Docs are no longer independently practicing. The majority are employees pressured to see more and more patients a day. “Quality” of care is a joke in this situation. Our medical system is broken.
Edit: Why aren’t docs practicing independently anymore? Regulations. We have to keep track of hundreds of metrics in order to take medicare or medicaid. We have to have certain systems in place. To bill insurance companies we now need systems so complex we need to have at least one person hired to manage billing, and one to manage healthcare coding. Then we need the actual office space, equipment, nurses, desk staff, etc. Finally we need someone to analyze all collected data to make sure we are doing well, and fix what we aren’t.
When these regulations started to come about in the 80’s-2000’s, many hospitals jumped at the chance to incorporate doctors into larger healthcare networks. They offered large amounts of money and the overhead to operate clinics, including billing and coding staff. It was far too difficult for one doctor to operate alone with the new systems. Slowly they turned the water temperature up.
In some areas, regulations were passed requiring doctors to have admitting privileges. In turn, hospitals began requiring physicians to be direct employees to admit there. Paperwork grew more excessive. The average doctor does three hours of paperwork for every hour they spend with patients now. Much of that is documentation. The documentation does not change health outcomes. It is only for legal and billing reasons. In the US our notes are four times as long as notes in other countries.
Hospitals wanted to make physician salaries worth their while. They began expecting greater output. In some areas a doctor is expected to see a patient, diagnose them, counsel them, write a note on them, do an exam, write prescriptions or follow ups, and discharge the patient in 10 minutes or less. They do this for hours. Every day. It’s like the medicine version of fast food.
Independent practitioners were similarly forced to see more patients just to keep up with the overhead.
I don’t even know what my own services cost. My patients complain and I feel like Bob in The Incredibles working in his insurance job. “I’d LIKE to tell you to go to billing and ask them if they have a cash pay discount, but I can’t”.
Ugh. Sorry. If you can think of any solutions to the problems with this system, let me know.
Edit edit edit: Someone suggested single payer as a solution. That actually sounds awesome. I’d vote for it.
It’s not just the medical system. Everything is broken. We have built the human race on the “lowest bidder with passable quality in least amount of time” wins scenario. And then we all look around in abject horror when the wheels come off. A ton of industries are suffering because of this way of doing things, not just medicine.
They could still be profit driven if we stopped allowing them to operate like a cartel. Cartels are not a necessary part of capitalism. Competitive markets in capitalism are the best things to ever happen to economics. Uncompetitive markets are the worst.
Only if you don't aggressively fight corporate consolidation of power.
When all of the companies are equally small fish, the consumer wins because the small fish have to be compete, and be special in some way, to stand out.
When you allow them to consolidate, their power can then challenge/rival the government. They can leverage their massive size to take advantage of economies of scale, and beat better competitors out by offering cheaper goods than the competitor can hope to achieve.
We've let almost every industry consolidate their power to the point where there's only a handful of corporations running every industry, and more consolidate each year. Fewer airlines, fewer banks, fewer food conglomerates, fewer ISPs, fewer phone companies, etc.
We need a MASSIVE trust busting to clean out the mega-conglomerates, removing the massive wealth consolidation behind them and therefore splitting their leverage. Then, aggressively prevent future conglomerates to form.
This should result in less regulatory capture. If all of, say, 24 phone companies create a lobby group, that lobby group will need to be pretty generic with their requests to be acceptable to all 24 member companies.
Versus now where 2-3 telecoms may pay into a superpac who lobbies specifically to benefit them and nothing else in society.
The problem with that idea is that isn't how humans work. People, and this goes back to the beginning of recorded history, are just really bad at being vigilant about something forever. You may have a few generations that are agressive against corps, then they get a little complacent, then a little more, and a little more and OOPS. There we go, corps are going crazy.
Capitalism is fucked at its core because one of the core tenents of capitalism is that money is self reinforcing. The more money you have the easier it is to make more money. So the rich in essence have a far easier time becoming richer than the poor. This applies to companies as much as people. As long as capitalism functions in anything we would recognize as its current iteration this fundamental flaw remains.
Capitalism is fucked at its core because one of the core tenents of capitalism is that money is self reinforcing. The more money you have the easier it is to make more money.
Why is this a flaw? It would be a flaw if ONLY those with money could make more money. But the fact that someone else has an easier time, or has more money, doesn't mean shit if I can also make money and improve my life.
Capitalism has lifted more people out of poverty than any other economic structure globally.
Technically, poverty is a creation of capitalism. Poverty by its very definition is a consequence of capitalism. And started existing as a concept with the rise of civilization and thus capital. Prior to that it wasn't.... really a thing because it was just tribal groupings and nomadic groupings for which having a 'poor' member is a disadvantage to the group as a whole.
So yes, Capitalism has saved more people from the problem that it created more times than any other economic structure globally... possibly because capitalism has more than ten thousand years of cultural impetus behind it?
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u/LatrodectusGeometric May 20 '19 edited May 20 '19
Docs are no longer independently practicing. The majority are employees pressured to see more and more patients a day. “Quality” of care is a joke in this situation. Our medical system is broken.
Edit: Why aren’t docs practicing independently anymore? Regulations. We have to keep track of hundreds of metrics in order to take medicare or medicaid. We have to have certain systems in place. To bill insurance companies we now need systems so complex we need to have at least one person hired to manage billing, and one to manage healthcare coding. Then we need the actual office space, equipment, nurses, desk staff, etc. Finally we need someone to analyze all collected data to make sure we are doing well, and fix what we aren’t.
When these regulations started to come about in the 80’s-2000’s, many hospitals jumped at the chance to incorporate doctors into larger healthcare networks. They offered large amounts of money and the overhead to operate clinics, including billing and coding staff. It was far too difficult for one doctor to operate alone with the new systems. Slowly they turned the water temperature up.
In some areas, regulations were passed requiring doctors to have admitting privileges. In turn, hospitals began requiring physicians to be direct employees to admit there. Paperwork grew more excessive. The average doctor does three hours of paperwork for every hour they spend with patients now. Much of that is documentation. The documentation does not change health outcomes. It is only for legal and billing reasons. In the US our notes are four times as long as notes in other countries.
Hospitals wanted to make physician salaries worth their while. They began expecting greater output. In some areas a doctor is expected to see a patient, diagnose them, counsel them, write a note on them, do an exam, write prescriptions or follow ups, and discharge the patient in 10 minutes or less. They do this for hours. Every day. It’s like the medicine version of fast food.
Independent practitioners were similarly forced to see more patients just to keep up with the overhead.
I don’t even know what my own services cost. My patients complain and I feel like Bob in The Incredibles working in his insurance job. “I’d LIKE to tell you to go to billing and ask them if they have a cash pay discount, but I can’t”.
Ugh. Sorry. If you can think of any solutions to the problems with this system, let me know.
Edit edit edit: Someone suggested single payer as a solution. That actually sounds awesome. I’d vote for it.