Doctor: I gave up on healthcare in America

[TeyshaBlue]

Short, but interesting read. Never heard of locum tenens as a alternate career path.

http://money.cnn.com/2013/04/25/smallbusiness/doctor-quit-healthcare/index.html?iid=Lead

[boutons_deux]

why would locum be superior to what he found in Australia?

[TeyshaBlue]

I don't claim that it is. I was just unaware of the practice.

[leemajors]

Sure took his sweet time even attempting to move to electronic records.

[mrsmaalox]

Locum tenens has been real popular in nursing and allied health for as long as I can remember. For doctors I think it's relatively new, but I don't really know as I have only ever worked at teaching hospitals and never experienced a doctor shortage.

The thing that strikes me from that article is that he says only one third of his patients were Medicare patients, but yet changes in those was enough to bust his practice. I can only assume the other two thirds were insured? I would think he was very well reimbursed from them.

Doctors are not famous for being business savvy. When I was in nursing school I worked parttime for one of the most prominent pulmonologists in the state. My job was to make rounds of the various hospitals and have his patients sign their Medicare/insurance papers to be submitted. The Medicare papers were submitted immediately and reimbursed immediately, no questions asked. The insurance papers accumulated on the desks for months, because they required so much more documentation, and then after months of back and forth "negotiations" were eventually reimbursed. I think the guy in the article could have been the same way, made his business too dependent on the easy money.

[mrsmaalox]

And he did not "give up on healthcare in America". He gave up on how/what he got he paid for his job.

[Nbadan]

Mrs Maalox coming in with the solid take. Healthcare is a monopoly and everyone gets screwed except for big insurance.

[Nbadan]

In this case privatization without regulation and oversight has failed.

[boutons_deux]

locum is quite popular is over-doctored countries like France. very hard to find a spot to start a practice, so young doctors sub for vacationing docs.

in under-served rural areas, villages give free housing and exemptions to property taxes for doctors.

[boutons_deux]

for-profit health care has failed, sucking wealth from Americans, per capita cost 50% more than other countries with worse results

[TeyshaBlue]

locum is quite popular is over-doctored countries like France. very hard to find a spot to start a practice, so young doctors sub for vacationing docs.

in under-served rural areas, villages give free housing and exemptions to property taxes for doctors.

Sounds like teaching in Alaska.

[ploto]

The thing that strikes me from that article is that he says only one third of his patients were Medicare patients, but yet changes in those was enough to bust his practice. I can only assume the other two thirds were insured? I would think he was very well reimbursed from them.

Doctors are not famous for being business savvy. When I was in nursing school I worked parttime for one of the most prominent pulmonologists in the state. My job was to make rounds of the various hospitals and have his patients sign their Medicare/insurance papers to be submitted. The Medicare papers were submitted immediately and reimbursed immediately, no questions asked. The insurance papers accumulated on the desks for months, because they required so much more documentation, and then after months of back and forth "negotiations" were eventually reimbursed. I think the guy in the article could have been the same way, made his business too dependent on the easy money.

The doctor is full of it. Software for an electronic medical record system does not cost $100,000. And Medicare reimburses faster than most private insurance companies and at a higger rate than some.

[Nbadan]

And Medicare reimburses faster than most private insurance companies and at a higger rate than some.

Pretty much what she said...imo...

[RandomGuy]

Short, but interesting read. Never heard of locum tenens as a alternate career path.

http://money.cnn.com/2013/04/25/smallbusiness/doctor-quit-healthcare/index.html?iid=Lead

That kind of brain drain bodes ill for the US.

Less supply + more demand = higher prices.

WHen you are talking about doctors that can add up real quick.

I do get that from a lot of what I read about doctors, and what I see personally with my own PCP.

Too business-y.

You have some serious information assymetry issues, and the fact that health care demand tends to be very inelastic (not sensitive to price)

WH posted a really good, if long, article about the business of health providers.

Our problem is that we can do a lot for things we didn't used to be able to do anything about 50 years ago.

Being a doctor is a LOT more complicated for that reason.

[RandomGuy]

Locum tenens has been real popular in nursing and allied health for as long as I can remember. For doctors I think it's relatively new, but I don't really know as I have only ever worked at teaching hospitals and never experienced a doctor shortage.

