits, the paperwork will be worse, the older doctors will retire, and would-be doctors will be discouraged from going through medical school and residency. Thus, there will be a huge doctor shortage and those of use who remain will work under poor conditions.
What recourse do physicians have? People have NO IDEA how hard we work (I work 70-80 stressful hours a week for about $700 per week) and they don’t seem to understand that we have to give up 10 years of our life socially and economically to purse a medical career). And don’t forget debt…I owe $200,000.
Yet, I notice that nurses in [my city], who make over $70,000 per year and work only 3 days per week (three 12-hour shifts) are going on strike. They claims its for the patients (just like teachers only strike for the students) but its common knowledge that it’s about them wanting higher raises each year.
Should doctors form unions? What other option do we have, other than continuing to have others make demands on our time and wallets without being able to stand up for ourselves?
Honestly, as soon as I pay off my debt I’m thinking about getting out of medicine. I do careful work, get good reviews, test very well on boards, and I’m interested in what I do, but I hate working my ass off with a lawyer on each shoulder for increasingly entitled patients who overuse the medical system (not all of them but far too many) while getting hammered with regulations and high taxes (in my not-distant future) from politicians who don’t know anything and buy votes to get elected. If we actually had someone representing us maybe I’d feel different, but we don’t and now they are about to tie our licensing to accepting government plans that screw us over.
The entire health care debate was a joke because the truth is that “the poor” get all the free health care they want. They come into our EDs and walk-in clinics several times per month for complaints that aren’t even urgent yet we have to see them by law. We offer to set them up with regular doctors in regular outpatient clinics for free, but they don’t want it because with the EDs and walk-in clinics they get to be seen right away.
Sound expensive and inefficient? It is, and it’s only going to get worse (see RomneyCare, the father of ObamaCare). ObamaCare doesn’t address any of the drivers of health care costs and in fact will only make the underlying problems worse. It was all about political power over a large part of the economy.
At some point physicians will have to stand up for themselves and organize, in my opinion. We DO care deeply for our patients, but unless there is a point where we say “enough” regarding the environment we work in we will continue to get squeezed.
These days, unless you work for the government or are in a union (or both), you are getting screwed.
This is one person’s opinion, of course, but I suspect his views are shared widely.
Categories: My Blog
dfvazan
Pessimistic? This is the harsh new reality physicians must face. And its going to have dire consequences for the entire medical system.
David
This is sad but certainly believable. Unfortunately, I never saw anything like this covered by a major news source before the health care “reform” bill was passed.
dennis tuchler
By now there should be all sorts of surveys of physicians and surgeons concerning their reactions to the coming change in medical financing. Does the physician’s quote in your post represent a generally held view among medical providers?
Clev
Even before the recent legislation was passed our nation was already facing a large shortage of physicians due to all the aging baby boomers.
The legislation further exacerbates this shortage by both…
1) further increasing patient demand with “free” care and
2) encouraging older physicians to retire early (due to increased paperwork, decreased freedom, decreased reimbursement, and higher patient loads)
Zack
I’m a medical student as well. my amazement at the ignorance of my fellow students on these matters shouldn’t be ignored, even from people I consider my intellectual allies.
First: doctors do have unions. most of them aren’t publicly advertised because doctors are usually ‘forced’ to join them when they accept a position (post-residency). besides doctors have one of the largest lobbies in the nation called the American Medical Association. were it not for this group, medicare would be paying more (i submit). Furthermose without this lobby there wouldn’t be a monopoly on MD licensing (which they own) and specialties would be more prolific than they are today; you can see this in the rise of physician assistant programs that have been fought tooth-and-nail by the AMA… I could go on, but uniting as physicians is not a solutions that will either lead to significant increases appropriations or incomes. Price and profit are everywhere and always dependent on more than one variable: supply, demand, marginal utility… C. Menger, P. Samuelson, Krugman, and others should be required reading at every medical school. I swear I spend more time disbanding economic fallacies than learning medicine.
Second: the current legislation plans to increase 1˚ physician compensation and lower specialist compensation, so depending on the chosen residency, this person could be making more, not less, money. not saying that is a good idea, but the facts are the facts.
Third: no one told this guy to be a doctor. most of my fellow students would probably have chosen their profession without nearly as much reference to the current economic condition as this correspondent thinks. Not saying systemic complications don’t affect physician labor demand, only this person seems to assign more weight than appropriate. I’ve met plenty of OBGYNs who say “this is all my family knows and this is all I can see myself doing.”
Ok I’ll stop writing…
Clev
Zack,
1. Being a med student isn’t the same thing as being a doctor. Hold onto that idealism–you’ll need it to finish med school–but don’t pretend to know what being a doctor is like.
