What are you going to do?

The following is an actual fictional conversation that took place in the doctor\’s lounge at a local hospital.
Internist – Dang, these Medicare cuts are coming and I doubt that congress has the wits to avoid them.  I am not sure I can go on practicing if they cut them any more.

Family Physician – Yeah, we already get paid so little by Medicaid and the private insurers, we have had to start to look for other sources of revenue.

Int – Really?  We have been looking into that as well.  What are you thinking about doing?

FP – We thought about doing cosmetic procedures, but we have an especially good-looking population, so we really can\’t make it work.

Int – Bummer.

FP – Yep.  Instead, we have decided to open a kiosk for Krispy Kreme donuts.  We figure we can make money off of the donuts, plus we can get more of our patients obese.  Then we can treat worse diseases and code a higher level for each visit.

\"670px-Krispy_Kreme_10\" Int – Genius.  Plus, you can get all of the kids hyperactive on the sugar and treat their ADHD.

FP – And the \”Hot Donuts Now\” sign along with the scent of fresh-baked donuts will really draw in new customers…I mean patients.

Int – One of the GI doctors in town is doing the same sort of thing, opening a Starbucks in his office.  He figures he gets walk-ins, gets people with worse dyspepsia, and gets free WiFi to boot.

FP – Brilliant.  What have you been thinking of?

Int – We have noticed the interest our patients have in holistic medicine, and thought we should capitalize on that.

FP – So you are hiring a homeopath?

Int – No, they wouldn\’t set foot in our office because of the \”evil\” immunizations we use.  We tried to get all sorts of alternative providers, but they would always sneer at our practices.  And so we finally opted for two things: first, we are doing aromatherapy, which has our staff so relaxed that they don\’t seem to have noticed that we cut their pay by 50%.

FP – Great.

\"psychic\" Int – Second, we have a psychic who goes around in our lobby doing palm reading and tea leaves on our patients as they wait.  There are two positive outcomes from this: the patients who get bad fortunes told are so anxious that their blood pressure is up and they are ripe for anxiety treatment; the ones with good fortunes are happy enough that we can order all sorts of tests on them and they don\’t seem to care.

There is a downside, however.

FP – What\’s that?

Int – My partner now thinks that we should take our entire budget for next month and invest it in Power Ball lottery tickets.  He says it is a \”sure thing.\”

Hospitalist – Hey guys, what\’s up?

FP – We\’re just discussing what we are going to do to offset the impending Medicare cuts.  Do you have plans?

Hos – Oh yes.  I don\’t like the idea of increasing the load to 70 admissions per day.  50 is plenty.  Instead, we are capitalizing on the fact that our patients are a \”captive audience.\”

Int – This I\’ve gotta hear.

Hos – We figured that we have enough turnover that some sort of direct marketing scheme to our patients could be quite lucrative.  We are now certified Amway sales representatives.

FP – I love it!

\"imgabout01\"

Hos – Yep.  We have these patients in a position where they can\’t move, and we sell them cleaning solvents, vitamins, and skin care products.  Instead of taking cash, we just add it on to their hospital bill, so they usually buy a bunch.

Int – As an added bonus, the families of your patients will be so scared that you will try to sell them Amway products, that they steer completely clear of the hospital.

Hos – Bingo!  It works like a charm.  We got this idea from the intensivists who were holding Tupperware parties in the ICU.  The patients were sedated \”just enough\” so that they left the hospital with all sorts of cups, jugs, and bowls.

FP – Any complaints?

Hos – Not yet.  You figure, what we charge for the solvents is 1/4 of what the hospital charges for an Aspirin.  The patients really don\’t notice a little more charge.  We have even had some insurances mistakenly pay for some of our Amway products!

Int – You know, maybe this Medicare cut may just be a good thing.  Look at how it has pushed us to open new frontiers in medicine.  Our children will look back on this time as being one of the real turning-points in American healthcare.