The thing that strikes me from that article is that he says only one third of his patients were Medicare patients, but yet changes in those was enough to bust his practice. I can only assume the other two thirds were insured? I would think he was very well reimbursed from them.

Doctors are not famous for being business savvy.[emphasis mine-RG] When I was in nursing school I worked parttime for one of the most prominent pulmonologists in the state. My job was to make rounds of the various hospitals and have his patients sign their Medicare/insurance papers to be submitted. The Medicare papers were submitted immediately and reimbursed immediately, no questions asked. The insurance papers accumulated on the desks for months, because they required so much more documentation, and then after months of back and forth "negotiations" were eventually reimbursed. I think the guy in the article could have been the same way, made his business too dependent on the easy money.

Yeah, I get that impression.

I am HIGHLY tempted to go into the business of health care business consulting. B-School meets Med-school.

Doctors are no different than any other small business.

I always tell people that it takes two skill sets to run a successful small business.

One is that you need to have the skills to sell. If you are a printer you need to know printing, if you are a doctor, you need to have medical knowledge, etc.

The other, and this is where small business people tend to fail is that they need to have knowledge of how to make money at selling that skill/product. That requires some knowledge of accounting that most people lack.

For me it was always extremely rewarding to help people with their businesses, because I have exactly that skill set to help people.

I think the fact that medical records are still not computerized screams about how poorly doctors tend to run their practices from a business perspective.

[ElNono]

I guess I'm supposed to feel sorry for a guy that can't make ends meet making $150K/year?

[ElNono]

On the other hand, I'm glad that he seems genuinely happy of finding a new career path.

[boutons_deux]

I guess I'm supposed to feel sorry for a guy that can't make ends meet making $150K/year?

doesn't say whether $150K is his gross or net.

[ploto]

Pretty much what she said...imo...
I agreed with her.

[ploto]

The other, and this is where small business people tend to fail is that they need to have knowledge of how to make money at selling that skill/product. That requires some knowledge of accounting that most people lack...

I think the fact that medical records are still not computerized screams about how poorly doctors tend to run their practices from a business perspective.

Part of the problem is that many doctors think they are smarter than everyone else and will not listen to other people who know more about running a business than they do.

[Nbadan]

Physician says Affordable Care Act an 'experiment' that will fail


DAWES, W.Va. -- The Affordable Care Act is an experiment that will fail, the head of an organization that advocates for a single-payer health system argued Thursday.

"People will not be able to afford the health insurance that they're being pushed to buy," Dr. Andrew Coates, president of Physicians for a National Health Program (PNHP), said during a visit to West Virginia on Thursday. "And when they do buy it, it won't be good enough to cover health-care calamity."

Under the ACA, health insurance premiums and deductibles will not be affordable, Coates argued.

"I think it's a big experiment to drive people to (the health insurance) marketplace but the health insurance marketplace hasn't worked for years now and I don't see any evidence that's going to change," he said.

<snip>

"People say (a single-payer system) can't work here," said Dr. James Binder of the West Virginia chapter. "That's not true."

http://www.wvgazette.com/News/201304250121

[boutons_deux]

I want to the Repugs scream, and holler and bitch and defund ACA and thereby lay the groundswell for hard-core public public health insurance option for everybody, even allowing employees to opt out employer group plans.

next would be govt health care, like the VA, with salaried, coordinated care, computerized doctors, not fee-for-excessive-service doctors.

We need fuck back the predatory health care industry as hard as they have been fucking and sucking our wealth for decades.

[boutons_deux]

Exclusive survey: Practice expenses


(http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/personal-finance/exclusive-survey-practice-expenses)
Primary care physicians spent more than half of their 2002 practice revenue on operating expenses, according to the latest Medical Economics Continuing Survey, which samples MDs and DOs in office-based practice. Doctors in the specialty fields we analyzed—invasive and noninvasive cardiology, gastroenterology, general surgery, and orthopedic surgery—fared a bit better. But even those doctors spent from 43 to 50 percent of their earnings on overhead.

The biggest outlay was for office payroll, which easily outpaces the other two high-priced items: rent (or mortgage payments) and malpractice insurance premiums. "Without question, the greatest rise in expenses in California and Arizona over the past 24 months has been related to staffing and insurance," says Judy Capko, a consultant in Thousand Oaks, CA."Workers' compensation has nearly doubled, and unemployment costs are increasing even more rapidly," she adds.

