Ship of Fools...

Tomorrow is Match Day.  It's the day that 16,000 US medical school graduates will find out where they will be completing their medical training in residency programs across the country.  Tomorrow is also Doomsday for the health care industry... or so some say.

Let's think about what's underlying all the hype;  everyone should have health care coverage.  I agree, everyone should be able to afford health care insurance.  If you're under the socialist model, if you work you have health insurance.  You go to a state-sponsored clinic, show your worker's card, and get your basic medical care.  As for those 16,000 graduates, they would all be working at those clinics in return for having had free medical tuition.  They complete their mandatory one to two years of service then go off to specialize in their desired fields.  They don't have to worry about an average $150,000 in medical school debt.

But, our 16,000 new graduates do.  They have to face a health care system that is paying less and less for state-sponsored medical plans.  So much so, that many physicians won't see those patients.  I've been told we get paid $19 for a Medicare patient.  That's for an E.D. visit.  My insurance co-pay (so I found out one day due to an allergic reaction) is $50.  A family medicine physician gets about $9 for a Medicare patient.  Our insurance co-pay for an office visit is $20.

Now, before everyone gets all huffy about those "poor rich doctors who just want to make a bunch of money" let's take into account the price of practicing medicine.  I have no qualms saying my medical school debt is over $200,000, and I don't have undergraduate loans like many of my colleagues do.  If I went into primary care I would have to join a group, that rents an office, pays utilities, rents their medical equipment, buys office and medical supplies for their office, has to pay a billing specialist, a medical assistance, several nurses, and not to mention their own salaries.  Most practices are also adding physician-extenders like nurse practioners and physician's assistants to handle the work-load.  The more patients you see, the more money you make.  And, several of the larger  hospital-based groups have set R-something-U (Reimbursement something Units) that they have to meet.

So, you have to see more patients to bring money into your group to cover your expenses.  You're under pressure to "perform" or risk losing your job.  And, the government is paying less for the patients that are under their programs.  I am sure those 16,000 graduates-to-be would like to live their American Dream having worked toward it for the last 8 years and who are now getting ready to dedicate another 3+ years toward.  Maybe that's why recent articles in the Associated Press, Journal of the American Medical Association, and USA Today show that only 2 - 9% of graduates are going to go into primary care.

Given a generous 10%, that's 1600 graduates to be mostly spread around the lower 48 states.  So, on average each state will get about 33 new primary care doctors.  Of course, the more popular states like California and New York will get a bigger share of those, and less popular states will get the leftovers.  Ever wonder why there are so many foreign-born doctors in some areas...?  They fill the spots left open where there is still need.

Ever wonder why you can't get in to see your doctor?  Wonder why it takes several hours for a 10 minute appointment?  Well, that's part of the reason.  So, I get the overflow in the E.D.  A large percentage of the time when I ask a patient why they didn't go their own doctor it was because of a 2, 3, sometimes 4 week wait for an appointment.  Or, as one patient told me, they did go but after waiting 5 hours they left.

Now, let's pass a bill that's going to make insurance mandatory for everyone.  Let's flood the system with new patients who suddenly have the means to see a doctor.  There's a shortage of primary care physicians because reimbursement is so low.  And, I sincerely doubt that any federal program is going to pay much more than is currently being paid.  So, my business is going to go up.  However, in some parts of Los Angeles there's no E.D. to go to because they're closed due to budget constraints.  Small clinics are going to have to close down.  Everyone will have health care but there will be no where to go.

Also, from the grumblings I've heard, a lot of doctors are looking for alternative careers.  Just amoungst my med school colleagues I've heard of people practicing non-clinical medicine.  Many are saying they are thinking of working less hours to fall just under the $250,000 earnings line... remember that campaign promise that will probably actually be kept?  A friend of mine said, "Who wants to pay their patients to come see them?"  We pay the taxes that fund Medi-whatever State Care that is given to illegals, those on disability (don't even get me started on some of the bogus diagnoses that get a free ride), and many others who don't put a dime back into the system and then come in expecting everything.  As you can imagine that $19 doesn't even cover the cost of a chest x-ray.

So, at the risk of being long-winded, give doctors and teachers and police and firemen what they're worth.  If government is going to get into the business of medicine, make us all federal employees who will be eligible for our lifetime pensions when we turn 54.  You can't sue the federal government so we would no longer have to worry about tort reform.  Pay for our medical education and in return we will care for your huddled masses who came to this country to earn their American Dream.  They didn't expect anything to be handed to them... they expected to make money the Old Fashioned Way - they earned it.

Our 16,000 graduates-to-be have earned it... let's hope we give them a future that's worth it.

Ship of Fools - Grateful Dead

"Though I could not caution all, I still might warn a few:  

Don't lend your hand to raise no flag atop no ship of fools.  

Ship of fools on a cruel sea.  Ship of fools sail away from me."