My doctor basically just fired me

[Missy]

Sparkly, isn't that the European model?

 

[monarch64]

I'm sorry, Kenny. You know what would be awesome? If doctors worked for the love of their jobs and for helping people instead of for profit. But that's just not how the world works. So unfortunate but so true. Doesn't make them terrible people, just makes them human beans. And sometimes human beans just suck.

Monarch, would you work for little pay relative to your skill and what you have to offer people?

Yes. I do, and I am happy. Happier now at 35 than ever before in life. But that is just me, and as we all know, people vary.

 

[JewelFreak]

I'm so sorry, Kenny. This is the lovely other side of "free" health care. I've read that your dr's model is one many are considering in order to avoid practicing assembly-line medicine. So, did anybody really think it's possible to add 30 million new patients to the same number (or fewer, minus those who give up practice) of docs & at a lower price -- and still keep quality up? I got a bridge in Brooklyn to sell those folks.

--- Laurie

 

[Missy]

I'm sorry, Kenny. You know what would be awesome? If doctors worked for the love of their jobs and for helping people instead of for profit. But that's just not how the world works. So unfortunate but so true. Doesn't make them terrible people, just makes them human beans. And sometimes human beans just suck.

Monarch, would you work for little pay relative to your skill and what you have to offer people?

Yes. I do, and I am happy. Happier now at 35 than ever before in life. But that is just me, and as we all know, people vary.

I'm glad for you.
Care to share what you do and the years of education it took for your skill and degrees?

 

[Missy]

I'm so sorry, Kenny. This is the lovely other side of "free" health care. I've read that your dr's model is one many are considering in order to avoid practicing assembly-line medicine. So, did anybody really think it's possible to add 30 million new patients to the same number (or fewer, minus those who give up practice) of docs & at a lower price -- and still keep quality up? I got a bridge in Brooklyn to sell those folks.

--- Laurie

So true.

 

[Maria D]

Interesting how some are linking the "need" for this practice to Obamacare. This is not new. My mother's primary care doctor became a member of one of the organizations, MDVIP, quite a while ago. I'm not sure what year it was but it was definitely one of the first 4 Bush years. (She found a new doctor.) The doctor will not get to keep the entire $1800 by the way. I'm not sure how they all work, but MDVIP, which is owned by Proctor and Gamble, gets one third of the membership fee. This is to provide things like educational support, electronic record-keeping and sales and marketing. Just another profit-making enterprise between you and your doctor is how I see it.

I'm surprised that there are people that haven't heard of this -- it's getting more and more common. You can read more about it at:
http://www.mdvip.com/prospectivephysician/downloads/qa_brochure.pdf

I am especially amused by this paragraph:

What kind of patient will join my MDVIP–affiliated practice?
They will be patients who have a greater interest in their health. They will be patients who respect your expertise and time, value their relationship with you, and are motivated to work together so they can be their healthiest. They will be more compliant and will rely on your guidance, whether it involves lifestyle or treatment choices. Your patients know that their health is their responsibility, but they need someone to guide and coach them. The person they most trust is you, their doctor.

Hmmm...yeah, I guess if you're willing to pay $1800/year just for the privilege of being called someone's patient you are likely the compliant type!

 

[monarch64]

I'm sorry, Kenny. You know what would be awesome? If doctors worked for the love of their jobs and for helping people instead of for profit. But that's just not how the world works. So unfortunate but so true. Doesn't make them terrible people, just makes them human beans. And sometimes human beans just suck.

Monarch, would you work for little pay relative to your skill and what you have to offer people?

Yes. I do, and I am happy. Happier now at 35 than ever before in life. But that is just me, and as we all know, people vary.

I'm glad for you.
Care to share what you do and the years of education it took for your skill and degrees?

Thank you, and yes, absolutely!

