EMDoc0411

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I guess with the new bill passed today I'll get to practice the same broken, bureacratic healthcare that I have to practice in the military.
 

AF M4

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I guess with the new bill passed today I'll get to practice the same broken, bureacratic healthcare that I have to practice in the military.
Embrace the variance my friend. As a government employee, you can now work 9-4:30 with a two hour lunch with no repercussions as well as get every major/minor holiday off.

You can also move into one of the thousands of new administrative jobs that have just been created. There will now be dozens of people who got C's in college sitting around a table discussing how you, the doctor, can do your job better. And by better, they mean produce more RVUs. Don't you wish to be part of these meetings?

(If you answered no, then you are part of the reason we are here in the first place. When you start passing off your admin powers to others because you find them distasteful, don't be surprised when you wake up one morning to find yourself powerless.)

If you wish, you can then top off your government-funded salary by providing fee-for-service care for those who don't want to wait a long period of time for basic procedures. Setting up a medical home in a rich subdivision can also work.

You can also hire a small fleet of the nurse practitioners and physician assistants who are chomping at the bit to show that they're every bit as capable of providing quality primary care as all of those residency-trained FPs who are being systematically killed off. They'll all need a medical license to work under to pull this off, and if the Republicans can get tort reform passed then it might just be worth it to take a few under your wing.

If your soul has been completely blackened, get a J.D. from DeVry then proceed to slash and burn your way through various medical lawsuits, using everything you know is terrible about the current system to line the pockets of you and your firm. See you in Tartarus.

Like it or not, we are now officially a service industry my friends.
 
OP
E

EMDoc0411

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Embrace the variance my friend. As a government employee, you can now work 9-4:30 with a two hour lunch with no repercussions as well as get every major/minor holiday off.

You can also move into one of the thousands of new administrative jobs that have just been created. There will now be dozens of people who got C's in college sitting around a table discussing how you, the doctor, can do your job better. And by better, they mean produce more RVUs. Don't you wish to be part of these meetings?

(If you answered no, then you are part of the reason we are here in the first place. When you start passing off your admin powers to others because you find them distasteful, don't be surprised when you wake up one morning to find yourself powerless.)

If you wish, you can then top off your government-funded salary by providing fee-for-service care for those who don't want to wait a long period of time for basic procedures. Setting up a medical home in a rich subdivision can also work.

You can also hire a small fleet of the nurse practitioners and physician assistants who are chomping at the bit to show that they're every bit as capable of providing quality primary care as all of those residency-trained FPs who are being systematically killed off. They'll all need a medical license to work under to pull this off, and if the Republicans can get tort reform passed then it might just be worth it to take a few under your wing.

If your soul has been completely blackened, get a J.D. from DeVry then proceed to slash and burn your way through various medical lawsuits, using everything you know is terrible about the current system to line the pockets of you and your firm. See you in Tartarus.

Like it or not, we are now officially a service industry my friends.
Right on brother. Right on.
 

DrMetal

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Fear not. This healthcare bill will never see the light of day. It still needs to pass the Senate again. And even when signed into law, there'll be so many conlaw challenges it'll make your head spin. They wanna tax people for no having insurance??? In other words, just for existing? This undermines the entire bill.

We just need to face the grim fact that healthcare in this country equals private-enterprise capatalism (good healthcare at least). We can work to make it cheaper and more accesible, but the govt will run it into the ground they try to take it over.
 

dru2002

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Fear not. This healthcare bill will never see the light of day. It still needs to pass the Senate again. And even when signed into law, there'll be so many conlaw challenges it'll make your head spin. They wanna tax people for no having insurance??? In other words, just for existing? This undermines the entire bill.

We just need to face the grim fact that healthcare in this country equals private-enterprise capatalism (good healthcare at least). We can work to make it cheaper and more accesible, but the govt will run it into the ground they try to take it over.
The reconcilation bill aspect does but the core is a done deal and is being signed by Obama tomorrow. As far as legal challenges, I would imagine that our constitutional law professor president is confident the bill will hold up in court. But only time will tell.
 

a1qwerty55

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So what specifically don't you like about it?
Lie #1 - your insurance costs won't go up - when you eliminate the pre-existing condition exclusion (good or bad) the proportion of people insured with more medical needs increase as do costs. Prices must go up - but as another poster alluded to, the Dems don't care because step two is to then blame the insurers and push for a single payer.

