Wednesday, October 31, 2012

Well, at least it’s free…

A report from the Physician’s Foundation lays out a very grim picture of the future of medicine in America.

This paragraph sums up medicine today:

Over the last half century or more, medicine has evolved from the province of solo and small group practitioners who contracted directly with patients, to an increasingly centralized profession in which treatment is paid for by third parties. Several decades ago, both Medicare and private insurance companies paid physicians retroactively for “usual, customary and reasonable charges,” meaning doctors typically received what they invoiced. This system has been repeatedly modified since, in an effort to reduce costs and manage care, often creating a disconnect between the services physicians provide or believe is appropriate and the services for which they are compensated. This trend may reach a culmination on January 1, 2013, when physicians are due for a 30 percent reduction of their Medicare reimbursement under Medicare’s Sustainable Growth Rate (SGR) formula.”

So physicians today are paid what the government says they should be paid.  The only option for a physician is to become non-participating with all insurance companies, concierge, or direct care, all of which are all cash paid basis for the patient.  This directly impacts a patient, as individuals are becoming more responsible for rising insurance premiums in conjunction with physicians moving away from the third party payment system.

Additionally, “the bar to professional entry for physicians keeps rising, with four years of college education, four years of medical school, and as many as seven years of residency training necessary for those who wish to sub-specialize. Medical education and training come at a high cost, as medical school graduates now carry an average of $156,456 in educational debt, according to the Association of American Medical Colleges (AAMC).”

When asked which best describes their feelings about the current state of the medical profession, only 3.9 percent of physicians used the words “very positive,” while 23.4 percent of physicians indicated their feelings are “very negative.” The majority of physicians – 68.2 percent -- described their feelings as either “somewhat negative” or “very negative,” while only 31.8 percent of physicians described their feelings as “somewhat positive” or “very positive.”

The great majority of physicians (84.2 percent) agree with that the medical profession is in decline…. Practice owners are more inclined to believe the medical profession is in decline than are employed physicians and specialists are more inclined to believe the medical profession is in decline than are primary care physicians.”

This attitude is pervasive in the medical community.  Physicians are working harder to make the same amount of money they made a decade ago.  Regulations are sapping physicians' time in unnecessary paperwork.

There is no disputing that medicine is one of the most highly regulated of all professions, and that physicians must adhere to a vast array of laws and requirements imposed by the government and third party payers…. The Medicare regulatory code stipulating provisions by which physicians must abide is over 130,000 pages long.”

Costs such as EMR’s and staff are eating into an already thin profit margin.  Combined, these stressers are reflected in the survey in these findings:

Over one third of physicians would not choose medicine if they had their careers to do over.

Over 60 percent of physicians would retire today if they had the means.”

In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.”

The exodus of doctors from the practice of medicine has begun and the nations brightest and best are no longer interested in a career in medicine.  The high caliber of medicine in America, which was developed through the free market of capitalism, has been brought to the level of mediocrity.  Well, at least it will be free.

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