The Politics of Medicine

My apologies for being MIA this past week.  Some personal stuff got in the way and then news of government cuts to our public health care system have left me distracted.

When I decided I wanted to be a physician it was mainly to help people.  Sounds cliche, I know.  I have always had a very natural, instinctive interest in how the human body works, how disease and stress affect human functioning.  I didn’t know how much doctors made, it was kind of the last thing on my mind.

But then I started working.

I’m not about to complain.  I get paid pretty well for what I do.  Historically though, family physicians where I live have been underpaid compared to our specialist counterparts.  It has only been in the last 5-10 years that our compensation has reflected the kind of work we do.  I not only see patients in my office, but I speak to many over the phone, manage chronic illness both on the phone and in person.  I write reports for lawyers and insurance underwriters.  I act as an advocate for my patient when it comes to dealing with specialists.  I take the time in the office to support and educate my patients.  Over the last few years, our funding model has changed to reflect this work. Unfortunately, all this is about to change.

I have been discussing these issues with my patients all week, and have been rather surprised at the amount of support I’m getting.  I used to think the public felt physicians were overpaid.  I’m sure there are many who do think this; thankfully, most of my patients do not.  What one seems to forget is that I’m running a business.  I have staff, rent, and office supplies to pay for.  What has frustrated me most is the figures being quoted in our local media on how much physicians are supposedly making.  This isn’t taking into account the 25-40% in overhead we are responsible for.  The cuts our government is proposing, well not proposing but unilaterally implementing, will see my income decrease by about 20-25%, yet my expenses are going up.  As a the sole income earner for my family, it’s very frightening.

My colleagues are older and have lived through these kinds of cuts in the past.  They tell me it won’t be that bad.  Our practice model will have to change.  Instead of doing things over the phone, I’m going to have to start calling patients back into the office to discuss results.  My ability to see urgent problems will decrease.  More patients will be forced to go to walk-in clinics or the emergency department.  Wait times are going to increase. Patients are going to get disgruntled.  The cost of health care will actually increase, rather than decrease.  The changes are so short-sighted, it’s appalling to me.  Specialists hands are being tied as well.  As it stands now, if a woman has an abnormal mammogram, the radiologist “self-refers” her back the next day for a follow up scan.  She gets an answer in 24-48 hours.  Now, the situation has changed.   The radiologist is going to have to send me a letter, I’ll have to call the patient back in to the office and inform her she needs a follow-up scan.  I will then have send a new referral for the scan.  The patient will wait a week or two and worry she has cancer.  Tell me how this is benefiting patient care?  Oh right, it’s not!

For those reading who know what’s happening in our area, I plead with you to write a letter to your local politician or your local newspaper.  Your health care is going to suffer.  If your family doctor or specialist has a letter they’d like  you to sign, in opposition to these cuts, please do so.  Hopefully with enough push-back, we can change the tide.

Thank you.

4 thoughts on “The Politics of Medicine

  1. It’s helpful to hear the impacts described at the offic level and be reminded to put doctor’s offices in a small business category. When you talk about how much a business earns, you understand that the owner isn’t keeping all that. It seems unfair to talk about how much a doctor’s office earns as if it’s the doctor’s personal income. One question, though…Why do the reductions mean you need to call patients back to the office instead of phoning?

    • As it stands now, I am compensated on a capitation basis so that I can spend more time on the phone rather than face-to-face with patients. If the cuts proceed then that capitation will disappear and I will have to change my practice back to a more fee-for-service model in order to make up the difference. After all, I still have a business to pay for.

  2. I’m not even sure where to start on the remuneration issue. I think I could have a whole blog site just devoted to the Business of Medicine (and how much I hate that aspect. That and paperwork) The one thing that I liked about working ER was it was so simple – I wasn’t worrying about overhead, I was paid a set hourly wage – Heaven! I knew if I worked the hours, I would get paid and survive. I was gauranteed a certain amount of hours but could work more if I wanted more money. Now – no reassurance. In medical school they tried to tell me I was going to have to worry about money and business models – do people really want their doctor’s learning that or about medicine?

  3. Exactly! When I was in medical school they have some courses on office management but seriously, who was paying attention? I’m not interested in running a business but that’s exactly what I’ve gotten myself into. Oy.

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