I worry about the future of medicine, of doctors in particular, as the healthcare laws, mandates and reforms continue to change and evolve. It seems to me that outside of clinical and bench research and resultant treatment advances, few of the healthcare changes are occurring for patient benefit and certainly none are for the benefit of the doctor.
The outcry for “Healthcare Initiatives” by government and lawmakers because of the continued escalation of dollars spent on individuals’ use of medications, hospital services and insurance coverage, is never ending. Unfortunately, government’s answer to the problem never focuses on the root issue and therefore their proposals for fixing the situation will never be successful. A patient recently asked me, “How will Trump’s election and health care changes affect you?” My answer is that regardless of what Trump does or doesn’t do, most assuredly the changes won’t benefit me or other doctors in any way. We doctors can only brace ourselves for the impact and hope it doesn’t hurt too much.
For decades, the answer to rising healthcare costs has been to reduce doctors’ reimbursement rates. Doctors who have had a large percentage of their patients come from poor communities or who depend largely on government subsidized reimbursement (Medicare/Medical/etc.) have had to close their practices or work for someone else, such as Kaiser Health System, in order to have a guaranteed income. Not only are reimbursement rates reduced yearly, which is analogous to being demoted or taking a pay cut every year, doctors are actually being PENALIZED for not participating in more paperwork that does not improve patients’ health and adds even more uncompensated time to our days and increases our overhead. For example, Medicare devised the PQRS initiative, which stands for “Physician’s Quality Reporting System” that supposedly improves patient care by having doctors fill out various questionnaires regarding aspects of patients’ care and medical screening whether they are related to an individual doctors’ treatment of the patient or not. Doctors are being penalized by an additional 6% or more back to 2013 if they have not submitted the required paperwork. Unless something changes, future penalties are already scheduled up to 2018 for paperwork not submitted this year. The PQRS does not improve patient health outcomes; it gives the government a reason to do more of what they’re going to do anyway—make doctors pay.
It is ironic to me that the Medical Doctor, as a career, could be careening down such a treacherous road. I was eleven when I decided to become a doctor. I was told that it was a very noble profession but that I would have to sacrifice much in order to accomplish that goal. I would have to study hard, spend many years in school, and delay gratification for at least twelve years longer than most anyone else who wasn’t trying to do the same. I was warned that I would have to work very hard once I became a doctor and that my nights and weekends would not be my own. I was assured, however, that the reward would be worth it. The reward would be prestige, respect, financial comfort and independence, to name a few. Disappointingly, the promised reward is becoming ever more elusive.
I enjoy being a doctor, despite the undercut reward because I am gratified by working hard, taking care of people and “doing good.” Doctors are smart, kind people, who make decisions every day about how to best care for someone else. However, every person deserves to make decisions for their best benefit, especially if it concerns survival. I worry about what kind of people will become doctors in the future.The carrot should always be bigger than the stick and right now the carrot is shrinking at an alarming rate. The way it stands now, physicians are often the scapegoats and worker bees that businessmen and corporations oftentimes profit from unfairly. Government decisions are squeezing the very people who have sacrificed years of blood, sweat, and tears for their careers. Although I won’t quit, I for one would not make the same choice knowing what a doctor’s work and life would be like at this time. I am fearful about whether there will be any kind, compassionate, capable physicians when I need one in my old age. Despite all, I will remain hopeful that someday, smarter, wiser and gutsier politicians will step up and start looking out for the future of this country and its people.