Monday, April 30, 2007

Pay vs Worth

As further proof that our healthcare system is totally screwed up, I present the following.

On the one hand, we have a family doctor making $500 house calls in New York City which one patient describes as "ideal medical care". (Hint: it's not.)

Then as a polar opposite we have another family doctor in Chicago who chose to go "bare" (that is, go without any malpractice) in order to maintain his solo practice when his premiums jumped from $10,000/year to $40,000/year. Like Dr. Schleider above, Dr. Macumber doesn't accept any third party insurance. Unlike Dr. Schleider, he charges only $40 per visit.

What do they have in common? It is becoming increasingly harder for primary care doctors to practice "in the middle", and stay within a dysfunctional system that forces them to work long hours with inadequate pay. You either have to cash out and go for the high end, or do something radical like not have any personal possessions worth protecting.

In my former job as a staff physician, I calculated that my actual pay rate worked out to about $56/hour if you counted my actual hours worked. While that sounds pretty good, it makes me wonder why anyone would want to subject themselves to at least 7 years of postgraduate studies, amass mounds of student debt and live with the constant threat of being named in a malpractice suit when they could make $60-70/hour doing this.

Monday, April 23, 2007

More Micropractice Publicity

Another opportunity for me to talk about ideal micropractices, this time on public radio's, "Marketplace". Thanks, Pat!

But I'm even more proud and honored to be mentioned (albeit briefly) in this soon to be literary classic.

Tuesday, April 10, 2007

Blue Pill or Red Pill?

(With apologies to the Wachowski Brothers)
Dr. Moore: I imagine that right now you're feeling a bit like Alice. Tumbling down the rabbit hole? Or perhaps like you’ve been running on a hamster wheel?
Dr. Neo: You could say that.
Dr. Moore: I can see it in your eyes. You have the look of a doctor who accepts the amount of work he gets because he's expecting to get paid a fair price for his services. Unfortunately, this is far from the truth. Do you believe in fate, Dr. Neo?
Dr. Neo: No.
Dr. Moore: Why not?
Dr. Neo: 'Cause I don't like the idea that I'm not in control of my life.
Moore: I know exactly what you mean. Let me tell you why you're here. You're here because you know something. What you know, you can't explain. But you feel it. You felt it your entire life. That there's something wrong with the world. You don't know what it is, but it's there and you want to use your knowledge to help make people's lives better. But there is something in your way, holding you back. Like a fallen tree across the road -- blocking your path. It is this that has brought you to me. Do you know what I'm talking about?
Dr. Neo: The Medical-Industrial Complex?
Dr. Moore: Do you want to know what it is?
(Dr. Neo nods his head.)
Dr. Moore: The Medical-Industrial Complex is everywhere, it is all around us. Even now, in this very room. You can see it when you look out your office window, or when you turn on your television. You can feel it when you go to work, or when you go to church or when you pay your taxes. It is the world that has been pulled over your eyes to blind you from the truth.
Dr. Neo: What truth?
Dr. Moore: That you are a slave, Dr. Neo. Like every other medical graduate, you were matriculated into indentured servitude, trained inside a prison that you cannot smell, taste, or touch. A prison for your medical career. (long pause, sighs) Unfortunately, no one can be told what the Medical-Industrial Complex is. You have to see it for yourself. This is your last chance. After this, there is no turning back.
(In his left hand, Dr. Moore shows a blue pill.)
Dr. Moore: You take the blue pill and the story ends. You wake up in your on-call bed and believe whatever you want to believe. (a red pill is shown in his other hand) You take the red pill and I will show you a way out. (Long pause; Dr. Neo begins to reach for the red pill) Remember -- all I am offering is the truth, nothing more.
(Dr. Neo takes the red pill and swallows it with a glass of water)


What happens after you swallow the red pill? You may start posting messages like this one:
I work in an oppressive corporate IPA environment- I am nothing but a worker bee. I spend more time in paper work than patient care. I gotta go!

I am developing my sea legs- gathering information with the hope that I too can be an IMP.

Currently, I have panel size of about 4000 (yes, you read that correctly). I cannot imaging doing "today's work today" - I go crazy everyday w/ an already full schedule and patients wanting and demanding to be seen ASAP. Most of my work is "in the future". When I read Gordon Moore's reply "huge pent up demand that has been consistently shoved to the future and very limited capacity "today," hence poor access.", it struck a cord.

I never wanted to be in the situation I am now, overwhelmed by the demands of patients. I feel as a child who had the experience of accidentally going underwater, not knowing how to swim. Subsequently, being near water is frightening. Not being able to accomodate patients is very scary.

Otherwise, I think I can do an IMP.

Yes, Dr. Neo. You can.