2. Krugman and the other Keynesian economists push policies that fail in reality. The only reason they are popular is because they supply politicians with an excuse to meddle in economies and run up huge debts. Reality is the ultimate test, however, and in that arena Keynesian economics has always been a giant failure.
3. Obama can CLAIM he is going to increase pay for primary care doctors, but he has lied repeatedly on so many claims, especially when selling healthcare and the “stimulus,” that they aren’t to be taken seriously. The government had over 50 TRILLION dollars in unaffordable liabilities BEFORE it took over the remaining private healthcare sector. As debt continues to spiral out of control, the only statist cards liberals will have to play in health care are a) rationing and b) diluting the quality of care.
4. The AMA is NOT a union and the fact that you are pretending it is is, frankly, laughable. Physicians aren’t unionized in the US, though they are in some European countries.
Foge
Didnt know the forum rules allowed such bilrlinat posts.
dfvazan
“…no one told this guy to be a doctor. most of my fellow students would probably have chosen their profession without nearly as much reference to the current economic condition…”
Ahhhhh, the lofty idealism of a med student still cocooned in the fantasy of academia. Sadly, the invariable noble motives all medical school students surely possess (particularly when completing the essay portion of applications and eloquently rehearsing their interview monologues) eventually collide with reality: loans come due, payroll needs financing, supplies must be restocked, malpractice must be paid, etc. Suddenly, all that selfless sacrifice becomes, well, just as transparently unconvincing as it was during your sixth interview with Dr. Admissions Office.
No one told him the medical system would be undergoing a monumental trasformation before he entered medical school, as well. The rules of the game and the rewards for his time and work were rudely and unexpectedly changed mid-course.
brian
“No one told him the medical system would be undergoing a monumental trasformation before he entered medical school, as well. The rules of the game and the rewards for his time and work were rudely and unexpectedly changed mid-course.”
Completely correct.
During medical school and residency you work your ass off 24/7 for years and run up tons of debt. Your lifestyle and stress load suck and it’s difficult to maintain relationships with family and friends in the handful of hours you have off each week (hours in which you also have to study, run errands, etc).
You stay sane through that crap by telling yourself you will be rewarded for all your sacrifice and have a satisfying career in the end, but then one day a bunch of politicians in the pockets of lawyers trash it all and tell you they are going to sell your years of hard work, debt, and sacrifice in exchange for votes. Nevermind the fact that their previous efforts at socializing healthcare (Medicare and Medicaid) are projected to be trillions of dollars in the red despite forcing their costs onto people with private insurance for years. No, no they say…the key to controlling costs is to have Nancy Pelosi and company run the system.
The free lunch politicians promise doesn’t exist, and you aren’t entitled to steal the hard work and sacrifice of others. The system currently being forced down America’s throat will ultimately implode. We are on the same road as Greece and the rest of Europe, just further behind (and our politicians are hitting the gas rather than reverse or the brakes).
Michael
The writer makes a comment about lawyers. Perhaps he can enlighten us on another part of that issue. How many people die because of medical errors each year? How many are injured because of medical injuries each year? What percentage of these two groups or their survivors collects damages after all is over?
Jess Austin
Are you by any chance a lawyer?
A far better way to increase quality would be to restore the profit motive. In most other industries, those providers who perform low-quality work must charge less for their services, while the very best can charge premium fees. Because we must maintain the illusion that everyone has a “right” to only the best in other peoples’ time and toil, we have deprived physicians of an important signal they could use to increase the quality of their services. Also, people are dying.
Jayna
And I thought I was the sensible one. Thanks for setting me strgahit.
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Phil
Yet at the same time libertarian legal scholar David Hyman for some reason ignores all of this law trouble and opposes state based (hence, constitutional) caps on pain and suffering:
http://www.forbes.com/forbes/2008/0915/034.html
I think from a free market perspective all that Hyman proves is that caps should not be too low, but the culture of litigation behind medical malpractice – even if it only will decrease healthcare premiums by 1% (though, if we took the third party payment problem out ALSO I bet you that defensive medicine would truly disappear) – is such a harm to doctors and what they love to do that it should be repealed
JT
A few thoughts…
1. It is unfortunate that the AMA (Clev is right, it is a professional organization not a union, but the writer never said it is a union) doesn’t have a stronger representation from the professionals. Last I heard only about 30% of doctors are part of the AMA. If doctors were more unified, I think they would have more strength in guiding health care legislation.
2. I find it annoying when people cry about the number people who die from medical errors or nosocomial infections, “preventable hospital deaths”. Not that I don’t disagree that medical errors do happen and it is unfortunate when they do, but I don’t think the other side of the picture is ever given. The government continues to cut reimbursement in the Medicaid and Medicare programs, leading other insurance providers to follow their lead reducing revenues for hospitals trying to install technology and improve their process and systems to reduce medical errors. These changes in hospitals are not cheap.
