Dear Physician....A letter from you local PA/NP

Dear American Physician,

The changes in the landscape of the American healthcare system have called for some drastic changes in thought, process and execution over the past 10 or so years.  We have seen the invasion of computers into the medical landscape, the loss of autonomy as insurance companies require us to ask them for permission to provide care to our patients and a drastic change in who works for whom and how the American healthcare worker is paid.

In the middle of all of this, many Physicians are choosing to retire, leaving a significant shortage of physician providers to care for the masses in this country.  Emerging onto this landscape in the past 40 years is the "Mid-Level Provider".  The Physician Assistant and the Nurse Practitioner are poised for growth's in their fields unprecedented in the history of healthcare.  With this advent, the American Physician is concerned about how their jobs are going to change.  Will the Doctors act as team leaders, managing groups of Mid-Levels.  Will they act as consultants for the more difficult cases while the Mid-Levels focus their visits on "Healthcare Maintenance", or something else?  In short, the American Physician is wondering if they are going to be "replaced" by someone who has less education and makes less money, making them more attractive to business.

I hate to let the cat out of the bag, but the biggest elephant in the room no one is talking about is that you have already been replaced!  A physician preceptor once told me that some day, the actual practice of medicine would become the easiest part of my day.  I have found this to be true.  The place you have been replaced is not by lessor trained providers seeing your patients. 

YOU HAVE BEEN REPLACED FROM ABOVE, NOT BELOW!  You were in a unique position to guide healthcare organizations into this next century.  Instead, you have given up that job to less trained Healthcare Business Managers!  That's right.  The CEO of your local hospital, The CFO of the local insurance.  The business management staff of the medical group YOU own part of.  This has reduced the leaders of American Healthcare to "EMPLOYEES".  In a recent article in Medical Economics Magazine, the recommendation was made that Healthcare Organizations NOT hire physicians to the business management staff.  The reasoning was that they will think too much about patient care and not fiscal responsibility!

Yes it's true.  You have been replaced.  The CEO used to respect the Medical Chief of Staff.  Not anymore.  It's all about business and acceptable risks.  Is it worth risking a lawsuit so that you can save $100,000 by denying a life saving procedure?  What's the likelihood of a law suit?  Can we settle for less than the procedure would cost us?  These are the questions a Healthcare Business Administrator asks that a physician would never consider!

So the next time you feel like a "Mid-Level Provider" is stepping on your toes, remember, if we wanted to be Physicians, we would have gone to Medical School. (Every Nurse Practitioner or Physician Assistant I have ever met would have been more than capable of graduating from Medical School).  Remember, we are on your side!  We want the best for the patients in our clinics just like you do.  You need to fight to reclaim your role as the Director of the American Medical landscape.  We need you to set corporate policy, work with politicians to insure that the patients of this country are being cared for in the manner that is correct and proper.

We need to return management of healthcare to Physicians!  Remove the decision making from those that only care about the health of the corporate finances!  YOU need to return to your rightful positions as the leaders of this field!

And when you look around, we will be right there, supporting you in your efforts to provide high quality medical care the OUR patients!

Sincerely, your colleagues, your local PA/NP

Healthcare: Socialized Medicine VS Free Market? It doesn't matter!

Healthcare: Socialized Medicine VS Free Market?

(Spoiler alert!!!  IT WON'T MAKE ANY DIFFERENCE!!!)

I'm not actually argueing one way or the other, privats vs socialized. However, keep in mind this destruction of the system is being CAUSED BY THE GOVERNMENT and their OCD desire to micro-manage everything in sight! The computerization of healthcare started in 1983! (Full steam in 2004) It has nothing to do with Obamacare!  In 2014, only 4% of Doctors offices have met the requirements.  (instead of saying "gee, maybe there is a problem with our requirerents, the gov't is plowing ahead with 2015 requirements!)Those that have,  face the rosey outlook I outlined in my last discussion. They (the gov't) have created a system so complicated it's not possible to navigate without errors. AND in the U.S. medicare system, HUMAN ERRORS=CRIMINAL FRAUD!!! They do not recognize that their systems are CAUSING THE ERRORS.  On the flip side, the private sector has taken to sucking as many Medicare dollars from Doctors offices as possible. They are micro-managing us to death! We are spending Trillions to save Millions. 18% of the U.S. GDP is tied up in healthcare! Somewhere around 90% of the people that make a living off the healthcare dollar (Pharm, DME, Insurance, IT, Education and lisencing, ect) NEVER SEE A PATIENT!!!  This is not sustainable! They (the gov't AND the insurers) are scared to death to allow Doctors to actually make medical decisions! We need to allow healthcare providers to do what they are trained to do.....TAKE CARE OF YOU WHEN YOU ARE SICK! Not spend >50% of their working day putting information into a computer that makes it hard for them to do their job! (Computers CAUSE medical errors!!!) Physicians, NP's, PA's, RN's and everyone else are trained to deliver care! Not Code for your diseases, perform data entry, do referrals and the myriod of other items included in this process. A proper medical note now takes 10-15 minutes to write-20 Times a day! All this is done in your Doctors and Nurses "spare time".

