hospital, OB GYN, physician

Working the Holidays: The Invisible Heroes of Healthcare

No one wants to be sick around the holidays, or go into labor during Christmas Eve Service.  We are constantly reminded that we have no control over these things as emergencies arise 365 days a year and thankfully, there is always a place to seek help and someone who is ready to be of assistance.

The holidays are what remind us of what is important in life.  They are a time for gathering with family and friends when the otherwise hurried pace of life doesn’t usually leave time for a home cooked meal with Mom, chatting with cousins, or playing in the snow with kids.

Unfortunately, some people have to miss these precious moments- their jobs require it.

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If you walk through a hospital during Christmas, you will notice it to be eerily quiet.  Only patients with true emergencies will be there, and health care workers will be ready.

You will see a phlebotomist with a Santa hat on striking up a conversation with a patient while skillfully drawing their blood.  You will see a nurse comforting a woman in labor and a surgeon closing the incision from an appendectomy.  You will see a cafeteria worker flipping burgers and humming a song while he works, providing the sustenance to keep the rest of the team going through their 12-24 hour holiday shifts.

They are all happy to have their jobs, but they are missing their families immensely during this time.  Few professions require the dedication to work during a time when everyone else is tending to the people that make their lives meaningful.

Alternatively, some health care workers may have volunteered to work.  Perhaps the holidays are a particularly difficult time as they are acutely reminded of the loss of a loved one and the memories forged on these holidays in the past.  Working may provide a necessary and welcome distraction.

Regardless of the reason these people are working over the holiday, they are providing a desperately needed service- a service to others at the expense of their own families.  These actions are what remind us all of the need to take care of each other.

Thank you to all of the janitorial staff, medical assistants, nurses, phlebotomists, ultrasound techs, and doctors (to name just a few) who keep America’s hospitals running and care for our patients over the holidays.

Merry Christmas and Happy Holidays!

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physician, Uncategorized

Do Patients Pay Less for Cheaper Care? Why the CVS/Aetna Deal Matters

On a recent trip to urgent care for my child, I began to more clearly see how the changes in medicine are affecting our patients and who is benefiting from the bottom line of what is occurring in the US health care system.

A minor injury to my 2 year old son had me waiting patiently to be seen at a local urgent care center.  Eventually, a nurse practitioner evaluated, correctly diagnosed, and successfully treated my son.  (I make it a habit not to treat my own children as I feel it more appropriate to be “mom” instead of “Dr. Jones” to my children in these types of situations).  I appreciate nurse practitioners and feel they provide a great service and are filling in gaps in areas of need, especially in this time of physician shortage.

My concern arose as I considered how this medical care visit was truly playing out financially.  I paid a copay with my insurance- no big deal, it was $30.  My insurance would be covering the majority of the visit.  However, ultimately the company running the urgent care facility would be charging the same rate to my insurance, and same copay to me, for my care regardless of whether I saw a physician or a nurse practitioner.  I even went as far as calling a billing specialist in membership services at my insurance company to ask if this was the case.  She indeed confirmed that there is not a separate charge for urgent care visits depending on the level of provider seen.

My question to anyone who has seen a nurse practitioner or other qualified individual, is your co-pay lower for the service? Do you receive a discount for not seeing the higher paid/more trained physician?  In my situation, there was no reduction of copay.  So, if they are collecting the same amount for the service provided despite a disparity in income level of the provider, who benefits from this profit?

The company running the urgent care center reaps all of the benefits of employing a health care provider with a lower salary than that of a physician.  Their smaller salary likely means more profit for the company.

Again, I am in no way against using mid-level providers, nurse practitioners, midwives, etc.  They are here to stay and provide an important role in healthcare moving forward.  However, my argument is that if a company is benefitting financially from hiring “cheaper” people to provide care to their patients they should at least be passing the savings on to the patients who are receiving the care.  Often, these companies are looking for the financial bottom line and what they can get away with to reap the most profit.  It is a primary responsibility of top administrators to make money for the company, and we can hardly blame them for successfully completing the role they were hired to fulfill.

Transparency is required in these situations.  The patient must know they are not seeing a physician- when they could be- for the same cost to themselves and their insurance company.   They should have the ability to demand physician care if desired.

A prime example how this business scenario is becoming the future of medicine can be seen in the recent proposed merger of CVS and Aetna. The companies involved are in a massive media campaign to make patients think this is to their benefit.  Please remember, these are businesses at the end of the day and their ultimate goal is to increase financial return to investors.  The basic facts are still at play- a drug store is buying an insurance company.

On Wall Street, the widely held belief behind this merger is that by teaming up, CVS and Aetna can have a fighting chance against the behemoth that is “Amazon”, as this online giant attempts to get into prescription drug sales.

Often, the patient is the one to suffer in situations such as this merger, as they will actually pay more and receive less choice.  It’s a monopoly and if your insurance is owned by a drug store company, guess which prescription you will likely receive?  The one on formulary at CVS of course!  So, if the prescription chosen to treat your condition is on formulary at CVS, there most certainly is less overall cost in the health care transaction.  So, does the patient pay less since their prescription costs less or a lower copay for seeing a mid-level provider in a “clinic” that is now part of the plan to have in CVS stores?

