"If A Doctor Doesn't Do Excess Testing, He Isn't Going To Be Able To Live"
Afford to live, that is. Compelling piece at KevinMD by Sandeep Jauhar, MD. An excerpt:
Oni said he had received payments from a mobile echo company for referring patients for cardiac ultrasounds. Though he no longer participated in these contracts, he was open about the fees -- about $100 per patient, paid in cash -- and he saw nothing wrong with it. "As internists we don't do procedures, so we have to figure out another way to make money. But it isn't hard once you figure out how to do it.""We don't clock the number of minutes when we talk with our patients," someone said. "We don't hang up the phone as lawyers may do if they are not going to get paid. No, we listen to patients and answer their questions, however long it takes."
The family doctor suggested that patients call a toll number if they wanted to speak to their physicians. "Sure, I'll talk to you," he said. "Just call this 888 number. I'll talk to you as long as you want. I'll even talk dirty to you." People laughed. "My lawyer always tells me, 'If I'm thinking about your case, even while I'm taking a leak, you're getting charged three hundred and fifty dollars an hour.' "
Oni said, "I have a cousin who is an OB/GYN. He is paying one hundred and fifty thousand dollars a year for malpractice insurance. As an obstetrician, you have to earn five hundred thousand dollars just to make ends meet. That is why people don't want to do it anymore."
"I did obstetrics," someone replied. "They used to pay fifty-five hundred dollars for fourteen office visits plus a delivery when you stay up all night. Now they pay twenty-four hundred. You think that's reasonable? Your wife delivered. Is that enough money to make it worthwhile?" He shook his head, disgusted. "The problem is, they cut the money, they took away the autonomy, but they didn't take away any of the responsibility."
via @medskep
I hate human nature: I hate it in patients more than in doctors.
Crid [CridComment at Gmail] at September 14, 2014 11:37 AM
My OB/GYN switched to being GYN-only at the beginning of this year. It was not because she dislikes caring for pregnant women and/or delivering babies. For the record, I paid $3000 and my delivery was a non-emergency C-section at a civilized hour of the morning; however, I was high-risk and required more than the usual number of office visits. I can see why she switched. She has chosen a different approach to compensating for lost/missing income -- she promotes wellness, vitamins in powdered form, weight control programs, etc. etc. I listen with a smile and buy some of the specialized vitamins because I see it as a way to pay more at the level at which her service should really be valued.
Though, I admit, I get a little antsy when I see people railing against "unnecessary" tests. My delivery was radically different, in a good way, than it could have been had my OB not been a fan of extensive testing. (At the other end of the spectrum of outcomes, well…I wouldn't be here to comment any more. That is the extreme other end of the spectrum, but it gives you the idea.) My kids were also able to get the benefit of in-utero steroids (to promote lung development) and magnesium sulfate (a brain protectant for fetuses), which means that their NICU stays were likely shorter and less intensive (i.e. less expensive for all parties) than might have occurred otherwise. I didn't feel particularly terrible when I walked into my OB's office on the day of the appointment that ended with her telling me to go to the hospital…but my tests showed otherwise. That's one anecdote, I fully admit, but I think it's overkill to assume that doctors who order a lot of tests are solely, or even primarily, motivated by the Benjamins.
marion at September 14, 2014 12:39 PM
☑ Dave B at September 14, 2014 12:36 PM
Crid [CridComment at Gmail] at September 14, 2014 12:43 PM
Whoops-- thread selection error.
However, while I'm here:
☑ Posted by: marion at September 14, 2014 12:39 PM
While having no opinion about the prices Marion paid for her work, I appreciate the thoughtful broadside against the theme of the post, which is kinda Drudge-tabloid-fearmongery. (Mosts posts here are that kind of thing, but after a few years of this, I see the verge a little more clearly.)
I mean, yeah, people in the health care business want to make money keeping you healthy.
That's what we want, right? We want them to make a living at it. And because we want the best people we can get, we want them well-paid. Amirite?
Right.
Crid [CridComment at Gmail] at September 14, 2014 12:47 PM
"If A Doctor Doesn't Do Excess Testing, He Isn't Going To Be Able To Live"
Afford to live, that is. "
And if he does do excessive testing, and your insurance stops paying for it, as they will, YOU aren't going to be able to afford to live.
Isab at September 15, 2014 6:34 PM
There are a few problems with excessive testing that don't normally come up. Time is the biggie.
If I am sent for a test, I have to find the time to do it. If I am a working person, this can mean lost wages or used-up leave that could be better spent when actually necessary.
If I am not a working person, this takes time and energy away from my other activities, such as volunteer work, caring for relatives, etc.
I got a tick bite. According to multiple doctors, there was no risk of Lyme disease since the tick was on me less than 12 hours (and they say 48 to spread the illness). Yet, there was an insistence upon my having a blood test for it "just in case." Fine, I can do that in office right then and they won't really let me leave if I don't, so whatever. I have to make an appointment to come back and get the results (wtf?) and THEN they say I have to do it again (two more appointments) in two months to do a comparison because it takes that long to produce antibodies.
So, why do we need the first test? I won't have antibodies for it. Why can't I get results over the phone? Money.
I want my doctors to make a living. I want them to make a GOOD living. I do not want them wasting my time!
Shannon M. Howell at September 16, 2014 7:42 AM
So, why do we need the first test? I won't have antibodies for it. Why can't I get results over the phone? Money.
I want my doctors to make a living. I want them to make a GOOD living. I do not want them wasting my time!
Posted by: Shannon M. Howell at September 16, 2014 7:42 AM
Insurance companies have structured their payments, so the doctors, and the testers can bill separately for every office visit and every procedure.
In order for them to maximize their payment from the third party insurance company, they must waste your time, and your resources, in the form of co pays, and transportation expenses.
Lyme disease is notoriously hard to test for. There is no pre treatment that will prevent it, so unless you have symptoms, testing for it, and treating it, just in case, are pretty useless.
The treatments are not particularly effective either.
Isab at September 16, 2014 10:47 AM
Leave a comment