A primary care story via the Los Angeles Times

[ILikeFood]

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How heartwarming!!!

http://www.latimes.com/news/science/la-fi-doctors15-2008dec15,0,2323666.story?page=1

Exhibit 1:

The morning's last patient, a disabled woman on Medicare, trails her doctor into her office and confides that she doesn't have money for lunch. Tanyech Walford pulls out her billfold and hands her $3. It's money the doctor really doesn't have.

"I tell patients I'm broke, and they just chuckle," she said. "They don't believe me."

Walford's fashionable medical suite in a sleek black-paneled building in Beverly Hills was hiding a grittier reality: She spent much of her lunch hour that day in her office opening mail -- hoping to find payment checks to help fill the gap between her expenses and her revenue.

She hadn't drawn a paycheck for herself since February. On top of that, her practice has cost her $40,000 in personal savings and left her with $15,000 in credit card debt. Walford, 39, also owes $80,000 in medical school loans. She shops at Ross and other discount retailers, and rarely eats out or takes time off.

"I'm totally stressed out," Walford said. "How can I take care of my patients when I'm that stressed?"

Did you hear the joke about the lady who got free health care and lunch from her doctor?


Exhibit 2:

Dr. Jerry Connell kept his family practice going in Santa Rosa for 29 years. But he closed it in October because his income had slipped to $50,000 a year, even though he had 2,600 patients.

"I could make more with my Social Security and investments than I could by staying in practice," said Connell, 66.

He didn't bother looking for a buyer because "no one in Sonoma County has been able to find a replacement in five years."

Wow.

Exhibit 3:

Early next month, Walford will join 200 physicians in a multi-office practice affiliated with Johns Hopkins Medical Center in Prince George's County, Md. Her base salary will be $115,000, plus bonuses based on the complexity and quality of care she delivers. Benefits include vacations, health insurance, a pension plan and paid continuing medical education.

I'm studying hard in medical school. **** primary care.

 

[utahjazz]

Wow, depressing... Thanks for sharing.

 

[DrYoda]

If I ever feel unmotivated studying, I shall read this. Thank you.

 

[phospho]

a *licensed* practicing physician making 50K/year is doing something wrong... Yes, we can complain and bitch all we want about falling incomes, but this too much.

I'm a premed working in finance with a psychology degree, and I make MUCH more than that...

Either these doctors are doing something wrong, are idiots, or they're a combination of both.

 

[154465]

a *licensed* practicing physician making 50K/year is doing something wrong... Yes, we can complain and bitch all we want about falling incomes, but this too much.

I'm a premed working in finance with a psychology degree, and I make MUCH more than that...

Either these doctors are doing something wrong, are idiots, or they're a combination of both.

Yeah they did do something wrong. They modeled their businesses to deliver quality primary care to lower income people and got screwed for it.

 

[phospho]

Yeah they did do something wrong. They modeled their businesses to deliver quality primary care to lower income people and got screwed for it.

I'm just saying that this example doesn't necessarily represent primary care potential income... the docs chose this business model (quality primary care to lower income ppl), and this is the outcome of that route. If I choose that route someday, I will be making 50K, but I won't be complaining about it. They can easily switch their business model if they wanted to.

Just goes to show you that altruism sounds great and all (especially for medical school interviews though more and more adcoms can now filter the BS) - however, it isn't easy to actually implement in the real world.

 

[Obnoxious Dad]

The first lesson is that it's ridiculous to think that people who go $300,000 in debt on school loans can go into primary care and not get reimbursed.

The second lesson is that even if you want to treat the indigent you have to have a business model that works. Dr. Walford should have never gotten herself into a $7,900 a month lease if she wanted to treat the poor. She is probably a wonderful doctor and human being but she is no Harvard MBA.

You have to think like a bean counter if you open up your own shop. You need cheap space. You need to get volunteers to help in your office. You need to reach out to the community for supplies etc. You need to put systems in place to limit your time spent collecting and maximizing your time seeing patients. It's not easy but some people do it.

 

[154465]

This isn't an issue of altruism, these patients need to be treated and that isn't happening. This is not isolated, it's damn near universal. Every primary care physician that I have met has echoed these sentiments.

