We’re Listening…

There are lots of opinions out there regarding healthcare reform. I received a great email the other day from a friend of mine who also happens to be an orthopedic surgeon. I felt it would be appropriate to share his concerns about the current debate surrounding health reform. He has graciously agreed to allow me to post his thoughts on our blog.

Perhaps the most important thing to remember is that you — surgeons, support staff, device reps, and administrators — still have a voice. Your voice can make a difference. Ask for what you want. Stand up for what you believe. We are counting on you and your expertise to lead us into the future of healthcare. We’re listening to you.

Here is what Dr. Woods had to say:

Doctors are not very politically active as a group and we mostly hope that if we do a good job taking care of our patients everything will work out for the best.

That includes the 2AM drunk biker who crashes and gets hauled in on the helicopter so we can all get out of bed and fix him (or her) up. We put up with that scenario where we work on these people and follow them along for substantial amounts of time and never get paid a dime. Again, most of us figure that it will all be OK, and it’s part of our job. Oh yeah, I almost forgot…we also have federally mandated regulations with financial and possible jail sentence penalties if we refuse to treat an emergency patient based on lack of ability to pay us. That also goes for the hospitals as well. So, essentially, we are forced to work for free. Isn’t that called slavery? The “loss” associated with writing off the fees charged for those “free procedures” represents tens of thousands of dollars per year, just for me alone. It is also illegal for me to deduct those losses on my business tax returns. So if any or all of the above could somehow be fixed we doctors would love that.

Also, if something goes wrong with that patient, or if he just doesn’t like his outcome, he can and frequently will sue everybody; me, the hospital, the anesthesiologist, the implant manufacturer. It doesn’t matter that he was the one who rode his motorcycle drunk and crashed. It doesn’t matter that we all did our best to put him back together. He and his attorney want somebody to pay for his situation. It would also be nice to regulate that broken system.

The other big problem that physicians have is that for the most part we are unable to set our own fees for our procedures. We cannot even discuss what we charge with another colleague; that has been deemed illegal by the feds. The insurance companies that eventually pay us on behalf of patients, however, are able to discuss what they are going to “allow” as a “reasonable” fee. Who decides what a reasonable amount of money is for taking someone’s spine apart and putting it back together? Answer: a CEO of an insurance company somewhere. Want to guess who makes more money: the guy that does the work or the guy that controls the money. This is a huge problem in this country, and really is THE big problem with health care costs. These gigantic companies charge more each year for insurance premiums and pay the guys doing the work, physicians, the same or less each year.

Where is all that excess cash going? If it’s not being paid out to physicians, and employers and patients are paying more each year, it’s obviously staying in these gigantic companies. Much of it is being paid out in equally gigantic bonuses. A ton of that money is also being used to lobby the feds as well. That hasn’t changed a bit with the new administration and congress. It doesn’t matter who’s in power…money talks!

Buy the way, Medicare pays us as much or less for many procedures than they did in 1994…I kid you not!

We all signed up for this when we decided to go to medical school, so I guess somehow it’s our own fault…See my first statement about being politically naive. However, if the Feds and these private insurance companies step in and further regulate how I do my job and pay me less and less, you can bet that many doctors will not be able afford to keep their offices open. Many more of us will decide that it’s not worth the legal exposure and the late nights and will simply refuse to do it anymore. At some point doctors as a group will say “Enough!” and that may happen very soon. Let’s watch a CEO or a Senator or a plaintiff’s attorney fix a broken femur at 2AM!

Further, any bright kid coming up that is intelligent will not want to put in the effort required to become a physician. This is already happening and will get much worse if the current reforms take place. This obviously will have far reaching consequences for us Boomers as we get older and sicker.
So how do we fix all this…Sorry…I’ll bet you were hoping that I’d have an answer…unfortunately I don’t.

I can tell you that the current cluster that is occurring in Congress will NOT EVEN COME CLOSE to fixing any of the above scenarios, and will make the problem much worse. Until somebody reigns in the malpractice attorneys and the CEO’s of those big insurance companies the above scenarios will get worse, not better. You can write to your congressman, but they are mostly part of the problem, not the solution…as long as the big money lobbyists have their ear.

It will likely take a literal “revolution” by the medical community to change this, and my prediction is that it’s coming sooner than everybody thinks. I probably sound angry…and if I’m honest…I really am. But I am not the only doctor that feels this way…I would say that the majority of physicians have similar feelings to this. Recent surveys have shown that 65% to 70% of practicing physicians would not go into medicine if they had to do it over again…that’s a sad statistic.

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