Healthcare in the USA today.

[missy]

Wow we just got a call from the first surgeon we met with last week. The hospital's regional manager for the entire conglomerate called us an hour ago asking why we weren't going with them and we told her it was because 1. the biopsy and surgery got delayed because the surgeon was exposed to Covid and 2. we met with a different surgeon who did the biopsy immediately and we clicked with him.

Having said that I think both surgeons are excellent. Well the surgeon called to talk to us further at 4:30 PM today. Turns out though he had tried us at 10AM this morning but we missed the call and Greg just saw it now.

The surgeon was so honest with us. Probably too honest. But I appreciated it.

He told us how messed up the administration is and how poorly the hospitals are run and how they keep losing employees because they are treated badly and how it is just him and his assistant keeping the department together. How it's all a numbers game and how they have to refer within the hospital or they will get fired.

Greg spoke with him for over 30 minutes. The surgeon called him from his mobile and he is still at home in quarantine. What happened and why the biopsy was postponed was that the surgeon tested positive for Covid 19 during a routine test. All hospital employees get tested routinely. He had no symptoms and has been cleared to go back to work Friday.

We are both shocked but not surprised. This surgeon seems like a decent guy and an excellent surgeon but this is the state of health care in the USA today.

It's big business over caring about the health of the individual. I saw it in my field when new admin came in and it was the main reason I retired early. I refused to be told how to treat my patients and what to prescribe and who to refer to and I insisted on giving each patient all the time they needed. Which caused big problems. I still had to fight to leave (and retire) as they didn't want to let me but I had enough. And surgeons and MDs and other health care workers are going through a similar scenario every single day all over this country. Pressure to see the most people in the least time and refer within network and treat patients as they are told to by administrators.

Sad state of affairs.

 

[Snowdrop13]

That is sad. And it costs so much money! Where does it all go? Presumably into the pockets of the Chief Execs of the insurance companies?

I’m glad, at least that the surgeon was caring and helpful. It’s good to have confidence in the people looking after you.

 

[Matata]

@missy all of the things you mentioned in your OP is why I nagged DH for 5 yrs to retire. He just this year sold his practice and is now working for the people who bought it. He is out from under tremendous stress as an owner and trying to get used to working in a bureaucracy. Our health care system has been broken for a long time.

I can't find a doctor who will stick around longer than a year. The doc I registered with this year saw me for 15 min., charged me nearly $900 to ask me a few questions and order a pneumonia vaccine and quit 2 months later. And this is the guy it took me a year to find when the doc I adored quit medicine.

Our health care system a galaxy sized poop show where the actors play chess with human health as they chase $$$$$.

 

[MrsBlue]

I accompanied my son for emergency treatment in what had been an excellent hospital before the covid crisis. The place seemed so empty and when I asked about it, the nurse admitted that great doctors were retiring in droves. My friends in the field say the same--that they're being treated like garbage and don't know how long they can stand it.

The attending physician literally googled my son's symptoms on his phone and showed me the top hit. I was appalled. Is this the standard of patient care now???

Luckily we were able to see a specialist a few days later and confirmed that Dr Google was completely wrong but I'm still furious.

 

[canuk-gal]

HI:

What a hustle. Very sad.

cheers--Sharon

 

[SallyBrown]

@missy I had no idea you are/were an MD. Now I feel silly for my genetic testing recommendations. Doh!

 

[Daisys and Diamonds]

Oh @missy
This must be why our health system is full of American doctors
Gary's last eye doc was actually Indian but via Singapore
He was great and saved Gary's site
but saddly out here in the provinces they don't seem to be able to attract enough doctors
We even had to go on a wait list to get a GP when we moved

anyway what happens at the hospitals is then a dept gets understaffed and a doctor gets overworked and stressed and leaves because despite a nice gentle family freindly town his/ her work becomes as stressful as he left behind
Mr Gupta lost his 2ic (stress related) the week Gary saw him and he missed having the professional opinin of someone to confer with and someone to share the paperwork with

the provinceses arnt so bad for nurses because we have a ton of places that teach nursing so often a student nurse trains and then works in his/ her own home town, but only 2 medical schools (actually exactly the same for vets who are also stressed out) and most young doctors like big city life

Anyway Gary's new doc is American, but we are still to meet her, we have been told she moved her because of ...well fill in the blanks (but an orange tinged white house was one reason)

What happened to doctors and nurses running the health system-? not accountants

 

[missy]

That is sad. And it costs so much money! Where does it all go? Presumably into the pockets of the Chief Execs of the insurance companies?