Lie #2 - you can cut 500 Billion from Medicare - SURE ---- only way it to either decrease payouts or ration - wonder which one the Dems favor.

Lie #3 - Everyone will be covered - baloney - the mandatory provision doesn't kick in till I think 2014 if ever - all this does is allow healthy people who currently opt out of having insurance to still do so.

Lie #4 - Closing the "Donut hole" will save money - Hmm, it will save seniors but it will cost the rest of us a bundle - drug costs are one of the biggest sources of rising healthcare costs - this was a bone thrown to AARP to get their support.

other issues a 40% tax on "Cadillac" insurance plans- worth $8,000 for a single - nice touch - The goal here is to trash private insurance by making better plans prohibitively expensive - thus driving people into the cheaper, government mandated basic plan. Remember the goal of socialism is not to raise people to a higher level but to drop the high performers down to everyone else's lower level.

There are a lot of other issues - but I, unlike most of the Congressmen actually read most of this piece of crapola -

Physician incomes have fallen steadily for the past decade when adjusted for inflation, practice costs - while the overall cost of healthcare has steadily outpaced inflation - Docs are losing every year - the quality of medical school applicants show this and it isn't about money alone - the quality of life of many physicians continues to deteriorate thanks to ever expanding government regulation - read JC, HIPAA, etc. The AMA 100% doesn't get this and has not advocated for US Physicians for as long as I can remember.

For the last several years, I've looked around the civilian sector and while I probably would make more money - the quality of life is actually pretty bad, at least for my speciality. My military retirement is looking better and better however I'm sure it won't be long before the Dems come looking to ransack it as well.
 

AF M4

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Lie #1 - your insurance costs won't go up - when you eliminate the pre-existing condition exclusion (good or bad) the proportion of people insured with more medical needs increase as do costs. Prices must go up - but as another poster alluded to, the Dems don't care because step two is to then blame the insurers and push for a single payer.

Lie #2 - you can cut 500 Billion from Medicare - SURE ---- only way it to either decrease payouts or ration - wonder which one the Dems favor.

Lie #3 - Everyone will be covered - baloney - the mandatory provision doesn't kick in till I think 2014 if ever - all this does is allow healthy people who currently opt out of having insurance to still do so.

Lie #4 - Closing the "Donut hole" will save money - Hmm, it will save seniors but it will cost the rest of us a bundle - drug costs are one of the biggest sources of rising healthcare costs - this was a bone thrown to AARP to get their support.

other issues a 40% tax on "Cadillac" insurance plans- worth $8,000 for a single - nice touch - The goal here is to trash private insurance by making better plans prohibitively expensive - thus driving people into the cheaper, government mandated basic plan. Remember the goal of socialism is not to raise people to a higher level but to drop the high performers down to everyone else's lower level.

There are a lot of other issues - but I, unlike most of the Congressmen actually read most of this piece of crapola -

Physician incomes have fallen steadily for the past decade when adjusted for inflation, practice costs - while the overall cost of healthcare has steadily outpaced inflation - Docs are losing every year - the quality of medical school applicants show this and it isn't about money alone - the quality of life of many physicians continues to deteriorate thanks to ever expanding government regulation - read JC, HIPAA, etc. The AMA 100% doesn't get this and has not advocated for US Physicians for as long as I can remember.

For the last several years, I've looked around the civilian sector and while I probably would make more money - the quality of life is actually pretty bad, at least for my speciality. My military retirement is looking better and better however I'm sure it won't be long before the Dems come looking to ransack it as well.
Excellent post.

For every action there is a reaction. I am researching Papa Murphy's and Quizno's franchises. People will associate free healthcare with getting to do whatever they want to themselves because they'll be taken care of for free. Why not eat whatever you want? The gloves are off, we're living it up...
 
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Physician incomes have fallen steadily for the past decade when adjusted for inflation, practice costs - while the overall cost of healthcare has steadily outpaced inflation - Docs are losing every year - the quality of medical school applicants show this and it isn't about money alone - the quality of life of many physicians continues to deteriorate thanks to ever expanding government regulation - read JC, HIPAA, etc. The AMA 100% doesn't get this and has not advocated for US Physicians for as long as I can remember.

