Would I Quit?

I love being a doctor.  I like my patients (most of them), and have had a pretty good career.  One of the things I say to my older patients is that I want to keep them well enough so I can see them at my retirement party.  I just turned 48, so that would be 17 years… give or take.

Given what I have been reading lately, the \”takes\” may be getting the edge on the \”gives.\”  Apparently the department of justice and the FTC are getting active in the scrutiny of doctors.  From the Christian Science Monitor (via Dr. Wes):

This case is a watershed for two reasons:

First, until now the Federal Trade Commission, not the Justice Department, has taken the lead in prosecuting physicians. Since 2000, the FTC has brought about three dozen cases against physicians (all but one of which settled without any trial). But the FTC only has civil and administrative jurisdiction; the Antitrust Division has civil and criminal jurisdiction. The Sherman Act makes no distinction between civil and criminal “price fixing,” so in a case like this, it’s entirely a matter of prosecutorial discretion whether to charge the doctors with a civil or criminal offense.

Based on the descriptions in the Antitrust Division’s press release, there’s certainly no reason they couldn’t have prosecuted the doctors criminally and insisted upon prison sentences — and there’s little doubt such threats were made or implied to obtain the physicians’ agreement to the proposed “settlement.”

The second reason this is a landmark case is that the Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.” (Emphasis by Dr. Wes)

The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices,” in the form of the Idaho Industrial Commission’s fee schedule. The IIC administers the state’s worker compensation system and is composed of three commissioners appointed by the governor. This isn’t a quasi-private or semi-private entity. It’s a purely government operation.

What’s more, the Antitrust Division has linked a refusal to accept government price controls with a refusal to accept a “private” insurance company’s contract offer. This lives little doubt that antitrust regulators consider insurance party contracts the equivalent of government price controls — and physicians and patients have no choice but to accept them.

I must confess that my ADD makes reading legalese impossible (with out the use of a triple Ritalin latte), but the implication of this seems to be that I will be forced to accept what Medicare pays, and that contracts based on Medicare rates will follow suit.  I have also heard it told that lawmakers are considering making acceptance of Medicare a requirement for licensure.

This makes me ask the question: what would it take to make me quit practice?

Let me emphasize that when it comes to job satisfaction among PCP\’s, I am at least in the top 25%, if not 10%.  When people ask me if I would recommend medicine, I enthusiastically say I would.  At least I have in the past.  I love the job – I don\’t think there are many better.  But given the very small margins we work by in primary care, I am terrified by these possibilities.  I am a small businessman (no, I am not small; my business is small) who is providing a service and charging for it.  I get dragged around with a hook in my mouth by insurance companies and by government payors, but I do so by choice.  I stay in it, but I always know I can dump them if I choose.

These actions would change everything.  I don\’t know why people would do one of the most taxing and responsibility intense jobs with the government forcing me to do it cheaply.  It makes me furious.  It makes me terrified.  It makes me consider studying homeopathy and selling herbs for huge profits.  OK, not the last one, but the non-regulated nature of the CAM providers makes me envy their control.  Yes, I am actually starting to envy CAM providers.

I am sure I am not alone in this.  I go home tired every day – emotionally drawn out by the emotional energy of propping up people\’s lives, comforting their pain, and working to help heal them.  It\’s a very draining job, but it is also very rewarding.  If primary care doctors are not allowed to be payed in accordance to their true value (the ones who actually save money for the system), the healthcare industry will be in deep trouble.  The patients would be in deep trouble.

Yo, politicians: we are dangling out here.  You are playing political chicken with our futures with the whole SGR issue, but so far you haven\’t scared me off.  We are having the weight of reducing cost put on our backs and are then we may forced to eat the gruel HHS serves out.  Don\’t do it.  We are not evil.  We are not in a conspiracy to steal money from the government.  It\’s not about my Lexus (I drive a used Honda).  It\’s not about my golfing holidays (I don\’t own clubs).  It\’s not about a cushy retirement (I won\’t go there, but let\’s just say that I have a lot of work to do in that area).  It\’s about whether or not I will be around for my retirement party in 17 years.

I may just be selling herbs.

10 thoughts on “Would I Quit?”

  1. Happy belated birthday, Dr. Rob! And happy fourth blog anniversary!
    When I'm in a group and someone is complaining about their aches and pains, I tend to sympathize briefly, then sidle off and hope I don't have to sit next to them at dinner. You and your fellow docs have to listen to that over and over,day after day, then fill out mounds of paperwork whilst listening to politicians trying to convince everyone that you aren't worth paying a living wage. Sometimes I wonder why any of you even bother trying. I guess it's that silly notion about helping your fellow man, huh? Thanks for all you do! (And by the way, I also thanked my primary care physician last time I was in. She's one of the good ones and I wanted her to know that)

  2. It's blatantly obvious that you love your job, and I want to thank you for your dedication to the profession. It's going to take a lot to bring us down, huh?

  3. I am sorry to see that doctors are also being dragged down the conveyor belt of public opinion and politicians to be ground by the wheels of mediocrity.
    As a public school teacher in Florida, I'm right there with you.
    It is hard to sustain passion for a job you love when your life is oozing away as you are slowly crushed by stone after stone of government regulation.

  4. That does not change the threat of being forced to accept Medicare. That is my big fear. If we are not able to say no to contracts that lose us money, I will really think about quitting.

  5. I am so sorry about this Rob. It scares me as a patient too. It's just so wrong.

    Can't you all unite and lobby against this?

    It will be a huge loss if fine quality docs such as yourself are forced out!

    The people behind these decisions should have these decisions made for their careers in some comparative way. What is wrong with them anyway???!

    It's like they don't have a clue ..or care and certainly are incapable of seeing the larger picture.

  6. Dear Seaspray, we have already tried that already. The AMA has been pretty ineffective in this sphere, although has some effect in selective areas. Unite? While we all bitch about it, we disagree on many things, one of which is 'does the AMA represent doctors?” We have multiple specialty societies. Truth be known most of us are very busy, and exhausted by the end of the day…we'd rather be with our families. So some of us fight for the rights of our patients. But in the end it is up to our patients and the citizens of our country to defend physicians…

  7. Instead of selling herbs you should employ a few nurse practitioners or physicians assistants (maybe many) and expand the business to multiple locations. This is a whole other topic, but it seems that primary care is moving in the direction of mid-level providers?

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