FP – Yeah, today Amway…tomorrow….

Hos – Healthcare reform?  Higher reimbursement?  A fair payment model?

FP – Used Cars.

Int – I am so glad I went into medicine.

25 thoughts on “What are you going to do?”

  1. “You know, maybe this Medicare cut may just be a good thing. Look at how it has pushed us to open new frontiers in medicine.” Ha! Funny stuff–in a disturbing sort of way. 🙂
    Leigh Ann Hubbard
    Managing Editor
    James Hubbard’s My Family Doctor

  2. “You know, maybe this Medicare cut may just be a good thing. Look at how it has pushed us to open new frontiers in medicine.” Ha! Funny stuff–in a disturbing sort of way. 🙂
    Leigh Ann Hubbard
    Managing Editor
    James Hubbard’s My Family Doctor

  3. Here in California we not only face medicare cuts, but also medi-cal cuts, or cut-offs.I have given serious thoughts to filing a chapter 7, or 11. Its’ a great deal, espcially if you are older…A lot of other businesses do it all the time….have a liquidation sale! You can also probably write off the losses. There is no shame in telling your community that’s it…… Think about it….no more committee meetings,no peer review, no more prior authorizations, no more petty jealousies by primary care docs, no more malpractice premiums…..no more CME expenses, no more society dues to CMA,AMA,county, no more drug reps….
    There are several more options. Put a collection plate at the reception window.
    “in lieu of copayments, please donate to my family, they need to eat”

    Let’s face it, we almost have no control over our financial future….why should we worry about the health of our patients….the insurance companies, corporate money does not,
    i get a headache about what I am going to do about it…there is no real cure and why should we worry about it.
    Find another source of income….I live near a MacDonald’s restaurant and they are hiring. I see a lot of second career folks there, and a lot of cum laude ROP graduates……You could work your way up to regional manager very quickly. I have an application pending, and if I am hired I will give you a recommendation.

    Think about it….you could just sleep in…ride your bike, sell one of your cars, stop shopping at Nordstroms, Bloomingddales, no more mall trips, cancel your cell phone accounts, internet, cable, downsize your living space….

    No, I am fed up with others causing my problems. You see they know we are dedicated, and stupid….we are trained to shut up, not complain and carry on, because we ‘CARE SO MUCH ABOUT OUR PATIENTS’

    There are about 700,000 of us taking care of 300 million people in the U.S.
    Do the math! Frankly this is a bunch B-S. Fire all the folks who are not delivering health care and pushing pencils or keyboards. Then there will be more money for patient care.

  4. Here in California we not only face medicare cuts, but also medi-cal cuts, or cut-offs.I have given serious thoughts to filing a chapter 7, or 11. Its’ a great deal, espcially if you are older…A lot of other businesses do it all the time….have a liquidation sale! You can also probably write off the losses. There is no shame in telling your community that’s it…… Think about it….no more committee meetings,no peer review, no more prior authorizations, no more petty jealousies by primary care docs, no more malpractice premiums…..no more CME expenses, no more society dues to CMA,AMA,county, no more drug reps….
    There are several more options. Put a collection plate at the reception window.
    “in lieu of copayments, please donate to my family, they need to eat”

    Let’s face it, we almost have no control over our financial future….why should we worry about the health of our patients….the insurance companies, corporate money does not,
    i get a headache about what I am going to do about it…there is no real cure and why should we worry about it.
    Find another source of income….I live near a MacDonald’s restaurant and they are hiring. I see a lot of second career folks there, and a lot of cum laude ROP graduates……You could work your way up to regional manager very quickly. I have an application pending, and if I am hired I will give you a recommendation.

    Think about it….you could just sleep in…ride your bike, sell one of your cars, stop shopping at Nordstroms, Bloomingddales, no more mall trips, cancel your cell phone accounts, internet, cable, downsize your living space….