Doctors and hospitals have to deal with a patient base that just gets unhealthier by the year due to poor health habits and poor compliance with instructions from their medical providers. Like my experience in the ED when a patient is told by the triage nurse not to eat until the doctor sees them, but goes ahead and eats goldfish from the snack cart (because having a snack isn’t considered eating?!?!) resulting in a delay of tx because sedation is needed. Or the numerous patients who stop taking their antibiotic medications because the signs of infection leave, only to contribute to problem of drug resistant bacteria.
The medical professionals do so much to save MANY LIVES every year despite many patients who seem to care less about their health and rely on doctors and medicine to save them from their poor health instead doing simple things like eat healthy, exercise, and avoid harmful behaviors.
3. Our judicial system has a poor way of assessing medical malpractice cases. A group of 12 jurors ignorant about medicine listening to two opposing sides bring in their own expert witnesses and then make a decision. So they listen to two experts who don’t agree and are left to make the decision. In my opinion, medical malpractice cases should be decided by a board of professionals who are skilled and who understand the system and not a group of people who don’t understand medicine.
4. As the cost of a medical education increases and the conditions of the medical system decrease, less will want to enter the workforce. So, I say to the writer, stick with it. If shortages do occur, it could leave you in a better position to demand what you want.
For the writer- If you just want to get your loans paid off and want some protection from attorneys, consider a federally funded program like a branch of the military or the National Health Service Corp. The pay isn’t as great and you might end up in rural America or overseas, but they do offer nice loan repayment options and there is good legal protection working for the federal government.
Anon
You guys are crazy! The health care bill was supported by AMA, FAH, and AHA. You know why? Because it’s a trillion dollars of new government spending on the health care system. You know where that spending goes? To help uninsured people buy health insurance. And where does health insurers’ money go? To you guys!
Insurers have a right to complain because their business model is being completely turned on its head. But doctors and hospitals are getting hundreds of billions more dollars from new customers and giving up basically nothing. The lobbying groups can see the forest for the trees, but you guys are so wrapped up in “bleh bleh I hate Obama” that you can’t.
Anon
PS- Just clarifying that my comment is in reference to pessimistic views of the health care reform law expressed in comments here, not pessimistic views of the system as a whole expressed in the actual post.
dfvzazan
Gee, how could I have been so naive! Thank you, Anon, for ripping off my Obama Derangement Syndrome blinders and showing me the light.
One needs simply connect the dots to expose your obtuse logic. Here’s a crash course: The gov’t expands insurance coverage through massive subsidies and price controls (community rating and guaranteed issue); “greedy” doctors eagerly rub their hands together as they await the flood of new revenue; increased demand on the system raises the cost of medical care and insurance; healthcare costs continue to rise at an even worse rate; the gov’t again steps in proclaiming, “We tried it the free market way, now we’re nationalizing the whole industry;” every last minutia of medical practice becomes purview of our benevolent politicians.
If you are too blind to see how Obamacare was specifically designed to buy off doctors in the short term just to turn the screws on them in the long term, then I only hope your myopia is not the national epidemic I fear it might be.
Anon
To dfvzazan: Once again, are you crazy? With Democratic majorities bigger than anything they’ve had in decades, Obama barely manages to pass this health care bill, by the skin of his teeth, at great cost to his presidency and soon his majorities — and this is a bill that every health interest group except insurers supports! And you pretend that we’re inches from “nationalizing the whole industry”? What world are you and Clev living in?
Reality: Doctors OWN Congress. Congressmen bend over backwards to give doctors whatever they want. Nothing will ever pass Congress that takes a serious bite out of doctors — ever. When the cuts have to come, other people will take the pain.
brian
Anon,
There is no polite way to say this so I just will say it: You are a naive fool.
Unfortunately, our country is heading for the cliff because it is full of naive fools like yourself who practice magical thinking and completely lack common sense.
Clev
Anon,
Your comments are so silly that they don’t warrant reply, but I’m bored.
Simple math seems to be beyond your grasp. The government is bankrupt and to try to buy all these extra votes under those circumstances by screwing doctors and rationing care. Of course it didn’t SAY it was going to do these things…they wouldn’t have been able to cram the bill down America’s throat if they had. However, simple math is all you need, and you are naive to the extent that the future is going to be a cold, hard slap in the face.
P.S. The AMA is the closest thing to a lobby for physicians there is, and it only represents a small minority of physicians. Furthermore, it was bought off by the government and it’s ranks of doctors decreased during the Obamacare debacle because it wasn’t representing their interests.
Sincerely,
Reality
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