Furthermore, it is foolish to believe that this is happening because of a faulty business model that these physicians employed. This isn't a Best Buy that people can walk into and pay with their credit cards before stepping out the door. Medicine does not exist within the realm of the free market, and you can't exactly charge these patients cash. Did you happen to skip over the portion explaining that medicare/insurance payed out 14k instead of the full 70? These physicians are being robbed, and what do you have to say as a future physician? she should have gone in to dermatology? leased a smaller office? would that have made the insurance companies pay out her full amount? because if that's the case then someone should let her know.

 

[ILikeFood]

I'm suprised this story hasn't received more attention on here.

 

[Dissected]

Just goes to show you that altruism sounds great and all (especially for medical school interviews though more and more adcoms can now filter the BS) - however, it isn't easy to actually implement in the real world.

unfortunately this is true..especially with the way things are right now. No reimbursement = no chance for sustainability. Hopefully this Daschle guy can figure out what is wrong and try to help repair a broken system...*sigh*

 

[beachblonde]

Just goes to show you that altruism sounds great and all (especially for medical school interviews though more and more adcoms can now filter the BS) - however, it isn't easy to actually implement in the real world.

I've always found it ironic that med schools make you bend over backwards to profess your love of helping people in order to get in, but if you look at the most competitive residencies, it's stuff like derm and rads. I'm not saying that a dermatologist can't do plenty of good in the world, but nobody picks that path because they can go help others using their newly acquired botox-injection skills.

The article is sad, isn't it? While she may have not been running the smartest practice ever, she was trying and it's really unfortunate it didn't work out for her. I have been thinking about primary care for myself, and then I see these articles and wonder what else I'm interested in.

 

[phospho]

I've always found it ironic that med schools make you bend over backwards to profess your love of helping people in order to get in, but if you look at the most competitive residencies, it's stuff like derm and rads. I'm not saying that a dermatologist can't do plenty of good in the world, but nobody picks that path because they can go help others using their newly acquired botox-injection skills.

The article is sad, isn't it? While she may have not been running the smartest practice ever, she was trying and it's really unfortunate it didn't work out for her. I have been thinking about primary care for myself, and then I see these articles and wonder what else I'm interested in.

I think it's great that you're interested in primary care, and I don't think you should persuade yourself to do something else. Let your medical career shape your thoughts, beliefs, and goals.

Take a look at the family medicine forum/threads, and you'll see how some practitioners there are ecstatic about what they do.

Yes, primary care doesn't pay as much as everything else; however, these aforementioned articles aren't representative of the primary care profession - they are examples of doctors who are inept in business. That's all.

 

[154465]

I think it's great that you're interested in primary care, and I don't think you should persuade yourself to do something else. Let your medical career shape your thoughts, beliefs, and goals.

Take a look at the family medicine forum/threads, and you'll see how some practitioners there are ecstatic about what they do.

Yes, primary care doesn't pay as much as everything else; however, these aforementioned articles aren't representative of the primary care profession - they are examples of doctors who are inept in business. That's all.

You are so wrong that no quantity of adjectives can adequately be used to emphasize the magnitude of your wrong-ness.

 

[phospho]

You are so wrong that no quantity of adjectives can adequately be used to emphasize the magnitude of your wrong-ness.

haha, you just made me laugh...

 

[154465]

haha, you just made me laugh...

Alright, we are in agreement then.... laughter is good:

[YOUTUBE]http://www.youtube.com/watch?v=4pXfHLUlZf4[/YOUTUBE]

 

[Dissected]

Yes, primary care doesn't pay as much as everything else; however, these aforementioned articles aren't representative of the primary care profession - they are examples of doctors who are inept in business. That's all.

I would say its beginning to become representative of the small private clinics in primary care medicine, not all of them being inept in business I would imagine. A good business model can still fail if there are no funds to support it (ie reimbursements that simply don't appear and declining # of patients). Not nearly as representative of the big shared clinics like the one that was mentioned at the end of the article.

Alright, we are in agreement then.... laughter is good:

oh god, this is always good for a laugh.

