Back when I was in high school, my mother envisioned for me a future in health care, with babies, and she was right. Not only did I wholeheartedly want to pursue medicine and be with babies, but as a plus, everyone, I mean EVERYONE, told me as a physician you can hang a shingle anywhere and have employment "because people will always get sick and need you." There is nothing like knowing job security exists in your chosen field. My mother added that once you have a degree no one can ever take it away.
At the time I worked in a small one hundred-something bed hospital. I could see the nurse’s station, nursery, postpartum and labor unit all from one place (well, almost). The general practitioner (not a Board Certified Family Physician), relied on his experience and was still birthing babies. He took care of his babies, he was still doing non-obstetric abdominal surgery, and he cared for his own floor and ICU patient, also. Now, those responsibilities are clearly divided among Family Practice, OB, Pediatrics, Neonatology, Surgeon, Internal Medicine, and Hospitalist. He was also Chief of the Medical Staff. This was only 25 years ago. The nursery supervisor was an LPN and the OB supervisor was also an LPN. I adored both for the opportunity they gave me for meaningful high school employment. I actually remember when they brought in new RN BSN's to replace their positions that my mentors held. This was big change going from experienced pioneers to recruiting academic types from the outside. It didn't seem fair that this replacement was occurring. Likewise, the GP recently gave up his cesarean privileges to the new OB's in town. I suppose accreditation organizations and insurance now required these new credentials. That was just the beginning of changes I’d witness.
To practice medicine privately, I studied 12 years in school, left 8 year hospital employment realizing I could never offer individualized care being employed, moved out-of-state to avoid non-compete, moved back, opened up a business, avoid influence by avoiding hospital affiliation and AMA membership, had my own babies, leave my babies to go to work, give up family time. I don't mean just my kids. Many times I tell my mom, sister, and in-law's I can't be there. I take my own telephone calls after hours. I’ve passed an intense Family Practice Board Exam three times. I maintain my IBCLC credentials which involves a separate set of testing and education. You wonder why more pediatricians and OB’s don’t get "birth" and "breastfeeding." We have much bigger problems. I love providing flexible care. But I seriously wonder is it worth practicing anymore? Can I provide individualized patient care as the conditions become more crippling? Honestly, I think my own family needs me recognizing my limitations more than me fighting a loosing battle. I think about staying home. Since I don’t see any benefit from working as a government employee, I am thinking about it even more. I know I could not offer the services I do now if I worked for the government. I couldn’t as a hospital employee.
The biggest area of flexibility my patients enjoy is our office's vaccination policies. Vaccination for school is mandated by the government. I get confused when those in my practice most adamantly opposed to mandatory vaccinations want to push for a 1900 page document written by the government controlling healthcare.
As wonderful as many think the Canadian system is, my current mentor Jack Newman in Toronto receives no funding. He solicits donations from his website to keep his breastfeeding medicine practice open. He gets no public funding and he
is the world renown expert in breastfeeding medicine. What’s to happen to my little part-time practice under the forthcoming conditions? The new bill would not accommodate me soliciting donations to keep a clinic open. I couldn't compete and survive privately. I also happen to think the Canadian system and our system have actually benefitted from our differences. Theoretically becoming a like may not be beneficial.
It's my husband's part of the practice that holds us financially together and it’s because he is working super long hours with face-to-face patient care. (I guess I am lucky, I don’t have to work. :) ) I am not sure I would want us working here (in the USA) anymore if we have more "change." For the first time I find myself wondering where we can go ... like maybe to his family's apartment in Peru. (He says there is lots of whole organic food there!) I tell you it’s tempting. Right now, I really feel like very little is holding me here despite the huge thoughtful investment of time and energy I have put into getting where I am at. Once I was so full of hope. Well, I still am hopeful and ambitious, but I am really wondering if I need a new plan—- out of the country. And yes, we are remodeling, and I should feel very excited about finally having a house we’ve worked hard for, but anticipating the exponential rate at which government is taking over health care really sours me. I am not in the America that I learned about in high school.
Yes, we need reform. I agree.
We need obstetric reform big time. The health care bill offers no solution for the current obstetrical /VBAC issues. Tort (legal) reform would solve the problems of the defensive practice of medicine. Tort reform is a necessary part of a successful turn-around in medicine, but is not anywhere in sight. I know many people in America think that socialized medicine in America would lead to midwifery programs like in Canada or Europe. Reform is not offering that. In fact with the potential of cap and trade combined with nationalization of medicine, it will be increasingly very difficult to run a business. I don’t see how small birth businesses will survive.
We need insurance reform. There are several models posted on the internet. The health care bill is not the only model. Here is one of
resource which makes individuals and families the key decision makers in their healthcare.
We also need social reform. That is where patients take responsibility for their health. Most disease is self-inflicted. We can prevent a lot of medical expense with nutritional, fitness, and tobacco (and sexual behavior) reforms. This is not addressed at all in the current bill. You’ve heard me say it before on this blog, book, and face-to-face and here it is again. Social reform won't occur now because the food and pharmaceutical lobby is very powerful in D.C.
I know this rant sounds all about me and my goals and my sacrifice. I had a Human Gold patient ask me, if I thought his insurance will be affected by all this? He thinks Humana Gold will not be affected?