I am currently an apparel and footwear buyer for an independently owned, locally operated outdoor adventure store. Basically I choose the things people will wear while spending their disposable income (those people often possess initials after their surnames! I did not choose a profession so noble as healthcare) on traveling, living out their dreams, just surviving and providing for themselves and/or their families (farmers, who ironically may have more education than some M.D.'s), or just for fun and that is a succinct description (imo). My B.S. is in Textiles/Apparel/Merchandising, took me four and a half years to obtain because after entering college with a chosen major of Radio/TV/Film, I took a short break to re-evaluate and re-entered school with the intent of pursuing a degree in fashion because I discovered at 19 that it had been my true passion all along. I am happy to say that it still is, all these years later. This year I am excited to say that I am involved on a volunteer basis with the Boy & Girls Club and am organizing a Fall Fashion Preview from which they annually benefit!

An aside: I am a staunch Independent and currently do not support the ACA, hoping that is relevant...but do not wish to debate the issue so will likely bow out of the thread.

Back to the original post: I believe in everyone's right to work for whatever reason--money, fame, philanthropy, anything--to each their own. My point to Kenny was that sometimes doctors aren't working out of the goodness of their hearts for little pay, and that kind of stinks when you're the patient and have been happy with your healthcare provider and they freaking fire you. Of course I see all the sides of the issue...I really wasn't trying to contribute to a debate or bring up any profound points. Thank you for asking, it is nice to share my background and opinion here on PS.

*Edited to include an accidentally left-out word!

 

[Missy]

Ooh, love your career Monarch!! I always had a love for fashion but my passion unfortunately remains limited to Project Runway and shopping for myself sadly. Even my dh doesn't need my fashion expertise since he is quite stylish on his own.

I understand your point but in today's world I feel it is unrealistic. If you are independently well off then sure. The sky's the limit. In fact I cannot wait till I can just volunteer more of my time with homeless animals and helping this country become a kill free one. But alas, I must earn money for a quality of life and I do so in my chosen career. I don't earn a lot- in fact I am sure many would feel the same way- that they do not earn enough for all their hard work and skill. However, it was the happy compromise I struck with myself to earn a living and still feel like I am making a difference in what I do for work.

But getting back to MD's who sacrificed many years of their life/money and energy, sweat and tears- don't you think they deserve to earn a fair living? I mean, why is it OK for sports players to earn millions upon millions and teachers and doctors to just get by? Ofc, there is a difference in the pay scale of doctors vs teachers but just thinking aloud. I mean, professional liability has risen like crazy (see prior example of good friend OB/GYN) and now the politicians/insurance companies want to decrease the salaries and increase patient base of physicians and other health care workers? My patients are taking a huge hit because meds I prescribe are no longer covered by medicare/medicaid. These patients are DD and have very little in terms of money. It breaks my heart and yet the insurance companies think it is OK to say that no we are not covering that medication though it is the best for what their condition is. Too bad so sad.

ETA: In order to attract the best and brightest to healthcare (and other worthwhile critical careers ie teaching) we must compensate people justly for their time and hard work. It's the only way to really get the best. We are not living in a LaLa land fairy tale and people need to earn money for quality of life and shouldn't have to apologize for wanting to be compensated fairly.

 

[kenny]

When I talked to my doctor yesterday I told him the insurance statement says the hospital charged $117,000 for my operation last year, but my insurance company's contracted rate was $20,000 which is all my insurance company paid.

My doctor responded, if I was a cash customer with no insurance (and was informed and smart enough to negotiate) I would have been able to negotiate that $20,000 rate with the hospital.

Reminds me of Larry Fines statement ...something like ... the exact same piano can sell on the same day in the same showroom to two different customers, and one price will be double the other.

That $950 monthly premium adds up to $11,400 a year.
That could pay for lots of medical care for an uninsured patient who negotiates.
The money I'm saving by not being insured for two years could have paid for my operation last year.

Larry, you're smart to be not insured if you have the resources to pay for your own care, come what may.

I hate insurance.
The entire health insurance needs to be entirely elimated.

You don't pay insurance for police or fire protection and shouldn't for health care.
Trillions of YOUR dollars are wasted by the existence of this scam-industry.

