So is your usual experience in going to the doctor’s office characterized by calling for an appointment, and, if you’re lucky, waiting for several days to be seen? And when you finally get there, you feel that you’re not given the time to address your concerns? Have you even written down a list of your problems, to make your visit more efficient, and your doctor simply tells you that he can only deal with one problem on the list at a time, telling you that you’ll have to make other appointments for each of those other concerns? Have you left, feeling frustrated and ignored? Wondering why the physician would treat you like that? After all, didn’t he go into medicine to help people? Has your anger simmered as you walk out the door?
You may remember some TV physician lending a sympathetic ear to his patients. Or hearing a story about a specialist who calls their patients at home at night, just to see how they are doing. Why isn’t your physician like that? How did the present state of physician care devolve into what is happening today?
To find an answer one need look no further than recent banking regulations which made it much more difficult for new medical practitioners to get loans to start their own practices. Coming out of medical school, saddled with educational debt that, in many cases, exceeds 250,000 to 500,000 dollars, most new providers opt to go to work for hospitals or large medical clinics who can subsidize those loans and start-up costs. And in many cases it has resulted in physician schedules being managed by administrators with no medical training, who feel that the only way to recoup some of their expenses is to ensure that each provider sees patients every ten minutes; not enough time to address complex issues.
As a result, more and more patients are being referred to specialists for evaluation. More and more are referred to urgent care centers or to emergency rooms for treatment. And costs continue to escalate while the ultimate quality of care suffers. This has resulted in physician costs now representing 20% of the total cost of care. However only a small percentage of that is actually going to the primary care physician who ends up feeling as if he is providing medical care on an assembly line.
In Scandinavian countries like Sweden and Norway, where there is a single payer system, to avoid these pitfalls, physicians are given a salary rather than relying on their productivity to determine their income. And education costs to train a physician are not as exorbitant as they are in this country. But, on the flip side, there is no incentive for them to work long hours and care gets even more fragmented, with each provider only responsible for one aspect of each patient’s care.
So while our present system is expensive, and clearly not ideal, there remains no single solution to the current quandary. The employee who can best schedule physicians’ visits is the physician himself. Unfortunately few of them have been trained in how to do this efficiently or with an appreciation for the fiscal realities of supporting his/her practice. And many of the commercial insurers choose not to look at the overall cost of providing care to a patient but rather at the expense of each individual provider’s charges. And, in addition, will provide periodic audits of providers to find out if their visits are medically necessary, a time consuming endeavor for a physician already over-taxed trying to provide that care.
What’s more, insurers have come to the realization that, in the greater scheme of things, the costs generated by individual health providers is not the single biggest driver of the cost of healthcare at this point. Instead, when looked at overall, it is the type of patients seen, whether elderly patients, or those that are chronically ill, that are driving healthcare costs. And these expenses are derived from the expenses inherent in hospital care and home care provided to them. And in the expensive testing and treatment options that now exist. So while managers still try to increase revenue from their employed physician practices by increasing the number of visits per hour, insurers are looking elsewhere to try to limit the rising costs of health care.
Next time we will look at hospital care and explore why the lengths of your hospital stays are shrinking, leaving you feeling prematurely abandoned by the system. Questioning how you could possibly be ready to go home after that surgery or hospital stay.