You guessed it, the company will profit each time a prescription is written for a drug under their formulary instead of one that isn’t.  The company will also profit each time a midlevel provider sees a patient instead of a physician.  Again, is this in the best interest of the patient?

One last piece of information to consider, the Aetna CEO will walk away with $500 million in cash and stock if this deal goes through.  This executive, who is not a physician, has much to gain from this merger.  I don’t begrudge anyone good fortune, but I also don’t believe the media should portray that the patients are the primary ones to benefit in a deal such as this.

Patients and physicians are no longer accepting the status quo and what everyone outside of health care is telling us is “in our best interest”.  We see and understand what is going on.  We are speaking up and demanding better.

OB GYN, Physician Training, retirement

Is it Ethical to Retire Early from a Career in Medicine?

Eight weeks after I delivered my 3rd child, I was diagnosed with a 4 cm lung mass.  Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer.  Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis, and extremely unfair to a lifelong nonsmoker who has spent 12 years in the prime of her life dedicated to training to become a physician.

Luckily, I soon found out my situation was not as grave as first expected.  A PET scan leaned toward benign diagnosis (or at least consolidated disease).  I could temporarily push aside the paralyzing fear of leaving my 3 young children with no mother and focus on getting rid of this mass that was causing pneumonia, difficulty breathing, coughing for 2+ years, and go ahead with scheduling the thoracotomy.  After resection of the mass which was densely adherent to my pericardial sac and phrenic nerve, I lost about a 1/3 of my left lung.  To my amazement, after my ICU stay I left breathing better than I had been in years.  Benign diagnosis was confirmed.

This experience made me reevaluate my life and it stopped my “hamster wheel” of life I had been running on at a dizzying speed.  I viewed this health scare as a second chance at life.  I didn’t take this lightly as it almost seemed unfair that I got this chance to live while others who have a lung mass often have it turn out to be one of the most fatal of cancers.  Having to face the prospect of this potentially devastating diagnosis changed the course of my life. I was able to view my career for what it was and had become.

 

I had planned to work in my medical career as a physician indefinitely, or at least well into my 60’s.  It had always been my passion to work in obstetrics and I love my patients and the bonds I build with their families. It was never my intention to leave early, and it didn’t factor into choices along the way for my career.  But here I was, ready to retire in my late 30’s after several years of increasing disillusionment with the health care environment.  Apparently, I just needed this wake-up call for a chance to realign my priorities.

Loss of physician autonomy, pressure to increase productivity as opposed to quality care, and placing cost effectiveness ahead of best medical practice were weighing heavy on me.  In addition, the litigious environment in the US has become out of control and encourages frivolous lawsuits without any repercussions for those seeking damages without merit or basis for the claim.

I could no longer honestly tell myself that I was working so hard for the good of my patients, and I became cynical that my efforts were to the benefit of the financial bottom line of a health care system with its priorities out of sync with my own.  This is not specific to any health care employer, physician group, or hospital.  It is emblematic of the US healthcare system in general.  It is the reason I left medicine entirely and did not merely seek to work elsewhere. The problem is pervasive.

The decision to leave became a question of “why am I doing this, and for whom”?  I decided to retire early.

I have since learned that many feel this is not an appropriate thing to do in your late 30’s.  There is the argument that I owe a debt to society now that I have the skills acquired from all of those years of training. Or that the government paid for my residency salary and that I am indebted due to that.  Or that it is selfish to stop working to spend more time with my family.  There is the argument that it is not fair to leave my patients that I have been caring for over the years.
My response to the ethics of my decision to retire early: If you pay for the privilege of a medical degree and work hard to pay off this debt, should it be your decision if you want to continue to practice?  The government did pay my salary as a resident, which amounted to a little more than minimum wage for 4 years of 80 hour work weeks.  Do I owe something because of this?

As for leaving my patients, I actually do feel a little guilty about his one.  I love my patients.  I also struggle with no longer using my degree for clinical practice, something I worked so hard for.  We are already feeling the strain of physician shortages and this another thing that gives me pause.

In the end, the burden of practicing medicine in today’s environment no longer outweighed the positives for me.

Ironically, it’s my patients who hugged me and told me how happy they were for me to live the life I felt I needed to.  It’s my patients that spoke up (without me saying a word) about how the medical field has changed and that we are losing good doctors as the control of medicine is being handed to hospital administrators and politicians who are making choices about health care without a medical degree. It’s my patients that brought presents on my last days and thanked me for the care I did provide throughout my career instead of lament about what I “could” have done if I stayed longer.

It was a very personal and difficult decision for me to leave medicine and luckily, my colleagues who know me have been incredibly supportive.  On the other hand, one thing that has surprised me is the number of physicians contacting me who want out of healthcare but don’t know how, or can’t, get out.

How do we retain physicians? It is not by increasing salaries. Doctors aren’t in it for the money, we chose this profession to help people and save lives.  We do it by reforming the current health care environment and making this a profession that is sustainable.

Give medical decision making back to physicians.  Decrease the cost of health care by cutting out costly administrators and through tort reform.  This is the way to keep our best physicians and improve health care in our country for our patients.

Ultimately, is it ethical to retire early from a career in medicine? Or is it a bigger picture issue of how do physicians take back control of medicine so that we aren’t leaving at a time of shortage? This is a major concern for our country moving forward.