On April 4,2021, KevinMD published, “No wonder patients detest our health care system, and doctors are leaving medicine in droves,” an article by Dr C Fratila. Dr. Fratilia addressed an issue that I have been writing about for years, the insurance companies ever-present quest for profits at everyone’s expense. In particular, her article deals with the ever-present demand for “PRIOR AUTHORIZATION” and its burden on the physician’s staff and resources.
Her solution is novel and something I tried many years ago. She has her patients become “voluntary” staff and has them deal with the insurance company’s outrageous demands. Who better to sit on hold for hours, listening to the insurers’ propaganda than the patient whose medication is not on formulary? Who better to plead the patient’s case than the patient? After all, the patient knows his/her history better than anyone. The patient knows the impact of not having his/her meds better than anyone, as well.
So, what’s the problem? Letting the patient deal with his/her insurer seems logical, right? The problem is that it doesn’t work. The patient eventually feels put upon and gets angry. Rather than venting his/her anger at the insurer, he/she vents it at the doc and the doc’s staff.
I’ve written about it before. Docs have been under fire for years. The ground they stand on has been undermined by the insurers. They have been demoted from the MD status of the past to their current position as providers, buried in regulations and paper work. Their journey into the pits has forced them into contracts they never wanted and employed positions in which they have ceded control of their practice to a cadre of administrators.
Despite all of the changes, they have persisted in their roles as patient defender and advocate. I know some of you are thinking that I’m out of touch with reality. Let me assure you, I am not. The reality is that docs try to defend you but can no longer do so. The insurers have won and docs are retiring at an alarming rate. Doctor suicide is at an all-time high! I loved my profession and miss it.
In actuality, my profession left me long before I retired. I maintained the position of doc with my long-term patients but was seen as provider to the newcomers. I fought with insurers daily. The fights were expensive both financially and emotionally. Ultimately, the insurers put me out of business. I became an employed provider. Amita was good to me. They gave me time to see my patients. Eventually, that would have changed. To earn a living wage, I would have needed to increase the number of patients seen per hour.
What can you do to help your new doc? Unfortunately, nothing! They are stuck in their role and you, in yours. I envision today’s medical complex as a puppet show: we are the puppets and the great puppeteer in the sky is the insurer.
One last thought. Concierge medicine is a way out for some of you. Unfortunately, many see it as the rich man’s escape. In reality, many of my concierge patients were middle income individuals who placed their health above all. I sure loved taking care of them. Their commitment to being healthy was admirable.
The long and the short of it is that I wish I could be back in LZFTC, seeing patients and fighting the good fight.
Here’s your jokes for the day:
They say that during sex you burn off as many calories as running eight miles. Who the hell runs eight miles in 30 seconds?
“Give it to me! Give it to me!” she yelled. “I’m so wet, give it to me now!” She could scream all she wanted, but I was keeping the umbrella.
“I bet you can’t tell me something that will make me both happy and sad at the same time,” a husband says to his wife. She thinks about it for a moment and then responds, “Your penis is bigger than your brother’s.”
