Where did our profession go?

[medicine1]

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Why does it seem like more and more doctors are being controlled by the government, insurance companies, and mega drug companies?
Why have doctors become so complacent?
Cannot Doctors charge according to income (a flat percentage), that is fair and unburdensome to society.
http://downeastdem.dailykos.com/story/2005/2/2/13330/02997
Many people are saying that there are plenty of physicians, but none of those physicians want to spend adequate time with their patients, and or perform certain services due to third-party payers telling doctors what they can and cannot do.
http://www.dailyrepublic.com/articles/2005/02/20/local_news/news01.txt
And how much knowledge do doctors know about the drugs they are prescribing, especially all of the new drugs? Drug companies push doctors to prescribe their drugs, yet relatively little is know about them. And with commercialized drug products, consumers are either asking or telling doctors what kinds of medication they want, how much, and when.
http://www.headlice.org/news/2003/mercola-influence.htm
http://www.findarticles.com/p/articles/mi_m0689/is_n1_v34/ai_11986475
http://bmj.bmjjournals.com/cgi/content/abstract/312/7036/949
http://www.chairgrrl.com/Trib_2003/ABQ_Trib121603.htm

Why are doctors giving insurance companies, and other companies/corporations, power to overtake and override a physician's autonomy,practice, and services? And what would bring about positive change in the medical community? Should we not start with the medical profession itself?

 

[JohnDO]

Why are doctors giving insurance companies, and other companies/corporations, power to overtake and override a physician's autonomy,practice, and services?

Becase they control the patients, and thus control the money.

I don't know that physicians are complacent, per se. The insurance companies have worked themselves into a great position by controlling the patient flow. Now we've got a bunch of non-medical professionals telling doctors what they can and can't do, because they control the cash flow.

I agree though, we are in a terrible position: wedged right between trial lawyers and insurance companies. Both of them control the practice of medicine way more than they should. How can we get out of this mess? I'm not sure. I'd like to see physicians uniting and becoming a much stronger political force. The AMA does work hard to push measures that favor physician interests, but I feel that we have the power to put ourselves in a better position. I hope that the upcoming medical generation (us) will be a very vocal and persistant group. This is not a knock on the work that past (and present) physicians are doing. I'm saying we can do better. We must do better, and we will do better.

I also think that public perception and patient education plays a key role. As the public has gradually become aware of our malpractice debacle, the issue has become a front-running issue in political platforms. When people complain about the long waits and short visits at your office, take a few minutes and explain the situation to them. We must make people outside of the medical profession aware of our situation. When enough people know, the legislation will follow.

 

[medicine1]

In order for us to make change, we have to be able to change ourselves, how we perceive medicine, and where we want our profession to go. I will choose to take patients not according to insurance, but by their medical needs. I would charge according to income, e.g., if someone makes $40,000 a year (after taxes), they make about roughly $3,300 a month, I would charge them a flat rate of 4% of how much that person makes in a month, so roughly $133.33 for a GP visit ((40,000/12)*.04). So if someone makes $100,000 per year (after taxes), charge them roughly $333.33 per GP visit.

I want to provide adequate care, that is also affordable. I would try to have fund raisers, while living within my means, I would charge according to a flat percentage rate. If an indigent person can only afford $10.00 because they live on the streets, I would charge them this much. But I would have pay incentives, programs that allow people to repay through volunteer work, community service, etc. I would hope that the community would help and contribute, so that they could receive adaquate and affordable health care. Then people would not have to worry about health insurance.

Large hospitals are a challenge because they cost so much to run. Perhaps some major changes in how hospitals are ran, and how they utilize their money will help make positive changes.

 

[Buckeye(OH)]

You can thank the days of fee-for-service for much of the loss of control that doctors are faced with these days.

 

[medicine1]

Much of the high costs were brought on by new doctors charging insurance companies, the government especially, and other third-party paying companies large fees, and were getting paid. In a profession, professionals are not supposed to compete, and all physicians began increasing their fees and or demanding higher salaries.

I found an interesting article by the Washington's Retail Association on this topic:

Mandated Benefits Are the Cause of Health Care Problems, Not the Solution

by Ed Cooney, WRA Board Chair

http://www.retailassociation.org/in...ategory=Jan&newsletterid=269&menugroup=Home 2

 

[DORoe]

Much of the high costs were brought on by new doctors charging insurance companies, the government especially, and other third-party paying companies large fees, and were getting paid. In a profession, professionals are not supposed to compete, and all physicians began increasing their fees and or demanding higher salaries.

I found an interesting article by the Washington's Retail Association on this topic:

Mandated Benefits Are the Cause of Health Care Problems, Not the Solution

by Ed Cooney, WRA Board Chair

http://www.retailassociation.org/in...ategory=Jan&newsletterid=269&menugroup=Home 2

What do you think the retail association would say about a business that charged a rich person $10 for a gallon of milk and a poor homeless person $.10? What you are saying is that it is the doctor's fault for the rising cost of health care. You advocate that we charge based on a person's income which makes no sense if you are providing the same level of care. Would you like to someday have to pay more for your couch because you make more money? Don't even tell me that you wouldn't mind because you could afford it because if you were charged more for everything across the board. If it costs an ambulance service $400 just to break even on a run how would you justify charging someone $1.00? What happens in the poor sections of this country where there are a large portion of the population below the poverty line? You expect the community to just give you money to keep you running? I hate to tell you, but that ain't gonna happen. A lot of these people barely survive from one paycheck to the next and have no disposable income to just donate. The only way that you are going to get that much money is if you raise taxes and then the people are being charged one way or the other.
In addition how are you going to pay back that $200k in student loans in one of these areas. It will be difficult just keeping a practice running let alone seeing enough patients to be able to live yourself. See if you really look at your plan you can see that there is no incentive for a person to start a practice in a inpoverished area because they are never going to recoup their operating costs. It sounds good, but the fact is in a capitalistic society you can't do things like this or you will fail. What you are advocating is a plan that will further the lack of access to healthcare for the people that are already underserved.
Take Shannon Co. South Dakota. they have an average household income of 21k by your plan you would recieve $70 per visit. You would have to have 29 patients to make your $2000 per month loan payment. Then you would have to pay a nurse and a receptionist to work in your office so that would cost you $42000 (if you paid each 21k per year which might upset the nurse) that would be another 600 visits. Next rental on the building at let's say $500 per month which is another 86 visits. Now the electic company, gas company, and phone company might want you to pay your bills let's estimate $300 for that. Now you are looking at another 52 visits per year. You probably want a house and a car so a modest house costing 50k would run you $341.00 per month if you can get a 30 yr loan so that is another 54 visits. A car payment on a 10k car would be about $200 so there is another 35 visits. I would assume that you want to eat which would be about $200 per month in groceries which would be another 35 visits. Right now we have 891 visits just to pay this stuff. That is 2.5 patients per day every single day of the year (yes even christmas). That doesn't sound to bad, but I haven't added the cost of supplies, startup of a practice, bills at home, clothing for you, if you have a family the costs of a wife and kid, your wifes car, and countless other expenses that have to be paid you are looking at a lot of patients in a day to just live paycheck to paycheck. The patients are not going to get the time that you feel they so richly deserve according to your plan.

 

[cdreed]

I took a business for DOs class this last quarter. We had a few guest speakers, including lawyers, pharm reps, among others. They seemed to imply that the problem stems from a lack of physician support of their lobby. It was quoted to us that each year the average amount that each physician contributes is around $500, whereas lawyers average about $5000/professional annually. These non-physician professionals seemed to believe that docs could regain control of the profession if they were more politically active and more generous. True? I guess it's at least something to ponder.