Doctors Gone Broke

        The headlines were splashed all over the Internet this weekend. Doctors, esp in Family Practice and General Surgery, are going broke. What amazes me is that anyone is surprised. This trend began decades ago and the end result was predicted by most of us in the trenches. No one paid us any heed. In the end the perpetuation of big biz mis-truths only served to enrich insurance executives and empower elected officials. It was a mistake. Try to get help from them if you have a belly-ache.

        I am old enough to remember when “managed care” came to town. At that time some touted a no co-pay plan. I was one of the very last docs  to sign on. “But we can see you for free,’  some patients said.

        “Don’t you understand what they are doing?” I asked. They are like Potter in ‘A Wonderful Life.’ They aren’t selling you anything; they are buying. They are buying you all up in mass. Once they have you they can do anything with you they wish. You’re not going to like having to beg them for your medical care in a decade.”

        I also predicted co-pays would soon exceed our office visit charge at the time. My nurses would witness to this fact. It didn’t take long. Soon co-pays exceeded our old office visit charge from just a few years prior. Where did the money go? As the headlines indicate it wasn’t to country docs. Insurance companies run ads on television that cost more than our entire annual office budget back in the early days. Many of their executives make more in a year than what a country doc could make for decades of sweat equity.

       The trend took hold though, and once I could plot out my demise on a graph I signed on too. It was that or run aground at the hands of rich and powerful people.

       I recall when I started practice. People said I would do well  because I was well-trained, did well on Boards, liked people, and I cared. A good friend of mine who had an MBA said, “In a decade that will not be enough. If you don’t have the right business connections you will not stay afloat.” He was right and I am glad I listened. I did my best to survive in a world that came to be dominated by money and power instead of patient’s needs.

        If you were stranded on a desert island and could have two kinds of  doctors, you should probably choose Family Practice and General Surgery. It wouldn’t be pretty, but they could handle about 80% of what comes in the door. Think about it. What other two would you want? How about Radiology and Dermatology?  You get my point.  I have nothing against any specialist. I can see thanks to modern ophthalmology and I am alive due to the efforts of my oncologist and his staff.

        Primary care and general surgery are not sexy or glamorous specialties in a silly celebrity oriented modern world and have been ignored to the brink of extinction. And the kids going into medicine understand. They face a lifetime of excessive regulation which strangles any hope for efficiency. They will be underpaid and  overworked for the foreseeable future. They are not dumb. When some mid level executive who is ABCDA can make three times a seasoned doctor’s salary it is discouraging.

        Oh well, the money/power people didn’t pay me any attention when I was young and healthy. Now that I’m old and sick I’m certain that won’t change. I have been at work on “Acquisition Syndrome” for a few years now, and it addresses many of these issues in real life practice. It is fiction, but as I’ve always said fiction should show the truth but tell no facts. It should be out this spring.

        I’ll be back soon to report on bluegrass. Maybe it’ll take over the world and make it a better place. Oh well. A man has to have his dreams.

Dr. B

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14 Comments on “Doctors Gone Broke”

  1. Dr. B, your story shows that there is NO SUCH THING as a Free Lunch or a “free” anything. Think twice, heck, think a dozen times before you accept something that is labeled “free.” Social security, though we pay in, is NOT free. I might be a little younger than you, but I know I will never see a dime of what I paid in. Likewise, Medicare and Medicaid – NOT free. Someone somewhere down the line pays for it. And think, you accept a “freebie” you will end up a slave to whomever gave it to you.

    I would rather pay a doctor a fee than go through insurance. If I get a flu shot through my doctor, it costs $45, because they have my insurance info. If I go through Sam’s Club, it’s $20. Eye surgeons and plastic surgeons usually don’t accept insurance (or can’t) – how is it they can survive?

    We are waiting on pins and needles with health insurance. We don’t go often. The premiums are climbing, as is the deductible ($10K). Co-pay? What’s that? We pay full freight, both for visits and prescriptions. Right now we can afford it, but what about after the law kicks in? We’re a super-small business, even though we have nearly 100 employees. Most are part time. We can’t afford to give them all health insurance. No one can.

    I am glad you’re not going broke; I keep my fingers crossed I can keep myself from it. Bottom line, I’ll be working til I drop dead. I’ll be worrying about my kids’ future and the future of their kids when they come. If this trend continues, there won’t be anything left.

    • drtombibey Says:


      You make excellent points (as writers often do!)

      I think part of it because the specialists do a small number of big things and we do so many little things. Each little lab test requires the same paperwork as a big procedure. It takes a lot of blood counts to bring in the same $$$ as one face-lift.

      But I must say I am only an expert in primary care, and have little understanding of how the system works for specialists.

      Dr. B

  2. Carolyn Brooks Says:

    Thank goodness for dreams, Dr. B. I remember Bill speaking of just the same types of things you have mentioned. Thank God for the medical professionals like you – & him – that did what they did because of their love of people & desire to help. Big business forces all to do what they have to do to survive – but it is not always for the better.

  3. jel Says:

    hey Doc.

    dreams are what keep us a going! 😉

    hope all is well your way!

    hope you and your better half have a super day 🙂

  4. June Says:

    I undersand you comment. The same can be said of education. The beaurocrats tell you what to teach, when to teach it – almost down to the day and hour – and how to teach it. It is very frustrating.

    On another note – my son Brad met your daughter at Lindy Focus. I didn’t know anyone from Harvey County had ever heard of Lindy Focus. Brad is an avid swing dancer.

    • drtombibey Says:


      I think it is even more true in education as has been going of for a longer period of time.

      Yeah, even though we grew up rural kids are worldly nowadays.

      Dr. B

  5. inkspeare Says:

    Wow, this is so true; sometimes it feels that when you need to go to the doctor, you have to go to your insurance first, since they run the show. 😦

  6. Martin Waddell Says:

    A slightly belated happy new year from Scotland, Dr T.

    Boy, am I glad I live in Scotland! Although our British National Health Service gets a lot of criticism for its bureaucracy and waste, at leat we know in this country that if we get sick, the health service is there to take care of us, paid for by taxation and free at the point of delivery. South of the border in England, the UK government is bringing in changes which are designed to make the English health service more similar to what you describe in your recent posting. But in Scotland, where we have our own government with responsibilty, that ain’t happening. Long may that remain so.

    Looking forward to “Acquisition Syndrome”.

    Best wishes,


  7. Mike Ribadeneyra Says:

    Amen. Thanks Dr. B.

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