One example of what's wrong with America

[colossus]

So I haven't posted in AT OT in almost 5 years (I used to post essays here on all kinds of stuff), but this really got under my skin.

So I'm a newly graduated Family Practice physician in Southern California (graduated in 2006) and I do mostly hospital call trying to build my practice (I have 5 patients to my name after 2 years at this). I'm on ER call at Downey Regional (a local community hospital impacted by the massive closure of the Martin Luther King hospital last year). So anybody who comes into the ER and needs to be admitted and doesn't have an insurance plan that has a specified doctor I end up admitting. If they have no insurance I end up admitting. I do this in the hopes of finding patients who like me and end up switching to me as their doc. Most of the patients I end up getting are cash patients - which is a real misnomer. They have no insurance so they are expected to pay cash. Of the 476 of these uninsured patients I have seen to date, my biller has only been able to get payment from one guy. 475 people haven't so much as sent a thank you card, a pumpkin pie, zilcho.

So I just got a 23 year old woman who is being admitted for abdominal pain with a white count of 23K and free fluid in the abdomen. I haven't see her yet, and initial ultrasound and tests don't show any obvious source of a problem, but she is sick from the labs and clinically she looks/feels sick.

Now when I was 23 I had insurance under my dad. Sure he paid for it, but I owed him in the form of chores around the house (I'm 32 and still live at home until I get married in 3 weeks - sad, I know). I have yet to see a patient under 25 who I have admitted who had insurance. I guess it's not cool to have insurance - must put a damper on the sex life or something. Maybe it cuts into the number of beers you can buy.

Anyways, the nurse just conveyed to me the patient really wants me to "heal" her quickly so she can go to Vegas on Thursday :disgust:

Mind you I spend about $40 a day on malpractice even if I see nobody (that's how much it costs to do plain Internal Medicine and no in-hospital procedures). Figure I spend $10 on gas/car driving to the hospital. This woman is costing me $50 a day to see her! And she has no insurance and based on previous track record I have about a 1/500 chance of being paid by her. Instead she's taking the money to Vegas to do God knows what (of course I haven't seen her yet but that's what the nurse relayed to me when she asked for orders).

Anybody want to make a wager on the chances she
- will complain when I tell her she might be here past Thursday
- won't pay a penny for seeing her (despite the ER calling me at 2:43 in the AM and the nurse calling me at 3:41 in the AM)

I know I shouldn't judge people, but I've just about had it with medicine. I was going to do anesthesiology for the money and lifestyle, but I knew I would make a better family practice doctor (I do have a gift of being very patient and sitting with families and explaining everything). I thought I could make a difference and be a better doc than those paper pushers at Kaiser that my parents see (once my parents hit 65 and go on Medicare I'm yanking them from Kaiser). I paid myself $37K last year (it was my starting year) and I made less than most of the janitorial staff at the hospital despite easily working 80+ hours some weeks.

I don't want to be rich (I would have done business or traded on Wall Street if I wanted that), but when I can't even make enough money to buy a house after getting my graduate degree then I'm just fed up. In 3 weeks I'll be marrying an orthodontist. I didn't pick her because of her job or her looks (although I think she's damn cute). She made $3k in 6 hours time gross (if you take out the overhead it's still almost $2k). Working the way I work (really explaining stuff to patients so they don't do the same stupid stuff) I'm happy if I make $50/hour. And of course Medicare wanted to cut 10.9% and Congress vetoed Bush's veto (hypocritical conservative dumbass).

So now I wait to get my first lawsuit (it happens sooner or later in LA) or pay off my $240K of student loans. I'm too old to go into orthodontics (don't think I could look at teeth all day). This is coming from from somebody who went into Family Practice even though I had the scores to get Opthomology or Anesthesia (harder residencies). I can't even imagine what the money grubbers in the medical community must be doing/thinking.