Pay the doctors, nurses and hospitals the same way we now pay the police and fire department, with tax dollars.
By eliminating the trillion$$$$$$$$ consumed health insurance industry your taxes will go up by less than what insurance costs us now.

 

[kenny]

When I talked to my doctor yesterday I told him the insurance statement says the hospital charged $117,000 for my operation last year, but my insurance company's contracted rate was $20,000 which is all my insurance company paid.

My doctor responded, if I was a cash customer with no insurance (and was informed and smart enough to negotiate) I would have been able to negotiate that $20,000 rate with the hospital.

That $950 monthly premium adds up to $11,400 a year.
That could pay for lots of medical care for an uninsured patient who negotiates.
The money I'm saving by not being insured for two years could have paid for my operation last year.

I hate insurance.
The entire health insurance needs to be entirely elimated.

You don't pay insurance for police or fire protection and shouldn't for health care.
Just imagine, your house is on fire and you call 911, but they put you on hold to see if you paid your fire-insurance bill this month.
If you didn't your house burns to the ground. Tough Shet!
Trillions of YOUR dollars are wasted by the existence of this scam-industry.

Pay the doctors, nurses and hospitals the same way we now pay the police and fire department, with tax dollars.
By eliminating the trillion$$$$$$$$ consumed health insurance industry your taxes will go up by less than what insurance costs us now.

 

[monarch64]

Health insurance should not be eliminated, it DOES need to cross state lines. Insurance in general can be described as a scam but it doesn't have to be. I think that is pretty much all I have to say about my stance.

Missy you make valid and great points, I agree with most if not all. I really appreciate this discussion.

 

[LAJennifer]

It's called concierge service.

http://blogs.reuters.com/reuters-money/2011/07/18/is-a-concierge-doctor-worth-the-cost/

My monthly insurance premiums were $650 two years ago and rose to $950 so I cancelled my policy.
I'm now among the uninsured.

I'm fvcked.
I'm pissed.

Kenny. I'm sorry to hear you are now uninsured. However, I know a good doctor that might work for you. He is my DH's former doc, in Santa Monica and is an awesome physician. My bff, in LA, has been going to him for the last 7 years. She lost her health insurance 2 years ago and he has been great about working with her to get her the prescriptions she needs, etc. Do a google search for Dr. Elliot Felman.

 

[kenny]

Thanks LAJ.

 

[monarch64]

I hope you find a new doctor, Kenny, and one who will work with you in terms of payment.

I will say here that once upon a time, I was between health insurance policies (graduated college, came off my parents' policy, started a new job with a 90 day "probation" period) and broke an ankle badly enough to require surgery. I was able to barter with my doctors and surgeon and ended up paying around 25% of what the total bill for everything would have cost. Just food for thought, not gonna give my opinion on whether I think that was right or wrong.

 

[Fly Girl]

Sounds like it is time to go doctor shopping.

I was basically fired by the gynecologist last year. My baby-making days are over, so he suggested I get a family practice doctor as my primary physician. When I was shopping for a new doctor for my annual physical, I found one that had a concierge practice. I decided that her services did not fit my needs, but I can see how some people would love that sort of practice. Anyhow, I found a new physician that belonged to my favorite medical group and life goes on.

 

[Missy]

Health insurance should not be eliminated, it DOES need to cross state lines. Insurance in general can be described as a scam but it doesn't have to be. I think that is pretty much all I have to say about my stance.

Missy you make valid and great points, I agree with most if not all. I really appreciate this discussion.

Thanks Monnie. I appreciate that. I also agree we cannot eliminate health insurance. Kenny, your example doesn't work if people become chronically ill or have a much more expensive catastrophe/health issue. Going bankrupt from medical expenses is one of the largest causes of bankruptcy I believe. For uninsured people.



