Wednesday, December 26, 2007

Holidays (a late post by the way!)

I'm sitting in Illinois on a December day, writing this blog with the intention to reflect about this past year. It's been a steady year in my practice and I still remain committed to my vision about my practice. Overall, in the past 3 1/2 years since the inception of my practice, I believe that this style of practice is still least for me. Perhaps that's all one can really ask for, to find something that fits, even if it doesn't fit everyone. Here are my thoughts...

1. I am more and more concerned about the health care system of America. Every aspect of the deficiency of this system affects my practice but most of all, my patients. Things I have discussed before - such as the fragmentation of care, minimal value placed on primary care physicians, over-utilization of emergency rooms - all continue to be a trend that does not seem to be reversing. Every year, Congress is always threatening to decrease compensation to physicians but when reimbursement to primary care is already at the lowest tier, the very existence of primary care is threatened. There is so much talk about the need for preventative medicine, and a medical home but I'm concerned that it may be too little, too late. Will the upcoming election in 2008 focus on this important issue? I hope so, at least there's talk about it's just a matter if there is enough people power to overcome the huge medical insurance and pharmaceutical industry juggernaut. There is only a few presidential candidates that are willing to fight it, however.

2. Insurance companies are become more cunning about saving money and increasing work for physicians for what purpose? As I see this happening, I can surmise one thing...the tide is turning about their clout and the insurance companies are feeling it and milking everything it's worth in the health care industry dollars. And why are physicians complying with this? I know I'm just as guilty as the next doc but I'm thinking more and more about ditching this system unless some meaningful change exists (see #1)...which means the attractiveness of a cash only practice is looking better to me every day.

I recall a moment in my medical school training when I was doing a rotation in rural medicine in Rolla, Missouri. I was following an emergency room doctor at 1 in the morning seeing patients. During a lull, he sat me down and drew me a diagram of 2 boxes, one box being the patient, one box being the doctor. He mentioned that the connection between the 2 boxes, just like any other relationship, is important for both involved. The relationship is jeopardized, however, when a triangulation occurs between the 2 parties. This is the middleman, the insurance company. And as this third relationship evolves, which began to develop after WWII in America, the less the 2 initial parties began to see eye to eye. Just like Machiavelli, the role of this middleman, in another level, is dividing and conquering. They have succeeded and thus the role that they play now, politically and culturally. Now more than ever, any fear about the decline of this middleman is parlayed as threat to the doctors - "You won't get paid!" and to the patient - "You won't get good health care!" and who wins? What other industry works like this? Perhaps my previous work as a cashier in a bakery/restaurant highlighted this; how absurd this system has become. Over the past year, I've been more in tuned to this absurdity...and it has colored the choices I have to make as a doctor about my future.

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