The Healthcare bill has passed. On future realities from the “real” world…

It looks like the Obama health care bill will survive the House vote.  It was really close.  It took a last-minute executive order to placate a small number of congressmen.  A small band of anti-abortion congressmen required an executive order to garner their support.

Seriously?

Politics amaze me.

It is done.  So be it.

The list of problem issues for doctors and patients are too numerous to completely list.  Clearly, the present bill will accelerate the erosion of the doctor-patient relationship.  Making healthcare more like the VA system will surely allow more to be cared for, but at what costs?

Declining compensation, increased paperwork, and lower job satisfaction for doctors seems unimportant to the masses.  That is, of course until you or your family need a talented young doctor to fix something, like a heart problem, or perform a complicated surgery.  Or even more importantly, have a personal doctor who knows you and has time to spend with you.

Dr. Giurleo eloquently outlines the plight of the young person who is asked to invest up to 100,000 dollars, and many (3-10) years in the prime of their life for post-graduate training to learn how to become a doctor.   Reading her outline of a doctor’s business plan is incredibly instructive, and sobering. No other profession has such a dismal business plan.

Here is an excerpt from her piece:

After finishing the aforementioned training…
—The first order of business is to figure out how you will get paid for all of your good work. The standard business model is accepting payment from a third party.
–This third party decides how much your work is worth.
–The third party sets limits on how much work you can do with each customer.
–The third party can reject your invoices at any time for any reason.
–The third party prohibits you from discussing your fees with other providers of the same service.
–There are many of these third party payers and they all pay different, seemingly arbitrary rates.
–The third party can change what they pay you at any time.
–If you don’t follow all of the rules of the third party they don’t have to pay you at all.
–The business model requires you to rely on an outside source to determine what you work is worth, set your rates and reimburse you on their terms. They can change the rules at any time. Outside forces constantly and consistently determine your bottom line. You have no choice, no chance to test price points. If you want to add a new service that isn’t recognized by the third party, they don’t pay you. The third party tells your customers that you are responsible for accessing their funding on their behalf, so no one knows what they really pay you or what your services are worth.
–If you have any entrepreneurial spirit at all, please re-read the above paragraphs and tell me if you would sign up for this business model. Honestly, it’s ridiculous, don’t you think? Who in their right mind would invest $100,000 and years of their life in education, training and business and then turn over all hope of a profit to an outside entity?

Remember all, doctors are not machines.  We are fellow humans who have similar life stressors, similar bills to pay, kids games to attend, and hobbies to pursue.  This erosion of the incentive to choose medicine as a career is seldom mentioned in the healthcare debate.   In my small world of talented teenagers, none have expressed a desire to doctor.

JMM