Thursday, November 13, 2003

Forms, Forms, Everywhere are Forms

I hate filling out forms. FMLA forms, DMV physicals, employment physicals, worker's comp, nursing home clearances, insurance forms, disability. I don't mind doing the exams and evaluations. It's filling out the forms I hate.

So it's a major accomplishment for me to finally complete and send in my application forms for:

1) malpractice insurance.

It was a tossup between The Doctors Company, Norcal Mutual and SCPIE. They all had good track records. SCPIE had a slightly lower rating on A.M. Best, an insurance rating company. Norcal seemed pretty good, but I didn't like how the sales rep badmouthed the competition. The Doctors Company is physician owned, so I figure they should have my best interest at heart (more than an insurance company would), so I went with them.

Three years ago, I was named in a malpractice suit because, even though I hadn't seen the patient in 2 years, I was the patient's primary care physician. The woman who had had asthma diagnosed for years ended up having a rare bronchial adenoma which acted like a ball valve and caused shortness of breath. A transfer to another hospital for surgery was delayed, and she ultimately developed pneumonia and died despite having the adenoma removed. I was named, I guess, because a physician reviewer thought I should have diagnosed it earlier, even though all her chest x-rays were always normal, even though this kind of benign tumor is very rare, even though she saw many other doctors during that time. After my thorough review of my notes, I felt that I did nothing wrong. But the defense attorneys hired by Kaiser were pushing hard for a settlement, telling me that if I didn't agree to a settlement that I could end up being liable for a lot more than the settlement amount of $250,000. I even asked a colleague physician (who was also an attorney for Kaiser) if he thought I should settle or not. He said I should settle, so I reluctantly did. I've regretted it ever since, more for the principle than anything else. The attorneys and my colleague did not have MY best interest at heart, it was all about what was best for the organization.

But now whenever a form asks, "Have you ever been named in a malpractice case?", I now have to say "Yes" and explain the whole thing. I've never really had to worry about malpractice before. Kaiser provides its own malpractice insurance. But now that I'll be on my own, it's an area I'm very much concerned with. The more I read about malpractice, the more I realize how broken this system of jackpot justice is.

2) Supplemental info for disability insurance.

They wanted proof that I made the income I said I did. So last year's tax forms and paystubs were copied and sent. I was reminded last night how important disability insurance can be when I dislocated my left pinky finger while playing basketball. I spent an hour and a half in the ER getting x-rays, then reduction (YEEOWCH!), then a splint put on. While I was waiting, I thought about how lucky I was to have a relatively minor injury, and felt reassured that I have good disability insurance for now. If I didn't, would I have to stop playing my weekly basketball? I also wondered what price people would be willing to pay for medical attention if they don't have insurance. It cost me nothing, but a visit like this could easily run someone without insurance over $200, I think. And I feel guilty wondering if $50 is too much to charge for a 15 minute office visit.

That's the thing about working at Kaiser - I don't have a good sense of what physician time is worth. I only know how much I get paid. Once I calculated my pay taking into account ALL the extra time that I put in, not just scheduled clinic time, and it worked out to about $50/hr. But of course, I don't have to pay for overhead. A survey in Medical Economics magazine found the average FP charge for a level 3 visit was $105 for new patients, and $65 for established patients. Hmm, maybe it wouldn't be so bad if I asked for $60 for an office visit.

3) Hospital privileges

I dropped off the forms to Huntington Memorial Hospital, the best known hospital in the area. So much stuff to assemble: CV, DEA, medical license, board certification, 2 passport-sized photographs, list of CME credits. They said it would take about 6 weeks to process, but I'm still missing proof of malpractice coverage, since I just mailed that in yesterday, so it will probably take longer. I had to wait until I got an address for my office before I could send in the applications.

One part of the application I couldn't fill out was the part where they asked who will cover my patients during any absences or vacations. Since I have only been with Kaiser for the past 13 years, I have had very little contact with any non-Kaiser physicians. The only ones I know, in fact, are the ones I play basketball with. So the medical staff personnel gave me a list of family physicians on staff whom I could call to ask if we could arrange some kind of cross coverage, so I could get my application approved.

I would really rather not cover someone else's patients, and I had been planning all along to not have to ask anyone to have to cover my patients. It takes a lot less work to take care of someone you already know. I figured that even if I go out of town, it wouldn't be for very long, and I would still be accessible by cellphone and/or email. In a true emergency, I'd tell the patient to go to the local ER anyways, or call 911. So I left a message with one FP's receptionist, and will await his callback to discuss possible arrangements for coverage. This is a new culture for me, and I don't know what is the norm here. I guess I'll find out.

Next up: forms for participation with Aetna, Blue Cross, Blue Shield, etc. Arrrgghhh! Did I mention how much I hate filling out forms?

Countdown: 53 days until target start date