The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: health. Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is health care, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status.
I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essential of a skill as is medical knowledge – remove either one of them and you don’t have care. I hear the message: doctors should care about patients more than they care about themselves. That is what we are paid to do, and that is what we have neglected at our own peril.
So why is it, then, that those of us who try to be patient-centered in our care end up getting penalized? If the days of the doctor-god are over, then why are we still paying premium dollar for those huge egos? Why do we pay more for technology than humanity? When I face the continued threat of declining reimbursement (don’t forget, then next SGR battle will be over a 30% drop in Medicare reimbursement) I feel angry. I am the point of care, not cost. I am cheap. I spend my day trying to keep people well, trying to find cheaper medications for them, trying to avoid expensive procedures and consultants. How am I rewarded for fighting the tide of spending? With increased expectations, increased fear of the future, and decreased pay. I see the gratefulness of my patients, and that keeps me from fleeing altogether; but I also face the callous cuts by CMS, the increased micro-management by the insurance industry, and accusations of being a “greedy doctor” for not wanting my pay cut.
Why is this? Why is a system that is growing more and more expensive seeing cutting my pay as a means to saving money? Why not focus on the durable medical goods that solicit business from my Medicare patients, suggesting that they can get “free” commodes and scooters? In the past few weeks I have done three “mobility evaluations” for people who are trying to get scooters. They have done this in response to the commercials or direct phone calls from the companies that provide these devices. Beyond that, I have seen a huge increase in the number of ludicrous requests by these companies who prey on innocent and ignorant patients. They are leeches. They are bloodletters removing the life-essence from a dying patient. Yet their presence is growing.
Why not focus on the generic drug manufacturers who are still able to charge premium prices for their drugs? It used to be that when a drug went generic, it got cheap. For some reason, however, things have gotten far more complicated. I now need to know which are the “cheap generics” and which are expensive. I need to remember which medications that were inexpensive have been forced off of the market by more expensive competitors (cough syrups and colchicine, a drug used for gout are two examples of this)?
Why not focus on the hospitals who are buying physician groups so they can order more tests in their facilities? The pendulum has swung now back to the hospital-owned physician groups, with doctors fleeing the fear of SGR and other reimbursement debacles for the “safety” of a salary from a hospital. The problem with this is that the hospitals are huge consumers of healthcare resources. Hospitals hire doctors because doctors can send them “business.” In case you forgot, “business” is another word for “spending.” Hospitals are things patients should avoid, but doctors are hired to be a turnstile into the land of medical spending. I have lived in both worlds, and I am far more patient-focused and cost-conscious than I ever was when owned by a hospital.
We have a bunch of hands being plunged into the coffers of healthcare, and yet we are penalizing those who are too busy caring for patients to do so. I honestly get depressed when I see all of the waste around me and yet face huge cuts to my reimbursement. It shows people don’t understand. It shows people don’t care. Do you want doctors who care? Then put your money where your mouth is. Stop rewarding the parasites. Stop throwing money at the turnstiles. Stop rewarding the spenders.
There are some of us who still care, but it’s getting harder to stay that way.