More doctors are being owned by large conglomerate clinics or hospitals. And the hospitals are in cahoots with the government, or else THEY would be reaping the attacks for insurance fraud, because that is where the fraud lies. Hospital-owned doctors are instructed to order tests that aren’t really needed for diagnosis, but bring the hospital money.
Independent physicians are the #1 group attacked by the government for fraud and illegal use of the Controlled Substance Act. Why? To eliminate independent physicians because they work for the good of the patient, not the hospital. Once the government has eliminated all (or most) independent physicians, the government will have control of who lives and who dies. Legal genocide is in our future—Hitlerism.
The good physicians are leaving the profession. Here is an insightful blog written by a female physician who couldn’t bear with the state of medicine today. Too bad we lost her. But I’m sure there are more like her. And the robots coming into the profession will not be working for you. Answer? We need to end ownership of physicians by hospitals and large conglomerate offices. But this needs to be handled at state levels because the control of medicine is NOT under federal control.
The doctor’s story:
I sat there stunned, my ears burning and my stomach churning. Without grace or tact, my office partner scolded me and my low productivity. “You are incapable of seeing a full schedule!” She proclaimed. “You are too slow and you spend too much time with your patients and your medical students. The staff around here walk on egg shells because they are too afraid to schedule patients for you.” This unsolicited advice came after I had expressed some frustration about my schedule and the administrations unwillingness to accept any of my ideas on how to improve my numbers.
It wasn’t the first time I heard I was slow. During my surgical rotation during medical school, the general surgeon attending just shook his head and laughed when I presented a post-op laparoscopic cholecystectomy patient to him and I added that she had an amazing apple pie recipe. He asked what specialty I planned to pursue and I proudly told him primary care most likely family medicine and he thought I would be perfect.
In residency the issue came up during busy clinic times or when doing inpatient medicine trying to keep up with a stack of admissions in the emergency room. I adapted quickly and could “hustle” when I needed to. We pointed out to our program director that could it be possible that some of us might be slower because we were better? Better listeners? Do empathic women who have superior listening skills attract a type a patient that needs more time? Our answer was that yes that was a distinct possibility. I’m not sure that it has been studied. What was taught in medical school now seemed to be “punished” during residency.
My first practice was a multispecialty group and that was a fantastic first job. The specialists were in the building and always willing to help with any questions or concerns. Being thorough and a good listener helped my practice grow quickly. I started to become more efficient as anyone with more professional experience tends to do over time. The pressure to see more and more with less and less time became apparent right away. My boss took me aside one day and said, “You really should refer diagnosis or procedure X, Y, Z to the various specialists he employed.” “Why?” I asked. “Because I get paid 3X as much and that frees you up to see more people per day.” He was seeing 45 patients per day and referring everything out. But he was ER trained and I am Family Medicine trained. I would not budge. There was no way I was going to refer out routine pap smears and controlled hypertensive or diabetic patients. I literally saw my boss refer a broken pinky toe to an orthopedic surgeon. Last time I checked a Boy or Girl Scout can take care of that.
My second job was teaching full-time in a family medicine residency and it was heaven. It was great working with medical students and residents and I didn’t feel the same pressure since the residents did all the work. There were separate hassles but at least spending time with patients wasn’t frowned upon.
My third job was working for a rural underserved clinic. It was one of several clinics for a small community hospital. I took the job since it was closer to home and offered loan repayment. It started out fine enough with outpatient and inpatient medicine. I noticed after a year that I was still only seeing about 19 patients per day which was fine. The office manager said that was fine and to not worry about productivity. She praised me for spending time with the patients and the patients certainly appreciated it. Time passed and at each productivity meeting I inquired as to whether or not they were concerned about my numbers. The answer was always no, don’t worry about it. I started asking administration to allow us to adapt our schedules to try to improve productivity. Every single idea I had was refused. The other obstacle was that we were only allowed one MA and the electronic medical record was difficult to use. Without proper staffing, I started referring more things to the hospital. Procedures that could be done in the office were sent out for higher cost and at one point I had the highest percentage of referrals to our hospital system. Then the CEO told me that based on my productivity they were going to cut my pay. I countered with the fact that I had given several suggestions to improve my productivity and management declined to implement any of them. I also argued that I was the highest referring physician to the “mothership” of all the rural clinics. He said there was nothing he could do. I put in my notice when my contract was up for renewal.
My fourth and perhaps final job in family medicine was back in private practice in a well to do Kansas City suburb. However, this practice was all primary care physicians with a few NP’s and PA’s. I was blessed to have many of my patients follow me to the new group. It wasn’t too far from my previous practice and it was located in a growing community than many of my patients traveled to anyway for shopping, entertainment, work etc. I enjoyed my co-workers and my patients and will miss them very much. Private practice is a mine field with pressure to order more tests and do more things for the patients that they do not need in order to survive financially. I am not going to order a sinus x-ray on everyone with a cold. I refuse to. It is a waste of time and money and it doesn’t add anything to my clinical decision making. I am not ordering routine EKGs and chest x-rays on 28 year olds for their physicals. I don’t care about quality metric reports that not all my patients with diabetes have normal A1C levels. I’m not a “bad” doctor because some of my diabetics have elevated blood sugars. One patient I had recently had an elevated A1C and I asked her how she was eating and taking care of her diet and exercise. I found out that her husband was financially abusive to her by keeping all of their money and the little bit she gets from social security she uses to go to the local food bank. Our entire discussion changed right away and I offered her counseling on her life and asked how she was dealing with that. I hope I would be judged on caring and compassion for someone in need, not a chart showing a numbers game.