 

[phospho]

Alright, we are in agreement then.... laughter is good:

[YOUTUBE]http://www.youtube.com/watch?v=4pXfHLUlZf4[/YOUTUBE]

 

[airplanes]

Nice article. Thanks for the link. Health care in America is so jacked up, none of it surprises me anymore.

 

[154465]

I actually wouldn't convince you guys to stay out of primary care. I would, however, implore you to consider not going to med school. It has more overhead than revenue, and you have to take exams all the time. I would seriously consider taking over as CEO of GM rather than doing this...

 

[Obnoxious Dad]

This isn't an issue of altruism, these patients need to be treated and that isn't happening. This is not isolated, it's damn near universal. Every primary care physician that I have met has echoed these sentiments.

Furthermore, it is foolish to believe that this is happening because of a faulty business model that these physicians employed. This isn't a Best Buy that people can walk into and pay with their credit cards before stepping out the door. Medicine does not exist within the realm of the free market, and you can't exactly charge these patients cash. Did you happen to skip over the portion explaining that medicare/insurance payed out 14k instead of the full 70? These physicians are being robbed, and what do you have to say as a future physician? she should have gone in to dermatology? leased a smaller office? would that have made the insurance companies pay out her full amount? because if that's the case then someone should let her know.

Every enterprise needs to control its costs whether it's an automobile company or a medical practice focusing on the underserved. The basic lesson of economics is that people have limited resources even if they have unlimited wants.

In my previous post I noted that $7,900 per month for rent is excessive. If a physician wants to treat the indigent, paying rent at that level is just stupid. She did not pinch pennies. She needed to control her costs.

It may come as a surprise to you but there are other things that people need in this world besides health care. If we pay taxes at a marginal rate of 85% to pour every possible dollar into health care people will just stop working and saving.

Please be explicit as to what the policy should be. Should the taxpayers spend every possible cent to subsidize health care without regard to other sectors of the economy? What are you asking for?

 

[vokey588]

Although it is very true that primary-care physicians are treated like ****, I have to completely agree with ObnoxiousDad. Doctors tend to be bad businessmen/women but anyone who takes in only $50,000 with 2600 patients (or even regardless of the # of patients) is doing something really stupid with his practice and his finances . I think basic managerial accounting or some other business class should be an elective in medical school because business acumen is a must if one plans to open his own practice.

 

[Nilf]

I actually wouldn't convince you guys to stay out of primary care. I would, however, implore you to consider not going to med school. It has more overhead than revenue, and you have to take exams all the time. I would seriously consider taking over as CEO of GM rather than doing this...

I agree with you 100%.

Guys and gals, DO NOT GO TO MEDICAL SCHOOL.

To the OP, you are naive thinking that this crap is restricted only primary care. All specialties are on the same boat, except maybe for cosmetic stuff, and the ship is going down. You're greedy and you want a lifestyle residency--admit it, as there is really nothing wrong with that. But if you go to medical school BECAUSE you are greedy and want good lifestyle, then you're making a colossal mistake. By the time you'll be ready to enter residency, things will change FOR MUCH WORSE.

For instance... when I was a first year medical student, General Surgery was still somewhat competitive. Look what happened to... sooo many programs do not fill.

 

[chiz2kul]

All you guys are so depressing. I mean its bad, we all know...but the way ya'll spell it out....
Arent there any normal docs/resident/fellow on sdn who look at the glass half full instead of being so ascerbic n bitter?? We know it is bad but c'mon!

 

[chewsnuffles]

I agree with you 100%.

Guys and gals, DO NOT GO TO MEDICAL SCHOOL.

To the OP, you are naive thinking that this crap is restricted only primary care. All specialties are on the same boat, except maybe for cosmetic stuff, and the ship is going down. You're greedy and you want a lifestyle residency--admit it, as there is really nothing wrong with that. But if you go to medical school BECAUSE you are greedy and want good lifestyle, then you're making a colossal mistake. By the time you'll be ready to enter residency, things will change FOR MUCH WORSE.

For instance... when I was a first year medical student, General Surgery was still somewhat competitive. Look what happened to... sooo many programs do not fill.

