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
Here’s a link to the article:
Dr. Tom Bibey: Stories of the Bluegrass Music Road 