For the last several years, I've looked around the civilian sector and while I probably would make more money - the quality of life is actually pretty bad, at least for my speciality. My military retirement is looking better and better however I'm sure it won't be long before the Dems come looking to ransack it as well.
As a private practice physician (and aspiring Army Reserve doc) this bill is the "triple pay of no pay" for me. First, requires me to contribute more towards health care for my full-time employees and now dependents...Second, diminishing Medicare reimbursement...Third, more taxes for my level of income. Anyone thought to "throw a bone" for physician's too? Hmm....tort reform, physician reimbursement, GME.

Having more individuals on an expanded Medicaid-like coverage will do little to improve the system. Most physicians (including myself) will stay clear of this coverage and those that do accept it, will operate clinics which heard the masses into their midlevel operated substandard care clinics. Few patients on this new "expanded coverage" will see the monumental expansion of preventative care during the 3 minute patient slot allotted for the PA or NP.

In conclusion, the grass is no greener on the civilian side. My solution...require attorneys to pay costly malpracitce ("Mallitigation")insurance which will instantly repair the healthcare system and the remainder of our society. Good choice A1qwerty.
 

Perrotfish

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Lie #1 - your insurance costs won't go up - when you eliminate the pre-existing condition exclusion (good or bad) the proportion of people insured with more medical needs increase as do costs. Prices must go up - but as another poster alluded to, the Dems don't care because step two is to then blame the insurers and push for a single payer.
The proportion stays the same, because in addition to allowing coverage of pre-existing conditions they force everyone without pre-existing condiitions to buyinsurance to subsidize them. That's the idea of the mandate: right now the biggest group of people not buying insurance are the healthy young.

Lie #2 - you can cut 500 Billion from Medicare - SURE ---- only way it to either decrease payouts or ration - wonder which one the Dems favor.
The 21% Medicare cuts were not part of this bill, had nothing to do with the budgeting for this bill, and are not actually going to happen anyway. Every year when the federal budget comes out they pretend that Medicare will cost less than they know it will and then issue an 'emergency' extension of the old rates, an annual farce that started long before Obama or even Bush. This year the extension has been month to month instead of a full year because some people wanted to use it as a platform to push their own healthcare ideologies, but even still they've keep the rates up and everyone inside the beltway knows those cuts aren't actually going to happen. There IS a major cut in Medicare Advantage program in the bill (only 132 billion, though) but the idea of that is to move people back onto tradition Medicare and kill the advantage program so that they can decrease overhead, not to decrease reimbursements to physicians.

Lie #3 - Everyone will be covered - baloney - the mandatory provision doesn't kick in till I think 2014 if ever - all this does is allow healthy people who currently opt out of having insurance to still do so.
I'm not sure what the point of this is. Are you saying it's BS because the mandate doesn't start until 2014, so everyone won't be covered until then instead of being covered now? That seems like spliting hairs. Is it baloney that just about everyone will be covered when the bill is fully implemented in 6 years?

Lie #4 - Closing the "Donut hole" will save money - Hmm, it will save seniors but it will cost the rest of us a bundle - drug costs are one of the biggest sources of rising healthcare costs - this was a bone thrown to AARP to get their support.
I don't think many people were claiming this was a cost saving measure.

other issues a 40% tax on "Cadillac" insurance plans- worth $8,000 for a single - nice touch - The goal here is to trash private insurance by making better plans prohibitively expensive - thus driving people into the cheaper, government mandated basic plan. Remember the goal of socialism is not to raise people to a higher level but to drop the high performers down to everyone else's lower level
This was in the origional Senate bill, not the recocilliation package they agreed on with the house. In other words, it's not happening. Also I'm sort of surprised you're against this: this was considered a conservative measure, and it was killed by pro-union democrats. Conservatives liked it because it was a step towards divorcing health insurance from employment. You are clear that this was just a tax on 'Cadillac' heathcare plans paid for by your company, right? It wasn't a sales tax on healthcare you bought yourself.

I'm not a fan of this bill, I thought there was a better way to do this, but you should at least be clear about what exactly it is that you're angry about.
 