I’m glad, at least that the surgeon was caring and helpful. It’s good to have confidence in the people looking after you.

I wish I had confidence in them but truth be told I know surgeons are human and fallible and anything could happen. It worries me there is other pressure on them besides the need to do the best job possible for their patients. They cannot just focus on patient care and that is a huge concern. Of course it my nature to be a worrier but IMO, for good reason. We are choosing the surgeon we have the most confidence in and hoping for the best.

That is a good question. Where does it all go? IDK because I have a feeling hospitals are running at a deficit still. Health insurance and health care and hospitals are big business and with big business comes corruption but that is a topic for another day. It is heartbreaking IMO that physicians and other health care workers who dedicate their working lives to helping and healing others can put profit ahead of human lives. Not all of them and hopefully not even most of them but this issue is forcing many great physicians to retire early. And then where do we go from here? There are less motivated and qualified individuals heading to the medical field. That is a huge concern.

@missy all of the things you mentioned in your OP is why I nagged DH for 5 yrs to retire. He just this year sold his practice and is now working for the people who bought it. He is out from under tremendous stress as an owner and trying to get used to working in a bureaucracy. Our health care system has been broken for a long time.

I can't find a doctor who will stick around longer than a year. The doc I registered with this year saw me for 15 min., charged me nearly $900 to ask me a few questions and order a pneumonia vaccine and quit 2 months later. And this is the guy it took me a year to find when the doc I adored quit medicine.

Our health care system a galaxy sized poop show where the actors play chess with human health as they chase $$$$$.

I'm sorry @Matata you are going through that. I agree. Our health care system is broken and has been for a long time. It took me a few years to make the difficult decision to retire when I did. I wasn't ready. I loved my patients. I found great satisfaction in my career. I always went the extra mile for my patients and I knew they were getting excellent care. A challenging field, one where most people chose not to go because it wasn't glamorous or easy, but one where I felt I made a difference and to me that was everything.

I grappled back and forth and agonized over the decision. I worked with a special population and I knew I gave them the best care and if I left who would take over that kind of care. My successor is a good person and I felt OK leaving them in her hands. I was tired of fighting and I was burned out. I made the best decision I could under the circumstances.

I hope your DH is happy with his decision and where he is working now and that he can do what he wants to do for his patients. It boggles my mind how non medical people in the administration tell the physicians how they can and cannot treat their patients and how long they can spend with each patient. I know it isn't like that everywhere but it is like that wherever big corporations have taken over.

My own PCP, who I adore, has had his medical practice taken over by a big conglomerate and he is miserable. Last time we saw him he complained bitterly to us. Greg and I have been seeing him as patients for over 20 years and he has never ever uttered any negative words about anyone. Til we saw him this past summer. His medical practice was taken over last winter. Everything has changed. I would not be surprised if he decided to retire early. He is a few years younger than I am. But I digress. All this to say I get it. And feel for you. It is broken and I have no clue how to fix it. And obviously neither does anyone else as far as I can see.

I accompanied my son for emergency treatment in what had been an excellent hospital before the covid crisis. The place seemed so empty and when I asked about it, the nurse admitted that great doctors were retiring in droves. My friends in the field say the same--that they're being treated like garbage and don't know how long they can stand it.

The attending physician literally googled my son's symptoms on his phone and showed me the top hit. I was appalled. Is this the standard of patient care now???

Luckily we were able to see a specialist a few days later and confirmed that Dr Google was completely wrong but I'm still furious.

Ugh, I am sorry you experienced that and I see that happening too regarding excellent doctors retiring early. Standard of patient care has gone down. I am glad your son got the appropriate care by a skilled specialist and hope he is AOK now. I used to joke around (when I first experienced the merry go round that is health care here) that our health care system was excellent as long as one remained healthy. :/

There are still excellent doctors but it's just more challenging to find them and often insurance won't cover the expense. The rich and famous and powerful generally have less of an issue finding good care. Not 100% true but more truth to that statement than not. Good health care is a right and not a privilege and that needs to be true across the board. It is absolutely crazy that not everyone has access to good health care in our country. It is a crying shame. And it is a crime IMO.

@missy I had no idea you are/were an MD. Now I feel silly for my genetic testing recommendations. Doh!