    No, I am fed up with others causing my problems. You see they know we are dedicated, and stupid….we are trained to shut up, not complain and carry on, because we ‘CARE SO MUCH ABOUT OUR PATIENTS’

    There are about 700,000 of us taking care of 300 million people in the U.S.
    Do the math! Frankly this is a bunch B-S. Fire all the folks who are not delivering health care and pushing pencils or keyboards. Then there will be more money for patient care.

  5. Very poignant post, Dr. Rob. I suspect more PCPs will go the route of my own – micropractice, cash-only businesses.

  6. Very poignant post, Dr. Rob. I suspect more PCPs will go the route of my own – micropractice, cash-only businesses.

  7. Hello! I am a second year medical student at the University of Virginia. I am doing a research project this summer on blogs maintained by medical students and physicians and I have really enjoyed reading yours! I wanted to let you know about an online journal at UVA called Hospital Drive, which can be found at http://hospitaldrive.med.virginia.edu/ . I think you and your readers would really enjoy reading and perhaps even submitting material to the journal. Happy Reading!

  8. Hello! I am a second year medical student at the University of Virginia. I am doing a research project this summer on blogs maintained by medical students and physicians and I have really enjoyed reading yours! I wanted to let you know about an online journal at UVA called Hospital Drive, which can be found at http://hospitaldrive.med.virginia.edu/ . I think you and your readers would really enjoy reading and perhaps even submitting material to the journal. Happy Reading!

  9. It is fictional. I just put that there to be goofy.
    Gary: It is a good thing you don’t have strong emotions on the issue.

  10. It is fictional. I just put that there to be goofy.
    Gary: It is a good thing you don’t have strong emotions on the issue.

  11. i laughed, i cried…the summer’s most hilarious, no–depressing, no–hilarious dialogue comes from a sleeper of a blog!
    i was thinking of opening up a little boutique in the waiting room–postcards, snacks, t-shirts, shot glasses. and then, out the back, a bed and breakfast for those driving in from out of town.

  12. i laughed, i cried…the summer’s most hilarious, no–depressing, no–hilarious dialogue comes from a sleeper of a blog!
    i was thinking of opening up a little boutique in the waiting room–postcards, snacks, t-shirts, shot glasses. and then, out the back, a bed and breakfast for those driving in from out of town.

  13. Rob, I am feeling much better now….took my Lithium, Paxil, and did my monthlly anger management session….Ready to go again….Got my botox and restylane syringes fiiled up and all the cosmetic lasers are humming….they are energy star compliant…..gary

  14. Rob, I am feeling much better now….took my Lithium, Paxil, and did my monthlly anger management session….Ready to go again….Got my botox and restylane syringes fiiled up and all the cosmetic lasers are humming….they are energy star compliant…..gary

  15. I know this was meant to be funny an it was. except, my folks really did have a PCP who sold Amway products right out of his office. Old doc. B. would have you leave his office with a half gallon of aloe vera juice almost every time you went to him. At check out you paid cash for the Amway products you bought. he had my mom swearing that Amway was the new wave in medicine. Don’t you know everything can be cured by a little aloe vera juice? I think he still sells Amway. Where you been? He has been on to it for a long time…:)

  16. I know this was meant to be funny an it was. except, my folks really did have a PCP who sold Amway products right out of his office. Old doc. B. would have you leave his office with a half gallon of aloe vera juice almost every time you went to him. At check out you paid cash for the Amway products you bought. he had my mom swearing that Amway was the new wave in medicine. Don’t you know everything can be cured by a little aloe vera juice? I think he still sells Amway. Where you been? He has been on to it for a long time…:)

  17. The Covert Rationing Blog » Blog Archive » Medical Grand Rounds, Vol 4, No. 41

    […] maintained that PCPs need to think outside the box in order to salvage their profession, and in What are You Going to Do? Rob demonstrates thinking that is, uh, way outside the […]

Comments are closed.