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jabreal00

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---------------- Listening to: Billy Bragg - Days Like These (DC Remix) via FoxyTunes

I'm not a fan of this bill, I thought there was a better way to do this, but you should at least be clear about what exactly it is that you're angry about.
^^I agree with your last question wholeheartedly.^^

People's feeling towards the bill most likely mirrors their political underpinnings. It's that simple. The bill is not perfect. However, no one can argue that health care reform is not needed. I'd like to see how it plays out over the next several years.

Instead of being obstreperous about HCR, people should actually do or have done something. While the debate was raging, they should have written their representatives, who purportedly serve their interests, to let them know that not passing reform is or was not an option, even if they were oppose to the "Dem's" ideas.

The "Dems" were elected into office with a mandate of a vote both in congress and in the whitehouse. The Repubs had the previous 8 years to do something about it. The Repubs had congress from 94 to 06 and nothing was accomplished, regarding HCR. Hate him or love him, Obama, Pelosi et al. did something about it in a little over a year.

Just a thought and not a sermon.
 

HooahDOc

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Does anyone have any idea what the fees will be for those who decided to forego insurance? If it's less than the actual insurance plan, I don't see what would prevent someone from simply paying the yearly fine until they are diagnosed with something horrible and then, because of the inability to exclude those with pre-existing conditions, get the insurance; they would get to benefit without ever having actually paid into the system their fair share.

I am assuming the fine would be more than the average cost? I don't know, I really have not been following the bill that closely since I'm at least 12 years from private practice, maybe 20 since I'm not sure if I want to retire from the military yet.
 

dru2002

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Does anyone have any idea what the fees will be for those who decided to forego insurance? If it's less than the actual insurance plan, I don't see what would prevent someone from simply paying the yearly fine until they are diagnosed with something horrible and then, because of the inability to exclude those with pre-existing conditions, get the insurance; they would get to benefit without ever having actually paid into the system their fair share.

I am assuming the fine would be more than the average cost? I don't know, I really have not been following the bill that closely since I'm at least 12 years from private practice, maybe 20 since I'm not sure if I want to retire from the military yet.
I'm assuming wikipedia can be trusted on this:

Those who aren't otherwise covered and opt to pay the annual penalty (2.5% of income, $695 for individuals, or a maximum of $2,250 per family) instead of purchasing (presumably more expensive) insurance; this might be mostly younger and single Americans.
Those whose insurance coverage would cost more than 8% of household income; they are exempt from paying the annual penalty.

http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
 
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jabreal00;9437948 The "Dems" were elected into office with a mandate of a vote both in congress and in the whitehouse. The Repubs had the previous 8 years to do something about it. The Repubs had congress from 94 to 06 and nothing was accomplished said:
I agreee the Repubs did nothing to improve healtcare during their control. However, just doing "something about it" doesn't make it right or assume it to be successful. I am all for a good fix of the status quo. However, the backbone of the new reform IMO will not repair our broke system.

For those of us in the delivery of primary care in a private practice setting, we will assume a disproportionate burden of this legislation.
 

The White Coat Investor

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There were three problems that needed to be fixed. They fixed one, partially fixed another, and made the third one worse:

1) Reform the health insurance industry- well done for the most part. Republican and democrats agree on a lot of these items.

2) Increase coverage. Many more people will be covered by "insurance" now. Not everyone, but a lot more than before. I dislike how it was done, but it was done.

3) Decrease costs. Didn't even try. In fact, we dramatically increased costs. We need market-based reforms to fix this problem. Increasing transparency, choice, competition, and decreasing the practice of defensive medicine is the best strategy here.

Like urgentcaredoc, I'm a little pissed that not only will I take a cut in pay but I'll pay more in taxes and employee costs too when I separate in a few months.

Like some of the other posters, I'm happy to see the issue at least being addressed by the current administration and congress. But I honestly think the subject is so rancorous that it would take a supermajority for either side to actually make any real change. The republicans never had that. I think maybe it is time to do something about the filibuster and some of the other misused Senate tactics.
 