"Some practices are reducing fringe benefits and limiting pay hikes to the increase in the Consumer Price Index."The situation is the same in the Northeast. Rising health insurance costs are pushing staff expenditures skyward, according to Kenneth Bowden, a consultant in Pittsfield, MA.

"It used to be a fairly minor line item; now it's way off the charts. As a result, some doctors are asking employees to pay as much as 50 percent of their health insurance premiums." Malpractice costs, too, are "out of control," Bowden notes, "especially in Connecticut and Massachusetts, to the point where it's driving doctors out."

(http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/personal-finance/exclusive-survey-practice-expenses)
- See more at: (http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/personal-finance/exclusive-survey-practice-expenses)http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/personal-finance/exclusive-survey-practice-expenses#sthash.EslNt2Pk.dpuf


http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/personal-finance/exclusive-survey-practice-expenses

[mrsmaalox]

Yeah, I get that impression.

I am HIGHLY tempted to go into the business of health care business consulting. B-School meets Med-school.

Doctors are no different than any other small business.

I always tell people that it takes two skill sets to run a successful small business.

One is that you need to have the skills to sell. If you are a printer you need to know printing, if you are a doctor, you need to have medical knowledge, etc.

The other, and this is where small business people tend to fail is that they need to have knowledge of how to make money at selling that skill/product. That requires some knowledge of accounting that most people lack.

For me it was always extremely rewarding to help people with their businesses, because I have exactly that skill set to help people.

I think the fact that medical records are still not computerized screams about how poorly doctors tend to run their practices from a business perspective.

That's a great idea, there is a great need. Your biggest obstacle, however, would probably be busting the "doctor's wife as office manager" business model. While they may have some bookkeeping/secretarial type skills, usually their strongest skill in the business is to quell any possible NEW wife/office manager from emerging from the ranks :lol

[ploto]

That's a great idea, there is a great need. Your biggest obstacle, however, would probably be busting the "doctor's wife as office manager" business model. While they may have some bookkeeping/secretarial type skills, usually their strongest skill in the business is to quell any possible NEW wife/office manager from emerging from the ranks :lol

:rollin

[Agloco]

Locum tenens has been real popular in nursing and allied health for as long as I can remember. For doctors I think it's relatively new, but I don't really know as I have only ever worked at teaching hospitals and never experienced a doctor shortage.

There's been a move towards this for about 5-7 years now. With the ACA coming online, it's picked up steam. Most providers/institutions are of the opinion that Medicare reimbursement will fall on the order of 10-15%. With rates being as marginal as they are already, that's enough to send most practices off the precipice even at a 66/33 split.



The thing that strikes me from that article is that he says only one third of his patients were Medicare patients, but yet changes in those was enough to bust his practice. I can only assume the other two thirds were insured? I would think he was very well reimbursed from them.

Seems low on the whole. The demographic that the practice sees matters here though. I know that Mayo Clinic sees just over 50% Medicare and they are circling the wagons when it comes to their capital improvement budgets. All departments are being asked to slice 5% off their budgets, and that's for starters. There are some notable exceptions to this rule though, the opening of two large capital projects in AZ and MN being the biggest. Here too though, a new demographic (peds) is being considered as potential new clientele. Johns Hopkins is taking similar measures. All of this is to say that our nations most prominent institutions recognize the uncertainty that the future holds, just as individual providers do.



Doctors are not famous for being business savvy.

:(

Most of them at any rate.....

[EVAY]

What struck me as I read it was that he couldn't make the money he wanted to make with his practice, but he had no problem selling it, suggesting that someone figured they could make money at it.

My cardiologist told me last time I was in that medicine is only about money and business anymore, and he is thinking of leaving for that reason. Had nothing to do with ACA, just hated all the business aspects of medicine.

[exstatic]

The doctor is full of it. Software for an electronic medical record system does not cost $100,000. And Medicare reimburses faster than most private insurance companies and at a higger rate than some.

Medicare - Govt insurance. Australia - Govt healthcare.

Privicare fail.

[boutons_deux]

hated all the business aspects of medicine.

Even docs who give up independent practice to join groups of doctors, clinics, hospitals to save overheads are still seen by mgmt as nothing but sources of revenue, with pressures to produce revenue above all else.

google "doctors leave quit medicine", plenty of stories and hits.

