There is more and more evidence that doctors do not want to continue participating in the typical insurance-dominated health care system we have in the US. If people think this is bad, and many do, the thought of going to a National model would be ten times worse. Over in Germany and Britain and up in Canada, they have a shortage of doctors. Why? Because they get no personal satisfaction with the care and services they render. Also, the lack of decent pay for what they do, and all the education just isn’t worth it. Add the costs of medical malpractice insurance, I foresee a shortage of good doctors here in America in the next few years.

From todays Boston Globe:

Most primary care physicians at Boston’s top-tier teaching hospitals are so busy that they have officially closed their practices to new patients.

Callers to Massachusetts General Hospital’s physician referral line, for example, are told that all, or almost all, of the hospital’s 178 primary care physicians are not accepting more patients. All 42 internists at Boston Medical Center have had full lists since four months ago, and 108 of Brigham and Women’s Hospital’s 120 primary care doctors have closed their practices to new patients.

This is a long article, and it attempts to vilify doctors who have a full patient load but who manage to squeeze in an extra patient now and again. Claims of discrimination abound throughout this article, and whines about how the poor who have no access is mentioned many times.

“There is a huge crisis in primary care right now,” said Dr. Sherry Haydock, medical director of Internal Medicine Associates, a primary care practice at Mass. General. “If you have a family member already cared for at the hospital, you have a much higher likelihood that a doctor will take you. But as our [practices] have gotten to 150 percent the size they should be, a lot of us realize we have to say no even to family members.”

Many doctors blame a national shortage of primary care doctors for the limited access, but the reasons are more complex and vary among hospitals.

The heart of the issue is the role of a primary care doctor. This “position” is the result of insurance plans that are supposed to cut costs and keep waste under control. It was a good idea back in the day, I suppose.

Another article in today’s Concord (NH) Monitor shows how one doctor ditched the system and is providing better services and care:

Four years ago, Michael Stein ran a medical practice that, by all conventional measures, was highly successful. Stein earned about $300,000 a year and provided primary care for nearly 4,000 patients. But, Stein said, “I was killing myself.”

He needed 10 full time employees to manage the workflow. He often had appointments booked as frequently as every five minutes. He would finish a 12-hour day with stacks of untended charts littering his desk.
[...]
He also calculated that he needed to see 25 patients a day just to cover his overhead. In order to make his salary, he often saw 35 or 40. And he never could spend as much time as he’d like with them. According to his wife, Gena, practice employees had developed a ruse to keep Stein from talking to patients for too long. When a patient visit ran over, someone would knock on the door and tell him that another doctor was on the phone.

“You can’t take care of 25 or 30 patients a day,” Stein said. “That’s not possible. What you’re doing is running a cattle drive.”

Yes- many doctor offices are managed like a cattle drive. Doctors are rushed to see their patients and mistakes and other problems happen because of this. It’s a no win situation thats for sure.

What did Dr. Stein do?

If he could cut health insurers out of the equation, he could run a practice with a much lower overhead. He could see fewer patients a day, give them better medical care, and still make money.
[...]
It took a bit longer for the details to fall into place, but these days Stein practices medicine with a small office, one employee (his wife), long appointments and short waits. For $1,000 a year ($1,500 with certain extras), patients get unlimited access to Stein and his care. For no additional fees, they can come in for lengthy annual physicals; they can visit him weekly for advice as they quit smoking or change their diet; they can call him during the weekend when their child cuts a leg and meet him at his Hampstead office to get the cut stitched up. Because the annual fee guarantees his income, Stein can afford to see many fewer patients, which means he knows them all better and can spend more time with each of them.

Uh oh…the cries of special services for elites will soon be heard. It’s the entrepreneurial spirit here at work. Doctors are tired of being tied down to government and insurance rules and over regulation. Cut the ties to these wasteful overhead, they feel free to do what they should be doing: Providing excellent care to their patients. The more doctors who chose to enter this model, the higher the competition will be. That means better prices for everyone.

The key to his financial model, he said, is that he doesn’t sign contracts with insurance companies, which means he’s not bound by their reimbursement rates and not subject to their rules. He can decide what tests to perform or drugs to prescribe without having to make phone calls or fill out forms. He also doesn’t have to worry about laws governing health insurance or Medicare fraud. Since he doesn’t bill the companies, he doesn’t have to follow their rules.

Smart doctor. Maybe we need to become smart patients too.
For less than $20.00 a week, patients can have 24 hour access to a doctor who has new modern DX equipment, who is available to them 24 hours a day, who provides emergency care and who will spend time with us during our appointments. What a concept.
More time spent with the doctor usually means better outcomes too…doctors would have the time to fully assess their patients and come to the right DX and treatment plans. Few people would be able to pay for this model though…traditional health insurance plans cover hospital stays and these doctor only plans cannot offer that. BUT soon enough we will see hospitals offering plans that patients can chose from that are similar to what the doctors are doing.

Hospitals have entire departments working to digest the insurance industry. This equates to millions of our dollars that could be going towards more important things. It’s pretty sad to think that over half of what we pay for health insurance goes towards the costs of maintaining the red tape of said insurance!

The day will come when Americans have a real choice about their health care issues…they will be made to think a National model is best though. Based upon what Germany, Britain and Canada have experienced though, people would be wise to steer clear of that road. No group wastes more money than a federal government. We all know health care is expensive…we would stupid to let our government take it over. Look for alternative models and give them serious consideration. After all, our lives are literally at stake on this.