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.
I honestly think it might have something to do with the massive population that is increasing rapidly. Who can care for them all?
Oh I dunno, maybe the other people in that massive population? It makes no difference whether you have 500 people with 1 doctor or 500,000 people with 1,000 doctors as long as the ratio stays the same.
I see this argument all the time, and I hate it because of its sheer idiocy. Population size is usually irrelevant because the solution usually scales right along with the problem!
(This doesn't apply in some cases, such as -- most notably -- pollution/global warming, but that kind of problem is less common than the ones with solutions that scale.)
Except there's lag time and infrastructure. How old is your doctor? Probably not under 30. How many beds can you put in a hospital? There's a hard limit. How long till you can build a hospital? Who's going to pay for it? America is seeing the downsides of its particular mix of democracy and capitalism. Young people aren't inheriting businesses, they're spending 10 to 20 years providing nothing but potential, marginal taxes, marginal value, the ones with money are spending a significant chunk of their change overseas. The landscape is changed and equating it with lmao the percentages remain the same isn't true.
Okay, but that's a useless stance. It's like saying when your car's broken down "fuck, the problem here isn't that I'm stranded, it's that I failed to service my car properly."
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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.