No please don't feel silly. I am an OD but even if I was an MD you shouldn't feel silly at all. There is new info all the time and there is always more to learn. Plus I graduated a long time ago and I don't know everything about everything. No one does. There is always something new and important to learn or relearn. I always appreciate you chiming in and sharing what you know. Thank you @SallyBrown. I value your input, experience and your advice. Please continue sharing your experience and knowledge.

Oh @missy
This must be why our health system is full of American doctors
Gary's last eye doc was actually Indian but via Singapore
He was great and saved Gary's site
but saddly out here in the provinces they don't seem to be able to attract enough doctors
We even had to go on a wait list to get a GP when we moved

anyway what happens at the hospitals is then a dept gets understaffed and a doctor gets overworked and stressed and leaves because despite a nice gentle family freindly town his/ her work becomes as stressful as he left behind
Mr Gupta lost his 2ic (stress related) the week Gary saw him and he missed having the professional opinin of someone to confer with and someone to share the paperwork with

the provinceses arnt so bad for nurses because we have a ton of places that teach nursing so often a student nurse trains and then works in his/ her own home town, but only 2 medical schools (actually exactly the same for vets who are also stressed out) and most young doctors like big city life

Anyway Gary's new doc is American, but we are still to meet her, we have been told she moved her because of ...well fill in the blanks (but an orange tinged white house was one reason)

What happened to doctors and nurses running the health system-? not accountants

Exactly. Business people shouldn't be running physicians offices and hospitals. Somehow we have to make health care profitable and eliminate the middle people who are taking the profits and destroying the sytem. Or is it too late. I don't think it is too late as long as medical care attracts the best and the brightest but the issue is less qualified people are going into the medical profession. Nurses who are the backbone (IMO) of great medical care are leaving the profession (burnout and many other reasons some illustrated in the article below) and we have a nursing shortage. Dire circumstances IMO.

Nursing Shortage - StatPearls - NCBI Bookshelf

I hope Gary's new doctor is excellent and can help him @Daisys and Diamonds.


Thanks all for letting me vent here. It is a very serious issue and one where there is no easy answer but I feel a country is only as good as its education and health care. How we care for the weakest members of society (including animals) shows who we are as a nation and we are not doing a good job. We are not even (IMO) doing an average job. We are failing the children and most vulnerable adults among us and we need to do better. I don't have any answers. I am very tired. I know most of you are too. Thanks for allowing me a safe space within which to share my thoughts.

 

[missy]

https://www.nejm.org/doi/full/10.1056/NEJMp2000821

Covid-19 and the Need for Health Care Reform​

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. Although all aspects of U.S. health care will face incredible challenges in the coming months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.
About half of Americans receive health coverage through their employer, and with record numbers filing for unemployment insurance, millions find themselves without health insurance in the midst of the largest pandemic in a century. Even those who maintain insurance coverage may find care unaffordable.

