I know that many if not most of you will disagree with me (and I feel it is because almost none of you have run even one of your own businesses), but..... competition in business is never bad. That is why Lowes seeks out locations where a Home Depot is established to set up their new stores. Using the fear oriented state of mind, Lowes would try to be as far away from a Home Depot to reduce competition - Lowes would think of how much population per store they would have....but they don't - they purposely set their new stores up as close as possible to an existing Home Depot. I know many of you don't get that....and never will .... I don't think MD's as individuals have ever "gotten" business - that is why most prefer being employed versus self employed. That is why most need or want managers, marketers etc.
Competition is never bad, if you know how to compete. Any MD that loses a competition for patients to a NP, PA, DO, DC or another MD just simply does not understand the dynamics that drive their business - what brings clients in and gets clients to pay.
When I was doing general surgery, one month I rotated with a surgeon that did alot...ALOT of breast reconstruction after cancer. The patient was midway through the process, recieving brachytherapy. They had changed insurances and their co-pay went up because the surgeon was not one of the approved surgeons on the new insurance - but was out of network. Considering how many visits they had left, it probably would have left them with about $700 out of pocket. They politely told the surgeon that they would have to pick a new provider who was preferred because of the higher co-pay. The surgeon said they understood and the patient left, not rescheduling again. Previously when talking to the patient on another visit I noticed that they were getting their teeth whitened by a dentist - and this was costing over a grand. I wish I had not said it, but I could not help but say :
Wow, you are treating that ladies cancer and she does not find it worth $700, she dumped you for $700 bucks when she gladly spends more than that out of pocket to have her teeth whitened. She values what the dentist does for her teeth than what you do for her cancer. I know that dentist has no problems charging a grand to simply whiten her teeth, but this MD - surgeon with reconstructive training, having done years of residency, spending 18 hour shifts standing and doing surgery, could not explain why it was worth it for the patient to spend $700 with them. The MD surgeon did not have enough FCB (Faith confidence and belief) in their own services and product, to at least suggest the patient pay the money. They rolled over and played dead.
That is why MD's could not survive without insurance - if ALL insurance was eliminated, the medical profession would be the first casualty. Massage therapists, chiropractors, acupuncturists, dentists would hardly be affected. Without ANY insurance, MD's would be a thing of the past. Adios good bye. Insurance is the only reason medicine still survives as a profession.
I think most MD's relate to money out of fear. Patients spend $2000 for a refrigerator, but most won't spend that on their medical doctor. They do not have insurance that pays for the fridge, they pay for it out of pocket. But how many MD's can expect a patient to pay with real money instead of insurance - not many. It has nothing to do with the value of the service - people make more trips to alternative care providers and spend much more on alternative medicine than they do with traditional medicine (
http://www.whsc.emory.edu/_pubs/em/1996fall/alternative_medicine.html see note below **). Massage therapists doing "neuromuscular therapy (requires no special training) charge in excess of $150 per hour (with almost no overhead). They certainly do not expect people to use insurance, even though they may get 10 treatments.
Again, I know most of you will have many things to say in disagreement, or give reasons why MDs have to take insurance, or why its the patients fault because the patients expect you to accept what insurance pays, etc. All I can say is that its in your head and not elsewhere.
My favorite is when I would watch one of the doctors who was my internal medicine preceptor...over and over... interview the patient, decide silently in their own mind that the patient would do best with X treatment or X drug...then check their insurance benefits, and realizing their insurance would not pay for it recommend Y treatment or Y drug instead, because while inferior at least their insurance covered it. They never even recommended X drug/or treatment, they just simply recommended the inferior Y drug/treatment - not wanting to have any sort of money confrontation. If they ever had the guts to say something like "You know I recommend X treatment, its better - but it will cost you money...however your insurance will pay for Y, which is not as good but at least its free" - he would have been surprised that many would choose X even if it cost them. I know some MD's do not have such money issues, but most I have seen do - they give away the shop because they cannot ask for money.
This problem extends beyond money. It extends to all facets of health care (and life in general) - competition is a problem if you are weak. That is all.
** The "wake-up call," as Dr. Gooding puts it, came in 1993 when the New England Journal of Medicine published a survey of 1,539 adults who were questioned about their use of unconventional therapies. The results? Based on participant responses, Americans in 1990 made about 425 million visits to alternative practitioners compared with 388 million visits to primary care physicians. While around 3% were looking for help with life-threatening conditions like cancer or AIDS, the vast majority were seeking remedies for long-term problems like obesity, chronic pain, anxiety, and depression. Tellingly, 72% declined to tell their medical doctors about these visits
