As a physician, I find myself awake at night – concerned not about a patient but rather all patients and about the future of medicine. I recognize fully that the rising cost of health care requires that there be modifications to the system and ways to reach those without access to care. The bills currently being debated in Congress are on balance very bad medicine that puts health care at risk in the near and more distant future.
I have had the great good fortune to practice medicine in my hometown in a long-established private practice of three doctors. I love caring for patients. However, I am not only a doctor – I’m also a small-business owner. I contribute to my community’s financial health with more than a dozen employees. I have faced an environment of flat or decreased payment for services at a time when the cost to run our practice increases 10 percent to 20 percent a year due to government mandates and increasing requirements. In order to keep the “business” of my medical practice viable, I’ve continued to see more patients each day and stretch everywhere I can.
The current health reform bill proposes structures and regulations that will push those of us running medical practices beyond the over-stressed levels in which we already practice each day. One of our concerns is the Independent Physician Advisory Board. While this may sound like a “reasonable” idea by its title, it is not. It is an appointed group of 15 individuals who would be creating all future payment methodologies without congressional approval or public accountability. This single change puts the future of a physician’s ability to run a practice at risk, and removes the balance of democracy that our wise forefathers laid out. And, due to a political side deal with the White House, hospitals will be exempt from this change.
The bill also contains a provision to penalize doctors who order more tests than average. That means that, as a doctor, you would be penalized for taking care of those who require more time and more care – the sickest patients. That just seems more than wrong.
Health care policy is too important to legislate behind closed doors and load up with sweetheart deals .
I can sadly predict that if this bill becomes law, in a few years it is likely many private practices will close. I would likely be forced to consider leaving my hometown and home state. Practicing here, I bear the burden of being in a high-tax state that is unfriendly to employers like me, with more regulation and lower payments than many other regions of the country.
California will also be forced to take on a tremendous Medicaid burden to meet the bill’s requirements. To meet those, the California Legislature will be forced to cut education, transportation, and so much more. As a result, there will be a continued outflow of physicians from our state and a dismal ability to attract new physicians to care for Californians.
In case you doubt this prediction, you need look no further than MediCal – where physicians may be paid $13 to see a patient. At that rate, with overhead costs exceeding $50 per appointment, and even taking no wages for the physician’s time, a physician loses roughly $40 for every patient seen. You can’t make that up in volume.
I agree that changes need to be made. This bill is the wrong way to do it.
Be bold, stand tall, and just say “No.” The future of the physician-patient relationship and our ability to care for patients depends on it. I believe history will look back at those who were bold and believed there was a better way to do it and commend them for having the courage to say that more time is needed to make the necessary improvements in our health care system.