Before the pandemic, research showed that more than half of Americans with employer-sponsored health insurance had delayed or postponed recommended treatment for themselves or a family member in the previous year because of cost.1 The loss of jobs, income, and health insurance associated with the pandemic will greatly exacerbate existing health care cost challenges for all Americans. For instance, in a recent poll, 68% of adults said the out-of-pocket costs they might have to pay would be very or somewhat important to their decision to seek care if they had symptoms of Covid-19.2 Failure to receive testing and treatment because of cost harms everyone by prolonging the pandemic, increasing its morbidity and mortality, and exacerbating its economic impact.
To address myriad issues raised by Covid-19, Congress has passed two significant pieces of legislation, with more likely to come. The Families First Coronavirus Response Act (FFCRA) requires all private insurers, Medicare, Medicare Advantage, and Medicaid to cover Covid-19 testing and eliminate all cost sharing (copayments, deductibles, and coinsurance payments) associated with testing services during the public health emergency. It also appropriated $1 billion for the Public Health and Social Services Emergency Fund to cover testing for uninsured individuals under state Medicaid plans. Although the FFCRA assists with testing costs, patients remain vulnerable to cost-sharing expenses associated with treatment (such as hospitalization) until they reach their yearly out-of-pocket maximum, which can exceed $8,000 for an individual and $16,000 for a family.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2.2 trillion pandemic-relief bill, requires all private plans to cover Covid-19 testing and future vaccines, but it stops short of eliminating cost sharing for Covid-19 treatment. Nonetheless, many private insurers, including Humana, Cigna, UnitedHealth Group, and Blue Cross Blue Shield, have agreed to waive cost-sharing payments for plan members treated for Covid-19. The CARES Act appropriated $100 billion for hospitals and health care providers, which Health and Human Services Secretary Alex Azar later conditioned on providers’ agreement not to bill insured patients more than their in-network cost-sharing amounts and not to bill uninsured patients at all for Covid-19 treatment. The federal government will reimburse providers at Medicare rates for treating uninsured patients. The CARES Act also provided substantial tax credits, emergency grants, and loans to help businesses keep employees on the payroll or on furlough through June 2020, while extending and increasing unemployment benefits for those who lost their jobs.
Though these laws provide critical assistance, additional policies are needed to ensure that Americans can continue to access affordable care as the crisis continues. First, I believe policymakers should freeze people’s insurance status as of April 1, 2020, to keep as many people as possible in their existing plans and with their current providers. People who had employer-sponsored insurance or an Affordable Care Act (ACA) marketplace plan as of that date should be able to remain on that plan through the end of the public health emergency, even if they lose their jobs or cannot pay their premiums. As an initial step in this direction, several states have instituted grace periods on insurance-premium payments for all policies.3 For example, the Ohio Department of Insurance ordered all insurers to offer employers a 60-day grace period for premium payments, enabling them to retain employees and their health benefits for an extended period.4 Premium payments could be paused, subsidized, or paid directly by federal disaster-relief funds.
Second, policymakers should secure coverage for people who have already lost their jobs by expanding access to ACA marketplace plans and Medicaid. Eleven states and the District of Columbia have opened new open enrollment periods for their state ACA marketplaces to encourage enrollment.3 Despite President Donald Trump’s announcement that he would not open enrollment in the 38 states with ACA plans hosted on the federal marketplace, people who have lost their jobs within the past 60 days or who expect to lose their job in the next 60 days can apply to enroll in an ACA marketplace plan during a special enrollment period (just as one can after a life event such as marriage or the birth of a child).
In response to the pandemic, nearly all states have received Section 1135 Medicaid waivers to meet the needs of their most vulnerable residents.3 Many states sought such waivers to eliminate Covid-19–related cost sharing, facilitate provider and participant enrollment, and waive preauthorization requirements for Covid-19–related services during the declared public health emergency. In addition, many states (including Iowa, which already applied for and received a Medicaid waiver to be allowed to maintain its enrollment) will pause disenrollment to receive a higher federal matching rate established by the FFCRA. Finally, no state is currently enforcing work requirements for maintaining Medicaid eligibility.
Given the size and scope of the pandemic, state or federal government officials could also implement something similar to the Disaster Relief Medicaid program (DRM), a temporary public health insurance program created in New York after the 9/11 terrorist attacks.5 The DRM allowed nearly 350,000 New Yorkers to quickly and easily obtain access to Medicaid benefits by raising eligibility thresholds, excluding asset tests, and using short-form applications. The program provided New Yorkers with 4 months of emergency Medicaid coverage during the most critical time of the crisis, and then helped them transition to other coverage. A similar emergency program could raise eligibility thresholds beyond Medicaid expansion levels and increase federal matching funds to help cover people who lost their jobs or remain uninsured during the pandemic.
Third, state and federal officials should continue addressing out-of-pocket expenses, such as cost sharing and surprise medical billing. Lawmakers can follow Massachusetts, New Mexico, and Washington, D.C., by eliminating cost sharing for Covid-19–related treatment. Hospital and provider reimbursement shortages can be covered by CARES Act appropriations.
Covid-19 also creates unique affordability challenges related to surprise medical billing, which can occur when a patient receives treatment from an out-of-network physician at an in-network facility. Staffing shortages and triage protocols make it more likely that patients will be sent to out-of-network facilities or be seen by out-of-network providers when they cannot check providers’ network status. Furthermore, provider shortages may require providers to fill in care gaps for many conditions, not just Covid-19, expanding the potential for out-of-network care and surprise bills during this time. Though more than half the states offer some surprise-billing protections, policymakers should eliminate bills from out-of-network providers that exceed in-network cost-sharing limits for any medical treatment received during the public health emergency.
While states should continue leading the way on Covid-19 policies, comprehensive protections demand federal intervention. The Employee Retirement Income Security Act of 1974 (ERISA) prohibits state laws governing health insurance from applying to self-insured employer plans, typically offered by large employers such as Apple, Intuit, and Microsoft. As a result, current state surprise-billing protections, cost-sharing prohibitions, and coverage mandates will not apply to nearly 60% of Americans with employer-sponsored health insurance (nearly 30% of the population). ERISA thus leaves millions of people unprotected by state health care reforms. Absent a federal response, states can avoid some ERISA entanglements by directly prohibiting providers from charging cost-sharing rates for Covid-19 treatment and from surprise billing, but historically this approach has been politically infeasible. Perhaps Covid-19 provides the necessary impetus for change.
Never before has the interdependence of all our health, finances, and social fabric been so starkly visible. Never before has the need for health care reforms that ensure universal access to affordable care for all Americans been more apparent. Our policies on health and health care, both during this pandemic and in the future, should reflect this reality, and we should not let the lessons of this crisis pass us by.
Disclosure forms provided by the author are available at NEJM.org.
NEJM.org.