Sparkly, I am really curious about your statement before:

No one wants to pay for anything but everyone wants everything handed to them by the government. That works well.. oh wait, no it doesn't. (This is not directed at anyone in particular but at the US culture as a whole)

That is not the USA model- at least not yet but I do believe it is the European model. So I would love to discuss your thoughts that led to this statement. Sure there is a segment of the population (large one probably) that wants everything for nothing and feel very entitled to it but you tend to see that in socialistic regimes.

 

[kenny]

I also agree we cannot eliminate health insurance. Kenny, your example doesn't work if people become chronically ill or have a much more expensive catastrophe/health issue. Going bankrupt from medical expenses is one of the largest causes of bankruptcy I believe. For uninsured people.

If we eliminated the health insurance industry and each person got health service like we now get fire and police protection the person with an expensive illness would still get full proper care, the cost of which be offset by the many who never get sick - just like the current insurance industry, and just like how most people's home never burn down.

 

[Missy]

I also agree we cannot eliminate health insurance. Kenny, your example doesn't work if people become chronically ill or have a much more expensive catastrophe/health issue. Going bankrupt from medical expenses is one of the largest causes of bankruptcy I believe. For uninsured people.

If we eliminated the health insurance industry and each person got health service like we now get fire and police protection the person with an expensive illness would still get full proper care, the cost of which be offset by the many who never get sick - just like the current insurance industry, and just like how most people's home never burn down.

That means you want health care to be paid though our taxes, is that right? Our taxes would go up to 80% to do that. We are an aging population which means more health care will be necessary as one gets older and I fear bad things would happen if we tried to go this way. Like the hospital saying oh no Mr. Smith- you are too old for that expensive life saving surgery. Our system is overloaded and your age presents too great a risk to spend that money. Plus we don't have enough qualified doctors now that they are paid through the government.

ETA: no offense to anyone whose government might operate on this model btw. Just posing a scenario to Kenny as to why that might not be the best option. I have friends in different countries who actually have had family members come here to have what was deemed by their country as not urgent surgery which in fact really was.

 

[Maria D]

That means you want health care to be paid though our taxes, is that right? Our taxes would go up to 80% to do that. We are an aging population which means more health care will be necessary as one gets older and I fear bad things would happen if we tried to go this way. Like the hospital saying oh no Mr. Smith- you are too old for that expensive life saving surgery. Our system is overloaded and your age presents too great a risk to spend that money. Plus we don't have enough qualified doctors now that they are paid through the government.

ETA: no offense to anyone whose government might operate on this model btw. Just posing a scenario to Kenny as to why that might not be the best option. I have friends in different countries who actually have had family members come here to have what was deemed by their country as not urgent surgery which in fact really was.

Missy, I'm wondering where you are from? What country doesn't have enough qualified doctors now that they are paid through the government? Also, are you saying US taxes would have to go up to 80%? Where is that number coming from? Just curious....

 

[Missy]

That means you want health care to be paid though our taxes, is that right? Our taxes would go up to 80% to do that. We are an aging population which means more health care will be necessary as one gets older and I fear bad things would happen if we tried to go this way. Like the hospital saying oh no Mr. Smith- you are too old for that expensive life saving surgery. Our system is overloaded and your age presents too great a risk to spend that money. Plus we don't have enough qualified doctors now that they are paid through the government.

ETA: no offense to anyone whose government might operate on this model btw. Just posing a scenario to Kenny as to why that might not be the best option. I have friends in different countries who actually have had family members come here to have what was deemed by their country as not urgent surgery which in fact really was.

Missy, I'm wondering where you are from? What country doesn't have enough qualified doctors now that they are paid through the government? Also, are you saying US taxes would have to go up to 80%? Where is that number coming from? Just curious....

Maria, forgive me as I was just making numbers and scenarios up to pose potential problems with Kenny's solution. As for the number of qualified doctors again, I was posing a potential side effect (for the USA) of this "solution". If there was an easy solution I think we would be there by now. There is no perfect health care model. Ours (USA) needs fixing for sure but I certainly don't think other countries have the problem solved by any means.

