This is a great topic, and I appreciate everyone sharing! I think I missed out on a lot of the earlier generation doctor benefits. I have some old charts that show a single line note for a visit, especially for pediatric well visits. The doctors were just trusted to do their jobs. Now it's writing a book every day to satisfy billing and any future lawyer related "concerns." Some of my best practice was in India and Peru on medical missions, filling out just a note card like you see on the Doc Martin show in the UK. Just doing medicine, and not worrying about senseless documentation and billing!
I've been in Solo practice for 10+ years in Alaska. Recently I hired a PA. I grew from renting a single room from another doc, doing all the phone calls, blood draws, and everything myself. Slowly we added staff, computers, equipment, and changed buildings. In the last couple years, we were able to build a brand new commercial office building and add enough space to ultimately have 2 MD's, a counselor, and a PA. Speaking of this, I will be looking for another doctor before long. We are in a growing area, despite the decline in healthcare payments. We run traditional Family Medicine. I stopped doing OB, colonoscopy, and inpatient hospital work for lifestyle reasons. I used to pride myself in admitting all my own patients. But they were almost always Medicare and at 3 AM. You get paid 50 dollars for 3 hours work! While I loved it, it was a season in life and the personal time has been important beyond measure. I think my practice has been very successful, but insurance companies and the driving forces of government are killing traditional medical practice.
I grew up in Oregon, and when I considered returning there after residency, I found the insurance monopolies has completely locked down the region. The Blue Cross and Aetna are able to completely monopolize a region or a state. They collude to make deals, parsing up their "market territory." Many regions in this country have only one insurance monopoly. All the doctors work for that one insurance company. Meanwhile, it is a Federal Trade Violation for two of us to even discuss not taking Aetna, unionizing, or any other agreement.
Why has this happened? The US government is incredibly corrupt and I believe has become fascist. That's because the government exists to serve corporations and visa versa. An executive at Monsanto goes to sit on the USDA. Then he goes to work at the FDA. Then, it's over to Pfizer. The insurance monopolies have powerful lobbies that control the arms of the government. The idea that you are protected by government agencies is a joke. Did you know that all your meat comes from one of 5 companies that control everything from farm to table? But I digress.
When I first came to Alaska, it was traditional medicine. Insurance companies had reasonable premium prices and mostly paid what you billed. You could have insurance for your family on a personal plan for 600 dollars a month. Then "affordable care" was passed. You can't get an individual plan for less than $2000 per month, thanks to government meddling. I lost my insurance.
Then, just like Oregon 30 years ago, the PPO's moved in. Doctor's sold out by joining, giving up all autonomy to try and compete with each other for patients. The insurance co said, "Join our PPO, and you can have all the patients. Just take a 20% pay cut." Once they had done so, all the doctors had to join or they would get no patients. (One of my patients has 1500 dollars deductible in network, which I didn't joint, and 9000 out of network. I see her for free after 1500 dollars.) Then another PPO came in, and said you can take 50% or you will lose all your patients down the street. They successively ratcheted down the payment to doctors, who stood all alone and could not unionize, have meetings, or in any way organize under the government laws protecting the insurance cartels.
We still have it pretty good in Alaska. Medicare is the worst payer. However, Aetna is getting really close to Medicare on payments. Medicare is about 50% of most insurance payments, and we could not keep our doors open on Medicare. It's an expensive environment where you can pay 5 dollars for milk and 5 dollars for eggs at the store. Our overhead is about 60%. Nurses have not taken any pay cuts, neither have the snow plowers, the electric company, or the internet provider, or Amazing charts. Costs keep going up and payments keep going down. When all the insurance companies pay at Medicare rates, or when Bernie/Biden get "Medicare for All" it will be time to retire.
Perhaps some doctors will continue, supervising armies of NP's and PA's, but the era of someone seeing their Family Doctor will be over.
My biggest frustration is actually AC. It crashes every time I try to write a prescription. I don't bother with PriorAuths. I tell the patient it isn't on their formulary, and if that's a problem, call the nasty insurance company. Often that PA is over $7 they could pay themselves.
I actually love my job. I do a lot of procedures, from derm to orthopedics. It's the only job that keeps me fascinated, allows me to make a good wage, and also allows me to help people. (the perfect trifecta!) Much of that is because I went into Family Med, which never gets boring. I think I'd have quit long ago if I was a specialist.
Last edited by Boondoc; 08/12/2020 3:03 PM.