As an update, I've admitted 6 patients as of 5:03AM. 1 is Medi/Medi (Medicare & MediCal - I get paid about $50/day by Medicare and Medical has broke California's back so nobody is getting paid by them which I think is illegal but good luck suiing the government). The other 5 are uninsured. So tomorrow I'll make $140 (History and Physical for Medicare is about $140) for about 6 hours of work assuming I don't get anymore patients. This is pretax - as I am a corporation it's more like $120 - or about $20/hour.

This country is headed in the wrong direction and goverment can't fix it since the people itself are the problem... :frown:

 

[TruePaige]

Hey man, I can feel for you.

MaineCare system hasn't paid the hospital the last 3 years bills...it does seem very illegal.

Some way for them to set an example on how to be a decent umanbeing.

 

[Regs]

Welcome back! Great post, lots of words.


I to agree that the people are the problem. They keep voting for the dumbest idiots (who happen to appose abortion, with lower taxes and have more than one child), have frivolous law suites, and take advantage of their own system whenever they get a chance. Why? Because they think the world owes them something in return for their birth.

 

[PlatinumGold]

so, is this about stupid patients or how much money you aren't making?

i could have told you family practice doctors don't make money.

 

[MichaelD]

Nice read. I actually like the long rant threads; I used to post them myself. Though I'm just a nobody IT Guy who used to have misogynistic tendencies and not a Doc. You=Teh Specialz.

It's really a shame to read things like this. You honestly give a darn about what you do. You like what you do. You just just have "the nerve" to actually want to get paid for it and get a fair shake from the dice.

What about maybe moving to a different state with different laws on how you get paid? What about signing up at a big hospital in said state and just being a "regular doc on the payroll?" I have no idea how these things work, so sorry if I'm way off-track.

 

[Pliablemoose]

Sounds like you need to consider another field or move. We're always looking for family practice docs, fire me a PM if you'd like to move to Texas, or seriously consider an Anesthesia Fellowship, they make insane $, and there's more patient contact than you'd think.

I had to quit working in the ER, I now work in the surgery side of things, patients are a hell of a lot easier to take if I can pump them full of morphine, fentanyl, versed, etc...

And unless it's an emergency surgery, the $ is all taken care of before the surgery, a massive plus.

<----Nurse for 25 years

 

[mugs]

At least they'll have the pleasure of dealing with collection agencies for years.

 

[Tweak155]

Interesting post. No, I don't have any other input.

 

[Vette73]

Kaiser is a POS for health care, I agree. I hope your parents don;t get real sick while they have them. I can;t wait for open season.

 

[moshquerade]

Are you looking for or considering another job? You do know that rural areas would LOVE any family practitioners they can get their hands on, and you would be paid a lot better than you are now. Plus there are incentives to come here.

Why do you stay in the situation you are in when you obviously are being used poorly?

 

[Cattlegod]

Can you lower your rates? You may have a better chance of collecting if it isn't so expensive.

 

[PlatinumGold]

it's funny how patients abuse insurance checks. i'm doing some work for a surgical center, a patient had surgery done their. they billed his insurance company for him, insurance company sent the patient the check. he cashed it, the insurance company has the cashed check with his signature on it, and he claims he never received it. :roll: and to top it off he's a labor lawyer.

 

[Gibson486]

GRRRRR....My dad's insurance dumped me after I graduated. I had to go to the emergancy room for an injury while I was moving out of my apt (involved Uhual truck, TV and my foot). Well...I told them I had no insurance, so they said, fine, you can use MassHealth. Well...at the same time, MA was making in mandatory to have insurance. I did not want to do MAssHealth, but I could not afford regular insurance with no job ($500 a month with no income is a no go). Well...I signed up and went through the process. 2 months later, after I become employed, I get a collections notice. WTF???? Turns out that even after I was admitted into MassHaelth, thye still denied my claim. WHy? Because my time in the emergancy room was 1 day before I was signed into MassHaelth. They do not cover dates before enrollment. Yes, they have no problem covering a person who goes to the doctor to get laser surgery for acne, but they have a problem covering an emergancy room visit that was pre-dated by one day.