NoMoreAMCAS

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Can't forget the new additional 3.8% capital gains tax for individuals with income greater than $200,000. That should apply to the majority of civilian physicians, especially specialists.
 

a1qwerty55

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The proportion stays the same, because in addition to allowing coverage of pre-existing conditions they force everyone without pre-existing condiitions to buyinsurance to subsidize them. That's the idea of the mandate: right now the biggest group of people not buying insurance are the healthy young.
Sorry but this just isn't true. You seem to be missing the point that the pre-existing condition ban starts now, the mandatory enrollment of healthy people won't happen for years if at all. Net effect is higher premiums for everyone - leading to the Democrats blaming the insurance companies and renewed propaganda for a single payer. It is all very contrived and planned.



21% Medicare cuts were not part of this bill, had nothing to do with the budgeting for this bill, and are not actually going to happen anyway. Every year when the federal budget comes out they pretend that Medicare will cost less than they know it will and then issue an 'emergency' extension of the old rates, an annual farce that started long before Obama or even Bush. This year the extension has been month to month instead of a full year because some people wanted to use it as a platform to push their own healthcare ideologies, but even still they've keep the rates up and everyone inside the beltway knows those cuts aren't actually going to happen. There IS a major cut in Medicare Advantage program in the bill (only 132 billion, though) but the idea of that is to move people back onto tradition Medicare and kill the advantage program so that they can decrease overhead, not to decrease reimbursements to physicians.
I wasn't referring to the annual Medicare funding game - I was referring the the reality that if you create a system you can't fund, you have to cut and cutting physician salaries is always appealing to the blue collar voter, or the uber rich liberal Democrat, than limiting service. This is a zero sum proposition. If you don't limit care - costs continue to outstrip economic growth and tax revenue - cuts will come from reimbursement - this already is happening - ask any spine or Mohs surgeon.



Im not sure what the point of this is. Are you saying it's BS because the mandate doesn't start until 2014, so everyone won't be covered until then instead of being covered now? That seems like spliting hairs. Is it baloney that just about everyone will be covered when the bill is fully implemented in 6 years?
I'm not sure where your confusion is - Do you really think Americans will be as supportive of mandatory enrollment once insurance rates rise? - there will be a voter backlash and the mandatory provision will never get passed.


not a fan of this bill, I thought there was a better way to do this, but you should at least be clear about what exactly it is that you're angry about.
j i think I'm fairly clear - I also would point out that American healthcare is totally screwed up - but only because we have decoupled cost and value - Newer meds/procedures etc often come with a markedly higher price tag with often only a marginal improvement in outcome. When there is no disincentive for asking for the most expensive product, people will always demand everything. When healthcare is perceived as free or a fundamental right, it also is no longer valued.
 

a1qwerty55

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^I agree with your last question wholeheartedly.^^

People's feeling towards the bill most likely mirrors their political underpinnings. It's that simple. The bill is not perfect. However, no one can argue that health care reform is not needed. I'd like to see how it plays out over the next several years.

Instead of being obstreperous about HCR, people should actually do or have done something. While the debate was raging, they should have written their representatives, who purportedly serve their interests, to let them know that not passing reform is or was not an option, even if they were oppose to the "Dem's" ideas.

The "Dems" were elected into office with a mandate of a vote both in congress and in the whitehouse. The Repubs had the previous 8 years to do something about it. The Repubs had congress from 94 to 06 and nothing was accomplished, regarding HCR. Hate him or love him, Obama, Pelosi et al. did something about it in a little over a year.
Doing something is not necessarily an accomplishment. Every bill creates loop holes and unintended consequences - this one will have many adverse ones which will no doubt negatively impact the physician workforce and thus the patient.
 

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MaximusD

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Can't forget the new additional 3.8% capital gains tax for individuals with income greater than $200,000. That should apply to the majority of civilian physicians, especially specialists.
You do realize what capital gains is? The workhorse physician who busts his ass for a salary as a sole means of income won't be effected. The business saavy one will pay <4% more on his investment portfolio gains. Still an annoyance but it won't effect salaried or wage income.
 

VHADOC

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You can also move into one of the thousands of new administrative jobs that have just been created. There will now be dozens of people who got C's in college sitting around a table discussing how you, the doctor, can do your job better. And by better, they mean produce more RVUs. Don't you wish to be part of these meetings?