 

[MakingTheGrade]

Yeah I stayed in academic medicine partially to avoid the corporate culture of for profit systems. But even at one of the top ranked hospitals in the world, we aren’t immune from having to cater to RVUs (it’s our unit of revenue as clinicians). I actually sit on many meetings about billing cycle etc and I will say most of it is genuinely motivated by wanting to keep the lights on and maximizing our reimbursements from insurance so we can put that money back into the department to offer more care and resources in the community.

Our approach to maximizing has been to make our documentation and work flow as efficient and painless as possible for our MDs instead of making them see more patients. Good docs are very hard to replace. We optimize note templates and hire support staff like scribes and social workers so our docs can focus more on patient care and less on paperwork and phone calls. I can’t tell you how many hours I’ve spent calling insurance companies to get prior authorizations done. I literally learned how to code in my 30s, while working as a physician, in order to do some of this work because it made me so angry!

These days I get more of a seat at the C-suite table because I have a better understanding of how the money flows and they know I can help them make it better. Sadly none of this was taught to me in medical school and I went to one of the best. It’s one of the reasons physicians are poorly armed to combat the business side taking over the clinical side. We get told that if we want to support our own salaries we need to see more patients. We were often purposefully not taught the business side of healthcare, to our and the patients’ detriment I think. But I think things are changing, my partner is currently in medical school where they offer a healthcare admin track which I think is great.

And this is just my experience in academics at a place where most of our decision making execs are doctors and nurses and align with us in prioritizing patient care. Can’t imagine what working for a for profit hospital or group would be like. The salaries are significantly higher than what I make in academics, but I would be so much more miserable. Speaking of salaries, I know many of my coworkers would happily get paid half their current salaries if med school didn’t cost $250k which usually ends up being 350-400k$ paid back after interest. This doesn’t include debt from college. This unfortunately means pressure to pick the job that pays the best.

How we finance healthcare is very messed up. For now I’m just doing what I can to keep myself and my fellow physicians as protected from burnout as possible. I would love for there to be mass reform in how we pay for care though. I for one am on team Universal Healthcare.

 

[Gussie]

I hear you @missy ! Insurance is in an awful state. We just sent my daughter for much needed mental health inpatient treatment. The facility is nationally ranked and definitely the best in Houston. But of course, it's out of network and I doubt the insurance company will reimburse us for any of it.

 

[Snowdrop13]

I guess no health system is perfect but I agree that access to basic healthcare should be a human right in a developed country. Things like maternity care, emergency medicine, cancer surgery and treatment and intensive care should be free, at least. Maybe some sort of public/private split for the rest? I’m very sorry to hear that so many health care workers are having a bad time, though. And the patients as a result.

 

[MaisOuiMadame]

I hear you @missy ! Insurance is in an awful state. We just sent my daughter for much needed mental health inpatient treatment. The facility is nationally ranked and definitely the best in Houston. But of course, it's out of network and I doubt the insurance company will reimburse us for any of it.

Gussie, I am happy your daughter is feeling better and in excellent hands!

I'm in Europe, I don't know what "out of network" means, would you be so kind to explain if you find the time?

 

[missy]

Gussie, I am happy your daughter is feeling better and in excellent hands!

I'm in Europe, I don't know what "out of network" means, would you be so kind to explain if you find the time?

It means that your insurance won't cover a doctor who doesn't accept your insurance so you have to cover the fees if you go with that doctor.

