Monday, May 23, 2011

Doctors And Money

There is an interesting discussion over at the Kane Scrutiny blog at Medscape. The author asked the intriguing and relevant question, "Why aren't doctors allowed to care about money?" Lawyers are allowed to care about money. The partners of Goldman Sachs are allowed to care about money. But for doctors it is unseemly to think about it. The article has gotten thousands of reads and hundreds of written comments. Judging from the comments it is apparent there is a lot of anger and frustration in the medical community.

The responses fall into several categories. The doctors are to blame. We've been too passive as the government has rolled back reimbursement for our critical services. Doctors somehow have equated stagnant reimbursements and wages in an era of high medical cost inflation as a victory. We've allowed the insurance companies to lull our patients into thinking they shouldn't have to pay for anything, even the copays. While other important services from plumbers to lawyers to car repairmen have demanded cash on the spot, we doctors somehow have been talked into providing our work first and asking for money later. Does that even make sense? There are also too many doctors that make headlines for defrauding the public. Thus there is little sympathy for the plight of the majority of doctors among the public.

Perhaps the patients are to blame. They resent us. They hate us because even the lowest paid medical field earns two to three times more than the average salary in the United States. They don't understand us. They never take into consideration all the late night and weekend hours we spend taking care of patients and the administrative hassles that are required to get paid for doing it. Patients also never think about, or don't care about, the years of sacrifice doctors go through to get their medical degrees and the debt that comes with getting one. They don't want to hear from whiny doctors.

The government is to blame. It only cares about getting itself reelected. But doctors don't contribute nearly as much money to political action committees as the lawyers, insurance companies, or banks. Is it any wonder they pay scant attention to the needs of physicians? We are also too uninvolved with matters involving our own needs. The teachers union in Wisconsin can shut down their state government for weeks with massive protests all because they are being asked to pay a few percentage more on their health care benefits. Yet doctors continue to work like whipped dogs for less and less money while the AMA "quietly" works behind the scenes and within the system to preserve the meager payments we currently have. People may think doctors should be grateful for ObamaCare and its millions of newly insured patients coming our way. All doctors will see are millions of patients who demand 100% perfection from their physicians while getting paid cents on the dollar for the service.

All are relevant points. And there are no good answers for the foreseeable future. For any college students who are thinking about going into medical school, this should be required reading.

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