Until the whole system and billing process simplifies and the decisions of how to care for patients are returned to the people who actually see the patients, socialized or private does not matter! We have destroyed the moral of the American healthcare worker! That is the most dangerous part. They know, no matter how good they are at taking care of YOU, ultimately, your care is decided by a 12 year old with a medical cookbook and no formal medical education. They also realize they are paid on their ability to navigate a rediculously complicated system that even the government does not understand!

The answer is not as simple as socialized medicine (newsflash! We do have socialized medicine, it's callet Medicare) or letting the free market decide! Honest! DEATH CAUSED BY INSURANCE is a COMMON cause of death.

A Business Summary of Healthcare.

A business summary of healthcare:

By forcing your Doctor to computerize, they see 30% fewer patients, Work 50% longer to see the patients they do see and pay at least $100,000 per year just to have the computer in their office.

Everytime your insurance requires a prior-authorization for a test or proceedure, it costs your Doctor's staff approximately 2 hours of labor. (Add 2 more hours to that if you do not go to the appointment and the auth has to be extended) Keep in mind also that for every dollar in the staffs payroll, about a dollar is spent in other costs (taxes, insurance, various government programs) A $15 an hour employee costs almost $30 an hour by the time the IRS and everyone else gets their cut.

Consider on top of that, increasing mal-practice premiums, increased taxes, increased costs of keeping the building open AND the fact that reimbumsement has been declining for the past 10-20 years.  In my local area, utilitities have increased 500% in the past 15 years.

Consider also that lifetime costs to BECOME a doctor amounts to around $1,000,000 in a lifetime. Money loaned to idealistic young Doctors, NP's, PA's and nurses at interest rates that would make the neighborhood loan shark proud.

Your Doctors are also required to close their practice, travel and pay large amounts of cash for somewhere between 100-250 hours a year for "Continuing Medical Education". Not to mention the fees and dues to maintain "compliance" to various professional and lisencing bodies. (Paid in the Thousands of $ every year)

One last thing, the providers in the office are the Only source of income. EVERYTHING else in the office costs money! (if it doesn't save time and make life easier, it's a drain on the practice)

So the next time your Doctors seem in a hurry or pre-occupied, they may have recieved a huge electric bill, mal-practice premium or a suponea requiring them to close the practice for a day.

Maybe there are real concerns about even KEEPING THE DOORS OPEN!

So, does this sound like a sound business investment? NO? That would be why medical corporations are, today in America, unable to obtain business loans!   The financial institutions of this country consider partnering with the future of American medicine a POOR INVESTMENT!!!!

Pitfalls of patient satisfaction reimbursment

In the future, healthcare provider (physician/np/pa) pay is going to be very closely linked with patient satisfaction. The happier the patients, the fewer lawsuits. The happier the patients, the higher the insurance reimbursement.

But, when pts are told to ask for this drug or that test by ads or Dr's on TV, they tend to be sicker longer, spend more time in clinics, money on meds, days in hospitals, AND DIE SOONER!

There's a reason Dr's go to school for 8 years, Nurse practioners/Physician Assistants-6 years. Add executives didn't go to med school. And Dr Oz is wrong 70% of the time. Plus, most of the tests he tells folks to get either aren't available or your insurance won't pay for.

We live in this consumer driven society.  While "The customer is always right" works in industry whose prime motive is to separate said customer from their cash, this is almost never the case in healthcare. The goal of healthcare is a means to an end. Healthy, happy patient while utilizing as little testing, medications and sick time as possible. All the while being pressured to do that "one more test just to make sure" if it will save the patient the pain and recovery of an invasive proceedure or spare the insurance company from a costly interveation. Being the one who will be held respondsible if the outcome is less than favorable is not a desirable position. Everyone is telling the provider what to do, yet the provider is the ONLY one who is accountable in the end.

So, be carefull what you are asking your Dr for. Pay attention to the look on their face. Make sure they aren't giving it to you to get you out of their office and avoid legal action.

It is said that doctors dont spend much time listening to their patients. In my 35 years of working with patients, it's never amazes me how many patiets never listen to their providers, never answer their questions directly and clearly and leave disatisified if they couldn't "have it your way".