I hate to name specific countries but my friends are from Canada and England and they came here for surgery because the waiting list was too long in their country. (And I know of other people/situations where this happened though not firsthand). You decide what that means.

 

[LAJennifer]

I also agree we cannot eliminate health insurance. Kenny, your example doesn't work if people become chronically ill or have a much more expensive catastrophe/health issue. Going bankrupt from medical expenses is one of the largest causes of bankruptcy I believe. For uninsured people.

If we eliminated the health insurance industry and each person got health service like we now get fire and police protection the person with an expensive illness would still get full proper care, the cost of which be offset by the many who never get sick - just like the current insurance industry, and just like how most people's home never burn down.

I think this is worth considering. Medicare for everyone. Our current system already provides healthcare (at public expense) to the two most expensive healthcare risks - the elderly and the poor. Since insurance is based on spreading risk through the entire population, there has to be some way that this can work.

 

[packrat]

Wow, that's crazy Kenny! I can see it happening tho, just based on my experiences working for Dr. almost 8 years. The office has 3 providers-Dr. and two ARNP's. There is so much crap required now for billing/insurance/etc etc, it's unreal. For three providers, we should have had 6 full time staff just to work front desk and transcription. Six. (didn't, and that's why everyone was so behind all the time) Add in another 4 full time for nursing/lab staff. Especially this last year, it seemed like every time I came to work on Wednesday there was another email about new things we had to do, forms the pt needed to fill out over and over, forms we had to print each and every visit..and it took about 47 clicks just to get to form to print-NIGHTMARE. If they're Medicaid, we had to call the hotline to make sure they're eligible, every-single-visit. Even if they'd just been seen 3 days ago. Patient's don't understand all the extra stuff, forms to fill out, forms to wait for etc, so every single time it's minutes spent explaining over and over..it's a circus/zoo/cluster f*. So, yeah, I can totally see Dr's getting fed up and doing what your Dr. did. The Dr and both ARNP's would have to see many many pts each an hour to cover everything-payroll, insurances, taxes, equipment etc..and the computer program used, when I found out the cost of that I about fell off my chair. It's sad.

 

[rocks]

Not. Another trend in high cost urban/suburban areas is doctors opting out of medicare. The reimbursements simply aren't adequate to run a practice when you consider the cost of malpractice insurance, permitting, waste disposal, sanitization, general overhead, staff, facilities (either rent or mortgage, utilities, plus real estate taxes). My husband pays more in real estate taxes alone than many people earn in a year, and that is for a small office on long island. Doctors actually take home a very small fraction of what is collected. This is lost on most people. And still, judgement abounds.

I can't even think about wearing much of my jewelry when I am in his office....patients all want to know what they paid for. Forget about the fact that we are both ivy leaguers, and I have an MBA from a top program....and a job. And, our insurance premiums are obscene, we are both healthy, and we wouldn't consider going without....

 

[kenny]

Missy, aaaaaaaaaaaaalllllllllllll the money that pays every salary, benefits, building leases CEO's golden parachutes, stockholders for the health industry is factored into YOUR insurance premiums.
Perhaps you have a job where you don't see it.


ALL that money is wasted.

 

[kenny]

Missy, aaaaaaaaaaaaalllllllllllll the money that pays every salary, benefits, building leases CEO's golden parachutes, stockholders for the health industry, and HUGE legal fees to protect insurance company's profits, is factored into YOUR insurance premiums.

Perhaps you have a job where you don't notice it, but without your employer having to pay it your take home pay would be higher.

ALL that money is wasted.
Down the toilet.

 

[Maria D]

That means you want health care to be paid though our taxes, is that right? Our taxes would go up to 80% to do that. We are an aging population which means more health care will be necessary as one gets older and I fear bad things would happen if we tried to go this way. Like the hospital saying oh no Mr. Smith- you are too old for that expensive life saving surgery. Our system is overloaded and your age presents too great a risk to spend that money. Plus we don't have enough qualified doctors now that they are paid through the government.