Some insurances do cover out of network at a lower rate than in network. For example if we go out of network our insurance will cover IIRC 70% of the usual and customary fee. Which is always less than their actual fee and you end up covering way more than 30%.

As an example: Our dermatologist accepts no insurance. His usual fee is $475 and up. We end up paying $350-375 of that $475 and insurance will generally cover about $100 or so.

If we use an in network doctor (one who accepts our health insurance) they will cover the entire visit minus a $50 copay. Till we reach 2-3K per individual (I don't remember which) in copays during the calendar year and then they cover in full.

 

[MaisOuiMadame]

It means that your insurance won't cover a doctor who doesn't accept your insurance so you have to cover the fees if you go with that doctor.

Some insurances do cover out of network at a lower rate than in network. For example if we go out of network our insurance will cover IIRC 70% of the usual and customary fee. Which is always less than their actual fee and you end up covering way more than 30%.

As an example: Our dermatologist accepts no insurance. His usual fee is $475 and up. We end up paying $350-375 of that $475 and insurance will generally cover about $100 or so.

If we use an in network doctor (one who accepts our health insurance) they will cover the entire visit minus a $50 copay. Till we reach 2-3K per individual (I don't remember which) in copays during the calendar year and then they cover in full.

Thank you Missy !!!

This is all so much more expensive than here .



A gp visit will cost 27€ .
A specialist 45-65€

If you don't have additional insurance (usually from your employer) you get 70% back.

The doctors who charge more have to state that clearly prior to visit and will charge 90-120€ /visit.

You still get your 70% of the insurance tariff back. Our insurance will cover 100% of their cost as well.

Plus free choice of doctor.

That's in France.

In Germany it is similar, but your insurance will cover 100% of the visit of the insurance tariff &you don't have to pay (we have a chilled card and insurance gets billed by doctor directly).

Free choice of doctor is also one of the most important things in the German system...

 

[missy]

Thank you Missy !!!

This is all so much more expensive than here .



A gp visit will cost 27€ .
A specialist 45-65€

If you don't have additional insurance (usually from your employer) you get 70% back.

The doctors who charge more have to state that clearly prior to visit and will charge 90-120€ /visit.

You still get your 70% of the insurance tariff back. Our insurance will cover 100% of their cost as well.

Plus free choice of doctor.

That's die France.

In Germany it is similar, but your insurance will cover 100% of the visit of the insurance tariff &you don't have to pay.

Free choice of doctor is also one of teh most important things in the German system...

Yes there are many differences.

I know of no perfect system.
I have had friends from other countries come here for what was considered an elective surgery in their country and consequently they had a long waiting (1year plus) period. They came here for sooner relief.

Having said that our healthcare system is broken.
Very broken.
And it’s a life or death issue.

 

[Ally T]

It means that your insurance won't cover a doctor who doesn't accept your insurance so you have to cover the fees if you go with that doctor.

Some insurances do cover out of network at a lower rate than in network. For example if we go out of network our insurance will cover IIRC 70% of the usual and customary fee. Which is always less than their actual fee and you end up covering way more than 30%.

As an example: Our dermatologist accepts no insurance. His usual fee is $475 and up. We end up paying $350-375 of that $475 and insurance will generally cover about $100 or so.

If we use an in network doctor (one who accepts our health insurance) they will cover the entire visit minus a $50 copay. Till we reach 2-3K per individual (I don't remember which) in copays during the calendar year and then they cover in full.

Isn't the point of having health insurance so that you are covered anywhere & by anyone you chose to see? How can particular Dr's pick & choose which insurance companies to accept patients from? You're insured - the bill will be paid, right? Or am I missing something?

 

[Ally T]

Although our NHS here in the UK is underfunded & over worked, I am so thankful that all patients are treated equally & profits are not a consideration. We may have to wait longer for certain things (or can choose to pay for private treatment if desired, or have health insurance that gives you this liberty rather than make a one off payment), but eventually you get the right treatment by the right Dr.

One of my daughters Dr's is American. He's been here for several years, after feeling he was no longer able to fulfill his role to the best of his ability in the US. That makes sense to me now after reading this thread.

 

[missy]

Isn't the point of having health insurance so that you are covered anywhere & by anyone you chose to see? How can particular Dr's pick & choose which insurance companies to accept patients from? You're insured - the bill will be paid, right? Or am I missing something?