(If you answered no, then you are part of the reason we are here in the first place. When you start passing off your admin powers to others because you find them distasteful, don't be surprised when you wake up one morning to find yourself powerless.)
Been waiting for some time to post on this forum, now may be as good a time as any.

I am a primary care physician at the VA, am also a veteran. The above is truth: every day meetings all over America are conducted were folks who don't know what stress is force more stress on the already over-stressed.

At least at the VA, I would take exception somewhat to the idea that physicians should be "part of these meetings." As far as I can tell, the easiest way to make your life easier as a physician is to show an interest in clipboards. The more "bright ideas" you have, the greater the likelihood you will have to be invited to a meeting to present your bright ideas. If your bright idea is catchy, before you know it said bright idea will be disseminated across the system. Said bright idea will now be one of a "thousand points of light" [i.e. medical chart pop-ups] that a physician will have to complete during each patient encounter. Recall the Microsoft paperclip video?:

http://www.youtube.com/watch?v=HwMmdnezhik

(instead of "hey it looks like you're writing a letter, imagine "hey, it looks like you're seeing a patient!")

If you get invited to enough meetings you get to become an administrative physician. No matter that your training is in medicine, you will now get to earn 100K+ more per year as an administrator over other folks (like em or not) who have advanced degrees in administration. And you won't have to go to that pesky "clinic" place any longer. One could argue that, at least, a physician at the table can represent physicians/patients; this doesn't happen in my neighborhood (it is as though line physicians are blue collar and, to get to the table as an administrative physician, you have to put on a white collar).


On a personal note, one of the reasons I work for the VA (read government healthcare) is that I abhor, frankly, what I would characterize as financially irresponsible sloppy/non-textbook medicine. Too many physicians over time have acted the part of a complacent and willing speedbump on the road to an unnecessary MRI or drug-of-the-month (financially expensive practice of medicine).

I can generally practice medicine like the textbook says at the VA...if you got a cold virus, you get sympathy from me...I don't have have to give you Zyvox just to keep you coming back to see me instead of Dr. Writesanything across the street. Vets are typically accepting when I tell them we need to wait to get an MRI for something with a good chance of improving on its own (I don't have to worry that I will lose "business" because I am "stingy" (i.e. correctly managing conservatively).

The "bureaucratic" issues I have with the VA are fairly predictable, though increasingly worse because of ever-decreasing limited funds. Otherwise its great. On my panel I have a Chosin reservoir survivor, a couple guys present at Pearl Harbor, couple D-day vets, all kinds of walking history.

In the end, I generally think govt medicine is inevitable because physicians don't self-regulate...we don't chastise colleagues who practice expensive and non-evidenced based medicine. Word to the wise, we don't have the money for such adventures any longer...no matter how you slice it.
 

AF M4

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Been waiting for some time to post on this forum, now may be as good a time as any.

I am a primary care physician at the VA, am also a veteran. The above is truth: every day meetings all over America are conducted were folks who don't know what stress is force more stress on the already over-stressed.

At least at the VA, I would take exception somewhat to the idea that physicians should be "part of these meetings." As far as I can tell, the easiest way to make your life easier as a physician is to show an interest in clipboards. The more "bright ideas" you have, the greater the likelihood you will have to be invited to a meeting to present your bright ideas. If your bright idea is catchy, before you know it said bright idea will be disseminated across the system. Said bright idea will now be one of a "thousand points of light" [i.e. medical chart pop-ups] that a physician will have to complete during each patient encounter. Recall the Microsoft paperclip video?:

http://www.youtube.com/watch?v=HwMmdnezhik

(instead of "hey it looks like you're writing a letter, imagine "hey, it looks like you're seeing a patient!")

If you get invited to enough meetings you get to become an administrative physician. No matter that your training is in medicine, you will now get to earn 100K+ more per year as an administrator over other folks (like em or not) who have advanced degrees in administration. And you won't have to go to that pesky "clinic" place any longer. One could argue that, at least, a physician at the table can represent physicians/patients; this doesn't happen in my neighborhood (it is as though line physicians are blue collar and, to get to the table as an administrative physician, you have to put on a white collar).


On a personal note, one of the reasons I work for the VA (read government healthcare) is that I abhor, frankly, what I would characterize as financially irresponsible sloppy/non-textbook medicine. Too many physicians over time have acted the part of a complacent and willing speedbump on the road to an unnecessary MRI or drug-of-the-month (financially expensive practice of medicine).