Seriously? Say somehow Humana Gold is not, but my practice definitely is. I am in a different place this year than last year when anticipating expansion opening a new office ... adding a nurse practitioner, and Dr. Coquelet Senior. We go into this new year tightnening our resources. This particular patient's care (and yours) will ultimately be interrupted. So called national health care bill affects us all. We have the right to question the 1900 page document.
At the time I worked in a small one hundred-something bed hospital. I could see the nurse’s station, nursery, postpartum and labor unit all from one place (well, almost). The general practitioner (not a Board Certified Family Physician), relied on his experience and was still birthing babies. He took care of his babies, he was still doing non-obstetric abdominal surgery, and he cared for his own floor and ICU patient, also. Now, those responsibilities are clearly divided among Family Practice, OB, Pediatrics, Neonatology, Surgeon, Internal Medicine, and Hospitalist. He was also Chief of the Medical Staff. This was only 25 years ago. The nursery supervisor was an LPN and the OB supervisor was also an LPN. I adored both for the opportunity they gave me for meaningful high school employment. I actually remember when they brought in new RN BSN's to replace their positions that my mentors held. This was big change going from experienced pioneers to recruiting academic types from the outside. It didn't seem fair that this replacement was occurring. Likewise, the GP recently gave up his cesarean privileges to the new OB's in town. I suppose accreditation organizations and insurance now required these new credentials. That was just the beginning of changes I’d witness.
To practice medicine privately, I studied 12 years in school, left 8 year hospital employment realizing I could never offer individualized care being employed, moved out-of-state to avoid non-compete, moved back, opened up a business, avoid influence by avoiding hospital affiliation and AMA membership, had my own babies, leave my babies to go to work, give up family time. I don't mean just my kids. Many times I tell my mom, sister, and in-law's I can't be there. I take my own telephone calls after hours. I’ve passed an intense Family Practice Board Exam three times. I maintain my IBCLC credentials which involves a separate set of testing and education. You wonder why more pediatricians and OB’s don’t get "birth" and "breastfeeding." We have much bigger problems. I love providing flexible care. But I seriously wonder is it worth practicing anymore? Can I provide individualized patient care as the conditions become more crippling? Honestly, I think my own family needs me recognizing my limitations more than me fighting a loosing battle. I think about staying home. Since I don’t see any benefit from working as a government employee, I am thinking about it even more. I know I could not offer the services I do now if I worked for the government. I couldn’t as a hospital employee.
The biggest area of flexibility my patients enjoy is our office's vaccination policies. Vaccination for school is mandated by the government. I get confused when those in my practice most adamantly opposed to mandatory vaccinations want to push for a 1900 page document written by the government controlling healthcare.
As wonderful as many think the Canadian system is, my current mentor Jack Newman in Toronto receives no funding. He solicits donations from his website to keep his breastfeeding medicine practice open. He gets no public funding and he is the world renown expert in breastfeeding medicine. What’s to happen to my little part-time practice under the forthcoming conditions? The new bill would not accommodate me soliciting donations to keep a clinic open. I couldn't compete and survive privately. I also happen to think the Canadian system and our system have actually benefitted from our differences. Theoretically becoming a like may not be beneficial.
It's my husband's part of the practice that holds us financially together and it’s because he is working super long hours with face-to-face patient care. (I guess I am lucky, I don’t have to work. :) ) I am not sure I would want us working here (in the USA) anymore if we have more "change." For the first time I find myself wondering where we can go ... like maybe to his family's apartment in Peru. (He says there is lots of whole organic food there!) I tell you it’s tempting. Right now, I really feel like very little is holding me here despite the huge thoughtful investment of time and energy I have put into getting where I am at. Once I was so full of hope. Well, I still am hopeful and ambitious, but I am really wondering if I need a new plan—- out of the country. And yes, we are remodeling, and I should feel very excited about finally having a house we’ve worked hard for, but anticipating the exponential rate at which government is taking over health care really sours me. I am not in the America that I learned about in high school.
Yes, we need reform. I agree.
We need obstetric reform big time. The health care bill offers no solution for the current obstetrical /VBAC issues. Tort (legal) reform would solve the problems of the defensive practice of medicine. Tort reform is a necessary part of a successful turn-around in medicine, but is not anywhere in sight. I know many people in America think that socialized medicine in America would lead to midwifery programs like in Canada or Europe. Reform is not offering that. In fact with the potential of cap and trade combined with nationalization of medicine, it will be increasingly very difficult to run a business. I don’t see how small birth businesses will survive.
We need insurance reform. There are several models posted on the internet. The health care bill is not the only model. Here is one of resource which makes individuals and families the key decision makers in their healthcare.
We also need social reform. That is where patients take responsibility for their health. Most disease is self-inflicted. We can prevent a lot of medical expense with nutritional, fitness, and tobacco (and sexual behavior) reforms. This is not addressed at all in the current bill. You’ve heard me say it before on this blog, book, and face-to-face and here it is again. Social reform won't occur now because the food and pharmaceutical lobby is very powerful in D.C.
I know this rant sounds all about me and my goals and my sacrifice. I had a Human Gold patient ask me, if I thought his insurance will be affected by all this? He thinks Humana Gold will not be affected? Seriously? Say somehow Humana Gold is not, but my practice definitely is. I am in a different place this year than last year when anticipating expansion opening a new office ... adding a nurse practitioner, and Dr. Coquelet Senior. We go into this new year tightnening our resources. This particular patient's care (and yours) will ultimately be interrupted. So called national health care bill affects us all. We have the right to question the 1900 page document.