Great name!

 

[otterpop]

Alright, we are in agreement then.... laughter is good:

[youtube]4pXfHLUlZf4[/youtube]

lol

 

[airplanes]

I agree with you 100%.

Guys and gals, DO NOT GO TO MEDICAL SCHOOL.

To the OP, you are naive thinking that this crap is restricted only primary care. All specialties are on the same boat, except maybe for cosmetic stuff, and the ship is going down. You're greedy and you want a lifestyle residency--admit it, as there is really nothing wrong with that. But if you go to medical school BECAUSE you are greedy and want good lifestyle, then you're making a colossal mistake. By the time you'll be ready to enter residency, things will change FOR MUCH WORSE.

For instance... when I was a first year medical student, General Surgery was still somewhat competitive. Look what happened to... sooo many programs do not fill.

Were people this pessimistic about medicine 5-10 years ago?

 

[154465]

Were people this pessimistic about medicine 5-10 years ago?


Were people this pessimistic about medicine 5-10 years ago/

I guess it's just easy to get bogged down with all of this crap constantly weighing down on you all the time. Med school is really exciting, until you get there. It does get better as you start adjusting.

 

[airplanes]

I guess it's just easy to get bogged down with all of this crap constantly weighing down on you all the time. Med school is really exciting, until you get there. It does get better as you start adjusting.

I was reading somewhere that the time between your first acceptance and the start of med school was the best part of your medical career. I hope it gets better, I can't imagine doing anything else.

 

[ILikeFood]

I was reading somewhere that the time between your first acceptance and the start of med school was the best part of your medical career. I hope it gets better, I can't imagine doing anything else.

(Why I won't be in school for the next seven months)

 

[airplanes]

(Why I won't be in school for the next seven months)

Because you have essentially joined the medical career path and you have no stress, worries, responsibilities, grunt work, busy work, scut work, or BS to deal with.

 

[cbrons]

If I ever feel unmotivated studying, I shall read this. Thank you.

haha right? I've gotten like 10 hrs of sleep in the past 2 days (finals) and now I'm even more unmotivated to continue.

 

[metalgearHMN]

I was reading somewhere that the time between your first acceptance and the start of med school was the best part of your medical career. I hope it gets better, I can't imagine doing anything else.

I think that's from Med-School Hell

101 Things You Should Know About Med School

It's # 90.

 

[cbrons]

I actually wouldn't convince you guys to stay out of primary care. I would, however, implore you to consider not going to med school. It has more overhead than revenue, and you have to take exams all the time. I would seriously consider taking over as CEO of GM rather than doing this...

I agree with you 100%.

Guys and gals, DO NOT GO TO MEDICAL SCHOOL.

To the OP, you are naive thinking that this crap is restricted only primary care. All specialties are on the same boat, except maybe for cosmetic stuff, and the ship is going down. You're greedy and you want a lifestyle residency--admit it, as there is really nothing wrong with that. But if you go to medical school BECAUSE you are greedy and want good lifestyle, then you're making a colossal mistake. By the time you'll be ready to enter residency, things will change FOR MUCH WORSE.

For instance... when I was a first year medical student, General Surgery was still somewhat competitive. Look what happened to... sooo many programs do not fill.

LOL

I'm gunna go just so I can grow old and actually have something real to complain about. I want to be the wise old man who tells the younger generation to pull their heads out of their ass. I actually am already doing that much now, I don't have any qualification whatsoever to do so but a drunk and loud-mouthed Irish kid of average intelligence can clearly tell when someone is living in the Land of Oz.

Concierge medicine? Sounds good but everyone thinks its evil... the socialist US government will likely outlaw such a business model so they can increase access to people with the "means" (but certainly their fair share of excuses).

 

[154465]

I was reading somewhere that the time between your first acceptance and the start of med school was the best part of your medical career. I hope it gets better, I can't imagine doing anything else.

I'm fully expecting winter break to be the highlight of my career, I can't wait

Actually, the highlight of med school so far has been the 30 minutes I spent watching the SNL clip this morning, and laughing so hard that I'm pretty sure I pulled something.