I can generally practice medicine like the textbook says at the VA...if you got a cold virus, you get sympathy from me...I don't have have to give you Zyvox just to keep you coming back to see me instead of Dr. Writesanything across the street. Vets are typically accepting when I tell them we need to wait to get an MRI for something with a good chance of improving on its own (I don't have to worry that I will lose "business" because I am "stingy" (i.e. correctly managing conservatively).

The "bureaucratic" issues I have with the VA are fairly predictable, though increasingly worse because of ever-decreasing limited funds. Otherwise its great. On my panel I have a Chosin reservoir survivor, a couple guys present at Pearl Harbor, couple D-day vets, all kinds of walking history.

In the end, I generally think govt medicine is inevitable because physicians don't self-regulate...we don't chastise colleagues who practice expensive and non-evidenced based medicine. Word to the wise, we don't have the money for such adventures any longer...no matter how you slice it.
You seem like an intelligent, thoughtful physician. I'm guessing that your patients genuinely like and respect you, as well as most of the staff and colleagues working alongside you in your clinic. You practice good medicine, work hard for your patients, and go home tired but happy in the work you've done. You're proud and you should be.

You're also going to get yourself and all of us slaughtered.

If you want to stop dumb ideas like that paperclip thing, the best way to do that is to nip them in the bud at the meeting where they're proposed. Otherwise they metastasize and acquire an organizational inertia once they've been started down the road towards implementation and suddenly you've got another dumb screen to click through or another CBT to complete.

I mean, who's going to bring those unknowledgeable "admin physician" types to heel? The nurses? Pharmacists? No way - everyone still takes their cues from the doctor in regards to clinical issues. Now an actual "clinical doc" may argue that the admin doc's recommendations are bull, but if the clinical doc isn't around when the decisions are being made then everyone is going along with the admin doc's recommendations because well, he's the doc. If you want the results of this faulty process to stop trickling down to your clinic, you have to be there to address the source.

And not every idea at these meetings has to be dumb. Most of the good ones are going to have to come from those who are actually doing the "blue collar" work as you put it, because we are the ones who know what the actual issues that are truly impacting patients and physicians are. And if you don't make your voice heard to the administrative types, then they will be happy to assume that you are not having any problems with what they're doing to you and your patients. I know because I'm seeing it personally in my clinic, and it's not pretty.

I know you don't like the idea but I urge you to try it. You don't have to go to every one of the endless litany of meetings I know go on, but pick one or two of the important weekly or monthly ones and sit in. You may end up finding that you can help make a decision during one of these meetings that has as much positive impact on your patients as a week's worth of appointments.
 

VHADOC

5+ Year Member
Apr 15, 2010
27
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Attending Physician
I know you don't like the idea but I urge you to try it. You don't have to go to every one of the endless litany of meetings I know go on, but pick one or two of the important weekly or monthly ones and sit in. You may end up finding that you can help make a decision during one of these meetings that has as much positive impact on your patients as a week's worth of appointments.
I don't have time for meetings, I see patients all day every day without a break in the action, period.

What am I going to change in a meeting? To summarize my experience, c-average people ruin my life only insofar as they sap resources (payroll) that would be better spent on clinical staff. I could take leave then show up for said meetings with a prepared speech on how everyone who is not a doctor, nurse, clerk, or orderly should find work outside of healthcare, but they aren't likely to listen/leave (this should be the headline in healtcare reform/cost cutting).

Frankly, I work hard as a physician. I provide pretty good care, efficiently, and my patients like me. As a physician, I don't do anything wrong and accordingly I have no job security concerns.

I look at things from the other side of the coin than you do, which is possible outside of a strict rank-structure environment (i.e. military). What I mean is, rather than playing the meeting game, I would advocate that physicians strictly avoid all "meetings." See patients. Asked to do something you didn't learn in medical school? Don't do it. Don't get involved cleaning someone else's castle in the sky. What is there to fear? The patient and physician are the real power players here. If you want to spread the power around by legitimizing the validity of paper-pushers in the system, I disagree. Any paperpusher who forgets why they have a job needs a come to Jesus meeting (easier done outside the military, also easier with the fed govt than an HMO as well probably).