5 years ago:

Half of primary-care doctors in survey would leave medicine

Nearly half the respondents in a survey of U.S. primary care physicians said that they would seriously consider getting out of the medical business within the next three years if they had an alternative.

Experts say if many physicians stop practicing, it could be devastating to the health care industry.

The survey (http://www.cnn.com/2008/HEALTH/11/18/primary.care.doctors.study/index.html?iref=allsearch#), released this week by the Physicians' Foundation, which promotes better doctor-patient relationships, sought to find the reasons for an identified exodus among family doctors and internists, widely known as the backbone of the health industry.

A U.S. shortage of 35,000 to 40,000 primary care physicians by 2025 was predicted at last week's American Medical Association annual meeting.

In the survey, the foundation sent questionnaires to more than 150,000 doctors nationwide.

Of the 12,000 respondents, 49 percent said they'd consider leaving medicine. Many said they are overwhelmed with their practices, not because they have too many patients, but because there's too much red tape generated from insurance companies and government agencies.

And if that many physicians stopped practicing, that could be devastating to the health care industry.

"We couldn't survive that," says Dr. Walker Ray, vice president of the Physicians Foundation. "We are only producing in this country a thousand to two thousand primary doctors to replace them. Medical students are not choosing primary care."

http://www.cnn.com/2008/HEALTH/11/18/primary.care.doctors.study/index.html?iref=allsearch

Just another symptom of how dysfunctional and diseased the for-profit US health system is.

For-profit health care is $3T national pulblic health disaster. But corporations pay politicians enough to screw up reform like ACA and keep true reform not even broached.

[TDMVPDPOY]

Medicare - Govt insurance. Australia - Govt healthcare.

Privicare fail.

u know what they wanna do down here now is put public hospitals especially management into private hands run by corporations instead of doctors running the hospitals....

[ploto]

These physicians claim they are overrun by all the red tape, but if they would spend the money on a qualified office manager, they would not even have to handle a lot of that stuff. I helped open a solo private practice, and the main thing I emphasized was paying other people to do what they specialize in, and let the doctor be the doctor. There was an attorney who handled the lease negotiations, a CPA who set up the financials, and a systems guy who set up all the computer stuff. In the long run, it is worth it to pay those people.

[spursncowboys]

The doctor is full of it. Software for an electronic medical record system does not cost $100,000. And Medicare reimburses faster than most private insurance companies and at a higger rate than some.
Cool story.

[spursncowboys]

Good article TB.
For the record Pueblo isn't very rural. It is however filled with illegals and Cali transplants.

[TeyshaBlue]

This doc did not give upon healthcare in America. Instead, he's offered a solution:

South Portland doctor stops accepting insurance, posts prices online

http://bangordailynews.com/2013/05/27/news/portland/south-portland-doctor-stops-accepting-insurance-posts-prices-online/

[boutons_deux]

This doc did not give upon healthcare in America. Instead, he's offered a solution:

South Portland doctor stops accepting insurance, posts prices online

http://bangordailynews.com/2013/05/27/news/portland/south-portland-doctor-stops-accepting-insurance-posts-prices-online/

super cool, distributes his very high overhead of fighting with insurance orgs onto his patients so he can cut staff and prices, snatches back control of his practice of medicine from insurance orgs.

It also increases admin overhead for the insurance orgs since they will have to handle directly 100s of his inexperienced patients' claims rather than his single experienced office, which could cause the insurance orgs, if 1000s of docs did this, to increase their prices to cover their additional admin overhead.

He's a true bomb throwing anarchist, I LOVE THIS GUY. I hope the medical and general press follows his experiment.

[RandomGuy]

This doc did not give upon healthcare in America. Instead, he's offered a solution:

South Portland doctor stops accepting insurance, posts prices online

http://bangordailynews.com/2013/05/27/news/portland/south-portland-doctor-stops-accepting-insurance-posts-prices-online/

I saw that.

Interesting experiment. I hope it works out.

There is an almost indescribable amount of waste and greed in our health care system. Reminds me of the inkeeper from Les Miserables.

The administrative overhead and insurance profits make our system the most expensive in the world for any given treatment.

[Bender]

The first comment under that article about the Maine doctor brings up a good point. If too many other docs start doing this, insurance companies will be all over politicians to put a stop to it.

[TeyshaBlue]

That's when you know the Docs are on to something good.:lol