The decision to leave family medicine has been very difficult for me. This current practice is so busy and the pressure to see patients every 15 min is only part of the struggle. When I graduated from residency in 2000, we were dictating our charts and we still had paper charts. HER, as most physicians would argue, have only slowed us down. While it is nice to have all the data in one place, clicking 50 or more tabs just for a normal exam is ridiculous. Patients also seem sicker and have more needs. I used to have a lot of children in my previous groups so it was always a nice pace with low and high acuity need. This community has plenty of pediatricians so we don’t see as many kids in our practice. I do well women exams which breaks up the day and I am also board certified in obesity medicine and that has been a joy to watch people improve their health and lose weight. I love the fact that my patients say over and over again how much they appreciate seeing a physician that isn’t judgmental about their weight and actually offers them help and counseling and medication if needed. But wellness doesn’t pay the bills.
Linda Cheek is a teacher and disenfranchised medical doctor, turned activist, author, and speaker. A victim of prosecutorial misconduct and outright law-breaking of the government agencies DEA, DHHS, and DOJ, she hopes to be a part of exonerating all doctors illegally attacked through the Controlled Substance Act. She holds the key to success, as she can offset the government propaganda that drugs cause addiction with the truth: The REAL Cause of Drug Abuse.
Get a free gift to learn how the government is breaking the law to attack your doctor: Click here to get my free gift
Totally true–here is a perfect example of someone we’d all want to be in the medical field being forced out thanks to the ridiculous metrics (I hate that term) and notions of bean counters. Only 19 patient a day? Wow, that might actually leave her with time to know her patients, diagnose them properly, avoid ordering improper tests and referrals–you know, keep costs down? I’m neurology and pain management and if I have 13 a day I am feeling swamped due to the complexity of the cases. If this doctor wants to move to Sonoma CA let her know she’s got an invitation!!
I have 14 years of recorded office visits, from Texas to Virginia, that absolutely proves that what this wonderful MD is stating is 100% true. She is not the first MD or RN that has expressed to me the same frustrations. One nurse recounted to me, sadly, that she loved being and RN in the Emergency Room. However, because she was treating pain patients with compassion, and for that was meant to suffer the verbal abuse of her colleagues, she was driven from the ER into family practice as a NP. Then, that practice was consumed by the Privia Medical Group. For that reason, I seriously doubt that she would have stayed, because the change in my treatment after 13 years was that they removed me from that practice in March of this year, and for contrived reasons.
This is – not any longer – a political issue. This is not Capitalism versus Socialism. Socialism would utterly destroy everything good about this country. On the other hand, these evils discussed here have nothing to do with real capitalism, i.e., as described in the Law of Exchanges: trading Value for Value… This is about government sanctioned preferences, and not the preferring of one thing and then the setting aside of another on the part of individual buyers and sellers in a free market, as encapsulated in that Law of Exchanges. This is undeniably and entirely about Graft and Greed. It is a horribly broken system, and there is one simple action that Congress could take that would end all of our problems. (Really?!! I call BS!!!) No, really.
Insurance, once introduced into any market, has proven that over time it will corrupt that market, and Real Prices and Real Menu Costs will cease to exist. (Depending on how it is implemented.) As a result there are no real pricing constraints, and instead all that we see is hyperinflated cost transferred straight onto the end-user. And then on the other side, indeed the counterpart to that end-user, we see hyperinflated and ill-gotten gains delivered into the laps of those individuals participating in this Fraudulent Exchange, and who are the Beneficiaries of such Government Sanctioned Preferences. Such Government Sanctioned Subsidies. Then with the government’s blessing these massive companies come in and gobble them all up and create the mother of all Patient Mills. In my home state of Texas, where I’ve had to spend the last year away from my new home in the mid-Atlantic region, on every corner, literally on every corner, there are specialty clinics, thousands of them as you drive across my home city of Houston. It is an unnatural phenomenon created by broken policies that are forced upon the citizens of this country. More importantly, it is mostly entirely absorbed by the most vulnerable of citizens, and those are the ones suffering illness, injury or any other physical defect. It is simply inhumane. Period.
All that is required to end this disgusting outcome is for Congress to pass a law prohibiting any business from offering any type of insurance as a part of a “Benefits Package.” To prohibit Insurance Companies from selling “Group Policies.” Or rather, limit the policies only to Family Policies and/or Individual Policies. And finally, yes, declare it be removed from all considerations the idea of any type of “Pre-Existing Condition.” We are all born with a pre-existing condition in that we are mortal. Any legitimate “Policy” that seeks to dilute “Risks” amongst the members of any “Risk Pools” should be forced to do so by creating Risk Pools that only include the policies described above… IMHO.
My suggestion is that the medical offices deal directly with the patient. Then the patient deal with the insurance company. Prices will come down in the doctor’s office because they will be paid for their work, while with insurance companies, they often aren’t, which drives the costs up. Also, insurance companies won’t deny patients their coverage as much as they deny the doctor. This will also bring the costs down for the uninsured, since everyone would pay the same amount.