The real death of healthcare started decades ago when the first physician hired a "biller" as an added service to patients. Time was, a physician did what he thought was right, regardless of cost. S/he ordered a test/treatment, end of story. Costs became hidden, patients asks for more, doctors forgot what stuff costs. Costs went up. Insurance companies started sending letters to doctors requesting a letter of justification (pre-authorization) arguably because there is a surplus of idiotic tests/expensive drugs being requested. We became customer service representatives and not physicians. Paperpushers understand customer complaints while focusing little on outcomes (my experience thus far in corporate and govt medicine).

In private practice/HMO the emphasis is on "patient satisfaction." Same goes, to a large degree, with the VA. Somewhere down the list is patient outcomes. This is the real problem. This is what physicians need to focus on, and they can't do this at a meeting while the patient is in the waiting room.

IF there is a meeting, and I believe there should be meetings, they should be exclusively held with physicians, clinical staff, and a statistician or two to review real performance (efficency and outcomes). Any other type of meeting is just an exercise playing someone else's reindeer game.
 

AF M4

Junior Member
10+ Year Member
7+ Year Member
Jul 6, 2006
884
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I don't have time for meetings, I see patients all day every day without a break in the action, period.

What am I going to change in a meeting? To summarize my experience, c-average people ruin my life only insofar as they sap resources (payroll) that would be better spent on clinical staff. I could take leave then show up for said meetings with a prepared speech on how everyone who is not a doctor, nurse, clerk, or orderly should find work outside of healthcare, but they aren't likely to listen/leave (this should be the headline in healtcare reform/cost cutting).

Frankly, I work hard as a physician. I provide pretty good care, efficiently, and my patients like me. As a physician, I don't do anything wrong and accordingly I have no job security concerns.

I look at things from the other side of the coin than you do, which is possible outside of a strict rank-structure environment (i.e. military). What I mean is, rather than playing the meeting game, I would advocate that physicians strictly avoid all "meetings." See patients. Asked to do something you didn't learn in medical school? Don't do it. Don't get involved cleaning someone else's castle in the sky. What is there to fear? The patient and physician are the real power players here. If you want to spread the power around by legitimizing the validity of paper-pushers in the system, I disagree. Any paperpusher who forgets why they have a job needs a come to Jesus meeting (easier done outside the military, also easier with the fed govt than an HMO as well probably).

The real death of healthcare started decades ago when the first physician hired a "biller" as an added service to patients. Time was, a physician did what he thought was right, regardless of cost. S/he ordered a test/treatment, end of story. Costs became hidden, patients asks for more, doctors forgot what stuff costs. Costs went up. Insurance companies started sending letters to doctors requesting a letter of justification (pre-authorization) arguably because there is a surplus of idiotic tests/expensive drugs being requested. We became customer service representatives and not physicians. Paperpushers understand customer complaints while focusing little on outcomes (my experience thus far in corporate and govt medicine).

In private practice/HMO the emphasis is on "patient satisfaction." Same goes, to a large degree, with the VA. Somewhere down the list is patient outcomes. This is the real problem. This is what physicians need to focus on, and they can't do this at a meeting while the patient is in the waiting room.

IF there is a meeting, and I believe there should be meetings, they should be exclusively held with physicians, clinical staff, and a statistician or two to review real performance (efficency and outcomes). Any other type of meeting is just an exercise playing someone else's reindeer game.
I get what you're saying. Perhaps a different brand of get-together is in order. But otherwise arguing for maintaining the status quo by doing the "stay in clinic, just do your job well" ostrich maneuver while things continue to slide down the drain just leads to every major management decision being made without you.
 

NoMoreAMCAS

10+ Year Member
Jul 10, 2008
1,263
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You do realize what capital gains is? The workhorse physician who busts his ass for a salary as a sole means of income won't be effected. The business saavy one will pay <4% more on his investment portfolio gains. Still an annoyance but it won't effect salaried or wage income.
Yes, of course I know what capital gains taxes are. :laugh: That's why i mentioned it. An extra ~4% being knocked off of your capital gains is just one more way to nick you for some cash. They'll approach from every angle possible in order to take you for every penny they can. Sucks.