No. In the USA having health insurance can mean you don’t have a choice as to the doctors but at least you have coverage. It varies wildly. And as with most things in life the more money you spend the better your care. Generalizing here but it is more true than false. Sad but true. And honestly isn’t that the way it works in many countries? Go private if you don’t want to go within the universal health care system.

 

[MaisOuiMadame]

No. In the USA having health insurance can mean you don’t have a choice as to the doctors but at least you have coverage. It varies wildly. And as with most things in life the more money you spend the better your care. Generalizing here but it is more true than false. Sad but true. And honestly isn’t that the way it works in many countries? Go private if you don’t want to go within the universal health care system.

Yes you are right. I think generally speaking one can always fast track anything with more money...when I compare my US friends and what I read on PS the core difference is the price. In the universal healthcare system people are still covered and , when I talk about Germany and France, covered VERY well. So the pressure/need to fast track is lower and doctors who charge too much don't have a market.

The second problem in the US is of course the court system.

Big sums following malpractice lawsuits don't exist here. So insurance is much much lower.

Mind you: if one suffers from disabilities or costs following a medical mistake, the doctor's insurance will cover those. On top the victim will be able to get a sum pretium doloris..but it's nowhere near American prices. I checked a bit and if the victim is paralyzed it's about 400k.

 

[missy]

And the news keeps getting better.

Docs Leaving Practice, but Not Solely Because of COVID-19: Survey

Yes, the pandemic is putting stress on physicians, but a healthy dose of pressure already existed. Some doctors are looking to hang up the white coat and pursue new endeavors, according to a new report.

www.medscape.com

"

Docs Are Leaving Practice, but Not Only Because of COVID-19, Says New Survey​

Avery Hurt
October 08, 2021



The COVID-19 pandemic has put enormous stress not only on the healthcare system but on individual physicians as well, whether they work in hospitals or other practice settings. But the pandemic arrived at the doorsteps of an already stressed and burned-out profession. Practicing physicians have been dealing with burnout for many years. As a result, many physicians are considering other career options.

These trends are reflected in the recently released Medscape Physician Nonclinical Careers Report 2021. In the survey, more than 2500 US physicians were asked whether they were thinking of leaving clinical practice and if so, why they wanted to leave and where they planned to go.

​

The results were sobering. Roughly 1 in 5 (22%) of the physicians surveyed said they were considering leaving their current jobs to pursue a nonclinical career; 58% of those said they planned to make the change within 3 years. Eight in 10 are actively exploring other options, and over half (53%) are looking online.


Burnout was most often cited as the primary reason for considering a change; 34% gave this reason. Twenty percent said they wanted to work fewer hours. Physicians seem to be aware of the extent of the dissatisfaction in their profession. One respondent said the reason for leaving clinical practice was the desire to find a career helping burned-out colleagues.

Systemic Problems​

The pressures forcing physicians to rethink their careers are ongoing and systemic and predate the COVID-19 pandemic.

Although COVID-19 has created challenges for physicians, only 7% put the blame for leaving clinical practice squarely on the pandemic. When asked why they sought to change careers, respondents shared their frustrations with the healthcare system. Much of this frustration involves billing and finances, but lack of agency and autonomy were cited as well. One physician said, "I really, really enjoy practicing medicine but don't get paid enough from all sources, especially the insurance companies who resist paying for services." Another indicted the healthcare industry itself and its treatment of healthcare workers: "Medicine has turned into an employed-labor commodity and exploitation."



There are indications that the nonfinancial reasons are more important to women. Although women were more likely than men (39% vs 30%) to say their burnout was not related to the pandemic, more men than women said they wanted to work fewer hours (22% vs 17%). Men were also more likely than women to say they expected to earn more in a nonclinical career (7% vs 2%).

Medical education requires a serious commitment of time and money, yet, despite the expense, almost half (45%) of those considering leaving clinical practice said they felt no guilt about the money spent on their educations. According to Michael McLaughlin, MD, founder of Physician Renaissance Network, the feeling of having wasted their training may be higher in physicians who feel trapped in their jobs than in those who enjoy a rewarding career that still makes use of their training.

Where's Everybody Going?​

Medical professionals who no longer want clinical careers have a variety of options, many of which make use of their training. In previous surveys, physicians who were considering other careers usually aimed for law, business, teaching, finance, and engineering. In this survey, teaching was the top choice, at 42%. The other options have been reshuffled or have dropped off entirely. Thirty-four percent of respondents said they are considering a career with a healthcare business company, and 27% said they are considering writing as a career. Law was the top choice for only 8% of doctors surveyed.