ETA: no offense to anyone whose government might operate on this model btw. Just posing a scenario to Kenny as to why that might not be the best option. I have friends in different countries who actually have had family members come here to have what was deemed by their country as not urgent surgery which in fact really was.

Missy, I'm wondering where you are from? What country doesn't have enough qualified doctors now that they are paid through the government? Also, are you saying US taxes would have to go up to 80%? Where is that number coming from? Just curious....

Maria, forgive me as I was just making numbers and scenarios up to pose potential problems with Kenny's solution. As for the number of qualified doctors again, I was posing a potential side effect (for the USA) of this "solution". If there was an easy solution I think we would be there by now. There is no perfect health care model. Ours (USA) needs fixing for sure but I certainly don't think other countries have the problem solved by any means.

I hate to name specific countries but my friends are from Canada and England and they came here for surgery because the waiting list was too long in their country. (And I know of other people/situations where this happened though not firsthand). You decide what that means.

OK, thanks, I didn't realize you were just making scenarios up.

When I lived and worked in Canada in the 90s (for six years) I did not meet anyone whose health suffered from having to wait for surgery. Quite the contrary, people enjoyed better health and health care there than we do here.

 

[justginger]

Taxes increasing to 80%, missy? I think you're pulling numbers from the ether. I currently pay 22% taxes in Oz and get about 60-70% reimbursement through Medicare. I do not know a SINGLE person who has left here for treatment in the States. Alternativey, I have dealt with patients (indirectly) that have come here from the States so they could afford treatment. Kenny may well do the same thing now that he is uninsured - treatment and a holiday for less than a year's insurance premiums in the States!

 

[Lady_Disdain]

Also, countries that have universal health don't ban private care, either. In most countries I know, you can always choose to pay for treatment as an individual, bypassing lines or getting treatment that isn't usually offered. My primary doctor works half the week in a public hospital and half the week in his clinic.

 

[Imdanny]

That is silly! Just plain silly!

I went to my doctor, well now ex doctor for migraines. The first ten minutes were about my migraines and he prescribed me medication. The next hour and twenty minutes was about his war stories and his son going off to college. Everytime I tried to leave, he would start a new story. When the insurance bill came, I got charged for three separate office visits. He talked about his freaking war stories!!

Omg.

 

[Imdanny]

When I talked to my doctor yesterday I told him the insurance statement says the hospital charged $117,000 for my operation last year, but my insurance company's contracted rate was $20,000 which is all my insurance company paid.

My doctor responded, if I was a cash customer with no insurance (and was informed and smart enough to negotiate) I would have been able to negotiate that $20,000 rate with the hospital.

Reminds me of Larry Fines statement ...something like ... the exact same piano can sell on the same day in the same showroom to two different customers, and one price will be double the other.

That $950 monthly premium adds up to $11,400 a year.
That could pay for lots of medical care for an uninsured patient who negotiates.
The money I'm saving by not being insured for two years could have paid for my operation last year.

Larry, you're smart to be not insured if you have the resources to pay for your own care, come what may.

I hate insurance.
The entire health insurance needs to be entirely elimated.

You don't pay insurance for police or fire protection and shouldn't for health care.
Trillions of YOUR dollars are wasted by the existence of this scam-industry.

Pay the doctors, nurses and hospitals the same way we now pay the police and fire department, with tax dollars.
By eliminating the trillion$$$$$$$$ consumed health insurance industry your taxes will go up by less than what insurance costs us now.

You know I agree wholeheartedly with your last paragraph but are you sure you don't want health insurance?! Obviously you are a savvy consumer but the health care system is whack. You could be putting your assets at risk every last one of them. This is quite alarming news. And your doctor is an *******. My smallest violin. I'm sure he has credit, a paid off house, and isn't hiking six miles and riding four buses to get to HIS medical appointments. Yet he cries and demands money for being special AND drops patients after 20 years when they won't pay up. Doctored aren't treated as well as they used to be particularly GPs but I'm sure he's not living a life of hardship. What a jerk. I'm sorry.