Doctors, An Endangered Species Thanks To The repugicans

After your next checkup, if you know your doc pretty well, take a little time and ask him/her how the insurance companies are treating him/her under the new government health care plan. If said doc is honest, he or she will admit to being extremely frustrated over developments that could cost their practice some really serious money.

Doctors’ fees under the marketplace segment of the Patient Protection and Affordable Care Act (ACA) are, in many areas, nose-diving. Kaiser Health News points out that many state medical associations are getting physician complaints that lowering the rates could lead to a two-tiered system with doctors bailing left and right and leaving sick patients without a road map to care. With the current shortage of family doctors, the problem can only get worse.

Many market exchange insurance companies refuse to pay nearly as much for an office visit as the higher premium commercial plans. That either leaves more money for the patient to pay or refusal of the doctor to accept the patient at all. The insurance companies are not going down without a fight. Doctors’ fees are just the latest strategy to sabotage the ACA. Kaiser quotes a Senior Executive at Blue Cross Blue Shield Association as admitting that “some” of its 37 member organizations are, indeed, offering lower doctor rates, in smaller marketplace venues, but the Association insists that plans know that without a good network of providers, customers will “Go somewhere else.”

What a crock. Many marketplaces have a minimal number of options and a great many states have few options (some only one) outside the marketplace. As I’ve said many times before, no medical legislation in my state of North Carolina ever gets passed without the direct permission from Blue Cross Blue Shield. NONE, EVER!!!

I’m on the side of the docs. And it’s not only because they’ve kept me on this earth on at least three different occasions when I should have been fitted for heavenly wings. The most recent close call was nearly five years ago, when quick work by physicians kept me afloat for the hours it took for lifesaving surgery. Yes, they’re paid a pretty penny and are likely to live in swell houses, but what kind of living is it? It must not be great for some because the profession with the highest rate of suicides is the medical profession. And female physicians kill themselves at a rate of four times the general population of women. Dentists, by the way, rank number two in suicides.

Taking a closer look at the doctor business, let’s start with education. Years and years and years of it. It’s not unusual for a psychiatrist (must be an MD, plus a four-year residency) to have celebrated his or her 30th birthday by the time they open their practice. Then throw in continuing education for good measure. For any and all physicians, there’s undergrad, med school, specialties, internships and residencies, all before the major bucks start flowing in the opposite direction. Bloomberg’s Internet site reports medical school debts as high as $400,000 at interest rates of anywhere from 7-13 percent. The median tab for a private medical school, start-to-finish, is pushing the $300,000 mark.

Finally, after years of sleepless nights, memorization of a virtual foreign language, verbally abusive mentors and repeated conversations with self about why in god’s name did I want to become a doctor, the nightmare ends. You drag your newly reconfigured brain, what’s left of your idealism and open up your own place. And you thought med school was a slog? It’s at this point you realize you’re equal parts doc and small businessperson. Offices don’t run themselves. At the very least, you’ll need three more bodies in place every day the office is open. A receptionist (probably two, for in and out), a billing clerk, maybe a medical assistant or two, an office manager and, unless you outsource your tests, a lab tech. These are mostly modestly paid positions, but pay the practitioner must do; like clockwork.

Then there are insurance companies to deal with. Most of them will argue over use of a Q-tip. Throw 25-30 patients in the mix and you’ve pretty much got the majority of a doctor’s typical daily working life. Yeah, a family doc will pull in a couple of hundred grand; some cardiologist and other pricey specialists nudge a million per annum, but for the most part, your physician is paid what he or she is worth.

And like the disappearing rain forests, doctors are becoming a rare species. Over 30% of doctors have passed their 60th birthday and not enough fresh faces are coming up to replace them. California is estimating a near-term shortage of 17,000 doctors and that’s just one state. And the moronic 2010 National Commission on Fiscal Responsibility (also called Bowles/Simpson or simply shortened to the ‘deficit commission’) proposed cutting $60 billion in Medicare support for physician Graduate Medical Education (GME) funds, or post-med school clinical training, over a ten-year period. In money terms, according to the Association of American Medical Colleges (AAMC) that total would represent a $254 million dollar loss for the state of Illinois alone, plus an estimated 3,500 jobs. The proposal collapsed under its own political weight and was never adopted, but you can bet the farm, it will reappear annually under the auspices of Paul Ryan and company. Incredibly, Ryan was one of the Obama appointees to the commission.

GME funding has politically ping-ponged between the parties in the last few years. The White House fiscal year 2015 budget requests (pandering to the right) read like a kaleidoscope of jumbled numbers that say one thing and eventually do another. The positives include just over $800 million for the National Health Service Corps (NHSC). This specific money enables under-served communities to gain 15,000 primary care providers. But, upon further examination, these “providers” are not all docs. In fact, I doubt a majority of them will be med school grads. Most of the doctors are likely to be very young and just coming out of residency. I suspect patients already in the program are serviced, first and foremost, by nurse practitioners (the future of medicine) and physician’s assistants who are certainly educated and hardworking, but fall far short of the medical knowledge of the average doctor. And looking at the Health and Human Services website, there may even be a problem in getting enough of them for this idealistic venture. It must be pointed out that Nurse Corps Rural Recruitment has been at their job for years in supplementing the NHSC, but the need remains great.

A new GME program would get a $5.23 billion bump over the next 10 years. HOWEVER, the George Washington School of Public Health and Health Services ferreted out the small print of the budget that unearthed the fact that two existing programs are included in the calculation. Both are gone after FY 2015. And, in even smaller print, Medicare’s ‘indirect’ GME payments will actually be reduced by $14.6 billion over the next 10 years. Not $60 billion to be sure, but that cut will be devastating to both doctors and patients.

With this continued political shortsightedness, American medicine will be in critical condition any day now.

There’s a solution. It’s at your nearest polling place.