Today there will be no discussion of weight control, my insights, suggestions, recommendations etc. I wanted to post an entry about my personal insights into the changes in the healthcare environment I have seen evolve over the 35 years year I have practiced in Northern Virginia. The inspiration of this posting comes from my recent encounter with healthcare practices as a patient, not as a referring doctor.
When I left the U.S. Navy and opened my private medical practice in Northern Virginia 35 years ago, the overwhelming majority of physician practices were privately owned. There were solo doctors like me, small groups of 2-5 doctors and larger groups. Most specialists owned their own practices as well. Back in those days, when I would refer a patient for a specialty consultation such as GI, Cardiology, Orthopedics, Neurology etc, I would provide the patient the name/telephone number, the patient would book the appointment and in fairly short order the consultation took place. On rare occasions, patients would call me and state that they could not get an appointment in a timely manner. I would call the specialist’s office, ask to speak with the physician directly and the doctor would graciously find an earlier date to see the patient.
The first inklings of chance occurred when HMOs such as Kaiser appeared on the scene with a business model of “the less we do for patients, the more $$$ we make”. Patients enrolled in these HMOs would often become frustrated because they felt there were many barriers to seeing the doctors/types of specialists they wanted to. Many times, I would have new patients come to my practice that were HMO members and were willing to pay $$$ for a doctor outside the system.
The major changes in the healthcare arena were the ever-increasing pressure on private doctors to stay profitable as insurance companies kept cutting rates they would pay for visits and procedures. The enhanced requirements for billing and other administrative costs combined with lower reimbursements placed many doctors into very precarious financial conditions…as busy as they were seeing patients, their take home pays dropped significantly.
Enter large hospital chains (in our area INOVA and SENTARA): Purchasing doctors’ practices provided these large healthcare systems with a mechanism if ensuring that all consults, procedures, surgeries ( i.e. the higher paid services) would be contained in the system. If they “owned” the practices, their larger billing departments, higher purchase power and other financially beneficial conditions would allow for the lowering of overhead as well. Private practice doctors, suffering from financial pressures, were sold on: “Hey…you went to medical school to become a doctor, not a business person…we will take all of the administrative tasks off your plate and all you need to do is “be a doctor”. Well, sounded good but in reality, most of the doctors I speak to that are employed by hospitals are quite miserable. Their autonomy has been lost and most are playing out their time until they are able financially to retire.
The lastest chapter: Private Equity groups coming in and buying out specialty or primary care practices in certain areas: Pain clinics, orthopedics, cardiology and others. The PE groups “roll up” practices with the eventual goal of selling to a larger healthcare entity at a price much higher than what they bought the practices for. Once again, when a business owns a healthcare practice, the bottomline profit becomes a major focus. Doctors working in these systems tend to also not be very happy, work their 8-430 jobs and count the days until they can retire.
What does mean for all of us, as people and patients? I did not use the word “potential” before patients because all of us, at some point, will need medical care. My answer to this: Take all of the necessary steps you can to PREVENT yourself from needing to avail yourself of the healthcare system. Whether this refers to being more focused on your weight control, exercising more, going in for preventative checkups or other.
There will be occurrences that are unavoidable and will require you to ask for help. My advice: Be a strong advocate for yourself and do not be afraid to speak up loudly if you feel you are not being afforded the timely care you deserve AND are paying for with your high insurance premiums.
Long entry today…for the 1-3 people that took the time to read this today, thank you! (And by the way, the house call doctor days are not dead..I still make them.
I guess my post is a sort of “yesterday vs today” reality in medicine…but Yesterday’s song’s sometimes do not change in message from today…enjoy Neil Diamond.
