I’ve been doing a lot of reading on health care policy and related things lately and I’m starting to get a little nervous…hopefully you can help me!
A trend I’ve noticed is that healthcare is becoming more “corporate” and profit-driven in nature and that physicians are having to spend more time dealing with billing issues and having to “justify” their existence by increasing “productivity” (i.e. running a patient mill, if you will 
) and that many physicians are leaving practice because of this. Having been an accountant, I’m very experienced with the “heartless” nature of business and changed professions because I couldn’t bring myself to function in that manner anymore. Now I’m getting a little worried that I’m jumping from the fire right back into the frying pan. I know business practices and am willing to work within them, however, I don’t want to be forced to make it my top priority or to have it negatively affect my ability to care for my patients.
Are there any opinions out there, any stories you can share, anything you can tell me about this trend and how it impacts your work. Are there any particular specialties or employment situations where this may not come into play as much? Thanks so much!
Hoo boy, this is a huge topic. Obviously you have to be concerned with the business aspect of medicine if you want to get paid for what you do. As for having it take over… well, there’s no question but that financial concerns are far more overt for physicians than they used to be. Doctors take home less because their overhead is so much more - and that overhead is generally in the form of personnel to help navigate the insurance world of referrals, phone calls, pre-authorization for services etc. etc.
At the family practice where I did my last rotation, they “ran the numbers” every day and informed each M.D. of how he or she had billed for the day before. Big numbers were definitely better than lower numbers. My preceptor got his report at the beginning of his work day. How did it influence his treatment of patients? Probably not much. If someone ended up being complicated and time-consuming, he gave them the time they needed. (though he might groan inwardly as he realized he’d get NO lunch time) He did admittedly do a happy dance when he’d see a kid with an ear infection on the schedule - almost guaranteed to be a short encounter!
And he told me that one reason he liked my notes so much was because I was so thorough that they were justified in billing at a higher intensity level. <!–emo&<_
The drive for productivity and the need to move patients in and out quickly is not motivated by greed, that is for sure. It’s because reimbursement is so low for many patient encounters that the only way to make ANY money - like, pay your staff! much less yourself - is to make sure you see enough patients in a day. Every primary care doc I’ve spoken with has a particular number in mind - “I have to see at least 15 / 20 / 25 patients a day.” This is a number figured out in consultation with their business staff or accountants.
Physicians are disheartened because they see more patients - spend less time with each of them - and yet bring in fewer dollars at the end of the day.
The system is in a horrible mess, groaning under its own weight and sure to collapse at some point. What will happen then? I don’t know. My own participation in this enterprise is a leap of faith that somehow I will be able to make a living and pay off my bills, AND most of the time derive satisfaction in the care I provide to patients. I have to be optimistic - or else why would I be here? 
Hey Jenni,
Not even being in med school I don’t have too much perspective. I did work for a 12 physician cardiology office for about a year, and remmember vividly how huge of a staff they had. They had a billing office with about 8 people, 4 full time nuclear techs, 6 treadmill techs, 2 echo techs, 10 med assistants (they roomed pts), 2 pacemaker techs (I was 1), 12 secretaries, 1 business mgr, 2 administrative assitants… The doc’s made $$$$ no doubt. They almost all drove Mercedes and BMWs that were leased for them by the practice and had big houses. Despite this some seemed unhappy more than they seemed happy and with the exception of one or two all seemed very stressed frequently. Their overhead was huge, money was always an issue at the monthly staff meeting, and the docs were often pitching fits when their ooms weren’t full and they didn’t have a patient to see right that instant. Maybe they were working too hard to drive those cars and pay for the houses?
On the other hand, I read the occasional story in physician practice journals or some medical groups(eg American Association of Family Practitioners…) website where a physician will take a gamble and open a practice without any staff. They do everything (make appointments, deal with insurance, room patients…). These docs make less money overall but they have very little overhead and they are in complete control of their lives.
Mary’s post was a very good one. She stated very succinctly (and I believe correctly) “The system is in a horrible mess, groaning under its own weight and sure to collapse at some point.” Some folks like the ones that rebel and do things their way are bucking the system and showing that there are better ways if you can think outside the box. This is the straw that I’m grasping as I continue to push forward in my attempt to be a Doc. Hopefully things will have hit their low point and will be on the way up by the time I’m practicing on my own. I know that this probably wasn’t to informative but hopefully it wasn’t a waste of time.