Whatever the new job will be, most physicians expect they'll be happy there. More than 80% said they are somewhat confident to very confident they'll like their new careers."

 

[Karl_K]

When I went to get my shoulders shot everyone at the doctors office acted like something bad had happened or something was off.
I cant really describe it other than a sense of gloom in the office and people?
They were all professional and everything and it wasn't just with me but even with the masks on you could tell something was going on.
I didn't feel right asking what was up so I didn't.

 

[missy]

When I went to get my shoulders shot everyone at the doctors office acted like something bad had happened or something was off.
I cant really describe it other than a sense of gloom in the office and people?
They were all professional and everything and it wasn't just with me but even with the masks on you could tell something was going on.
I didn't feel right asking what was up so I didn't.

It feels, to me, at times, as if we are in an apocalyptic world. An alternate universe. A very bad (or very good depending on how you look at it) never ending episode of the Twilight Zone.

 

[rocks]

When I went to get my shoulders shot everyone at the doctors office acted like something bad had happened or something was off.
I cant really describe it other than a sense of gloom in the office and people?
They were all professional and everything and it wasn't just with me but even with the masks on you could tell something was going on.
I didn't feel right asking what was up so I didn't.

Have they gone corporate? Sold to a regional medical group?

 

[Karl_K]

Have they gone corporate? Sold to a regional medical group?

They have been part of a multi-state medical group associated with a university for a while now(5+ years I think) and were part of a regional hospital medical group before that.

 

[Matata]

From my morning paper today:

 

[rocks]

They have been part of a multi-state medical group associated with a university for a while now(5+ years I think) and were part of a regional hospital medical group before that.

Ok….that isn’t the issue….

 

[missy]

Have they gone corporate? Sold to a regional medical group?

My internist's practice was taken over a few years ago by a big corporation. He used to be wonderful. Attentive and caring. Now he is just burned out. He is a bit younger than me. Maybe 50 or late 40s. It is a shame. A crying shame. They are working all their physicians too hard. They don't have enough time to think critically about any challenging patients and they don't have enough energy to do their jobs to the best of their abilities. My internist, who was never a complainer, never, complains to me every year we see him now. He is exhausted and I worry he is going to retire sooner vs later. This is my internist for over 22 years. His care went from high quality excellence and caring about his patients to sheer exhaustion and doing the best he can under challenging circumstances. He is, IMO, no longer giving excellent care.

But I can hardly place blame on him as I believe he is doing the best he can with the situation. But his patients are suffering. Big corporations put profit over all else. And in healthcare that is not the correct way to look at it. It should be excellent patient care and then profit. One can still be profitable without making that priority number one. In healthcare it should not be profit over all else. It just should not.

When my non profit healthcare multidisciplinary clinic was taken over by a big corporation in 2014/15 I tried to make it work. They worked hard to keep me but it was not good enough because they put profits over excellent care IMO. They wanted us to see patients in 15 minutes or less. We were working with and caring for a physically and mentally challenged patient population. They had developmental and physical disabilities. They required much more time than 15 minutes to care for them properly.

I spent a few more years there caring for them to the best of my ability ignoring the administration. MY patients always came first. Period. Despite the pressure that was put on me I continued caring for them the way I always did. I took the time needed and did my job skillfully. After a few years I was burned out due to the admin and the pressure and I retired. I was relatively young but I had put in 30 years and I couldn't do it anymore. I wasn't willing to sacrifice care for profits. It was time for me to retire and despite the fight the admin put up (they did not want me to leave despite my constant butting of heads with them because they recognized my value there) I was done.

All this to say I am 100% sympathetic to the plight of all those in healthcare. It is a travesty what is happening in this country. I cannot speak for other countries but I am well aware of my friends all over the world who cannot get the care they need in a timely fashion. It is not just the USA. But I have only personal experience in the USA.

A country cannot be excellent without excellent health care IMO.

 

[doberman]

This is definitely not the thread to read when your son is doing residency interviews.

 

[missy]

This is definitely not the thread to read when your son is doing residency interviews.

Good luck to your son @doberman! We need good physicians now more than ever. I hope he gets exactly the residency he’s hoping for.