I agree with all of the above. I to am in the in between generation.
I am a Pediatrician, like Bert. I have a practice that is 60+ percent Medicaid in inner city Chicago and underserved suburbs.
Bert, unlike you, Illinois has some of the lowest rates of pay in the country for medicaid patients. Now it has gone to managed care and many of them have restricted policies for taking on physicians. Plus the state will sometimes change them from 1 plan to another without telling them. Thus patients come in the next month and can't be seen because they are on a different plan. I currently take 2 of the 6 plans. I can't get credentialed with the others despite being board certified. The system is designed to cut costs by making it difficult to chronically take care of patients. Then the state sponsored vaccine program tightened up and many of the FP providers just gave up giving immunizations. Many more hoops.
I worked in 2 different Community Health Centers for almost 15 years but they were poorly managed and finally I decided to go into private practice. I had a nurse practitioner working with me, but had to let her go because of reimbursement. It was a choice of paying her or me!
Burnout? I don't think I have that, FRUSTRATION is a much better term for me. I am somewhat in control of my environment. I would suspect that a lot of the burnout is with the younger docs who are trapped in a corporate environment that treats them no better than clerks. Those systems expect more and more of them and hobble them with EMRs that can be frustrating.
Yes, I have to do a lot of prior auths. Every plan has a different formulary and my main MC plan changes it twice a month. Sometimes flovent is covered and sometimes not. Again, not really saving money, more just making it more difficult to provide necessary meds. But this is the world we live.
The AMA set the system up. It started with CPTs, which they hold the copyright and sell licenses. They then went on to develop RVUs. Congress (mostly lawyers) decided that unionizing doctors would be anti trust. But it was OK for insurance companies to collude. Follow the money!!! The AMA has never been a spokesperson for the average physician, especially in primary care. But again, this is the world we live.
Retirement? Sure, sounds great. but I don't have enough put away (remember, I couldn't keep paying my NP). If I actually was paid for what I do, I wouldn't have to worry about money. Not sure I would retire, but it might be nice to have the option.
Private practice is dying because of increased regulation. Corporations are becoming king. It was telling for me to learn that there are corporations that do nothing but medicaid. If you can make money at 2/3 Medicare rates what does that say?
I have closed except for routine newborns and healthy children. Only seeing patients a few days a week. I do telemedicine but it's not the same. It's a fascinating time when I tell patients "if you're sick don't come to see the doctor" Once more this is the world we live.