 

[colossus]

Originally posted by: mugs
At least they'll have the pleasure of dealing with collection agencies for years.

That's the thing. My biller hasn't sent any of these to collection. The only person who paid was the person who had a seizure on a cruise ship. He was 62 (retired at 60). His daughter drove a MB (I drive a Ford Contour). I saw him for 6 days for new onset seizure, Diabetes Out-Of-Control (admitting glucose was > 500 so he was near DKA - probably what triggered the seizure) and uncontrolled hypertension.

Apparently it's looked down upon for a physician to go after the patient. I'm finally fed up with these people. Not even a thank you card. In the old days they would bake you a pie at least. Not even a hint of gratitude from these patients. I think they think the hospital pays me.

THE HOSPITAL DOES NOT PAY PHYSICIANS
Except for rare cases the docs don't get paid by the hospital. They get paid by insurance companies. If you're uninsured, and the doc helps you - you owe the doc - at least a thank you if that's all you got.

The median home around that city (Downey, CA) is about 550 - with some as low as 410 but some as high as 3-4 mil (north Downey).

What pisses me off is this stupid 23 year old who chooses Vegas over her own health insurance.

You know the saying, well at least you have your Bellagio

I'm not looking to join another area of medicine. I did 6 months of anesthesia and loved it. I even matched in SoCal but I bailed to do FP. I thought I was doing the right thing. Guess no good deed goes unpunished. I'm angry at myself for feeling bitter. It was my choice, but I didn't think it would be this bad.

What physician in their right mind would send their kids into medicine?

I know pay is a lot better in other parts of the country. Starting FP pay is $120K here plus you have to do call. In other states that would get you $250 up to $300 to start. Yet everybody else here in CA gets payed ridiculously (even the waitresses make $100/hr on a good night).

Sorry I went Off Topic on my Off Topic rant - but that's just what it is. It's not just medicine. I've been writing to CalTrans for 3 years trying to get them to fix/restripe the 91/605 interchange but they don't listen. You don't need to be a civil engineer to figure out laminar flow. Any idiot can see where traffic builds up and where people cut in. Nobody listens - not even the people who should.

The one hope I have - a fellow resident's mom is a Congress Woman (guess that's the term) in NV. I'm going to work full time with her to pass nationalized EMR - that will save money and fix some of the wasteful redundancy....and catch those bastards docs who are abusing/cheating Medicare. Damnit - I pay into it - I want it when I retire. That's right, if I'm going down - I'm taking everybody else with me

I've been working every day for the last 748 days straight - no breaks. On call 24/7/365 - just like the President. Only my medical partner who covers me in emergencies (he was my chief resident) has gone longer (he just past 2.3 years going straight - he took a day off since his first child was 2 months preemie)

 

[colossus]

Originally posted by: Cattlegod
Can you lower your rates? You may have a better chance of collecting if it isn't so expensive.

I guess I could. Haven't mentioned it to my biller. But it does say on the bill that partial payments would be accepted if patients truly have inability to pay. The one guy who did pay (the guy with the seizure who had $) only paid $250 of a $1100 charge. And he went on a cruise.

 

[Modelworks]

This reminds me a lot of how social services works. My cousin is the manager of a local office. She complains often about how people can come in and get benefits, food, rent, utilities, then walk out the building and drive away in a $30K car, or go home to a $200K home.

I hate how large a cost malpractice insurance is for doctors. A doctor can be really great and never have had a claim and still have to pay insane amounts of money. I wish there was some way that us as patients could somehow allow doctors to work without having to have it. I think most doctors really try hard at what they do and they are human, so when a mistake happens, if it was an honest mistake I can't see suing my doc.

 

[Reel]

As a very affected doctor, what do you think is a reasonable solution? Would requiring all people to have medical insurance satisfy your complaints? Socialized healthcare? What do you think, colossus?

 

[Anubis]

Originally posted by: Cattlegod
Can you lower your rates? You may have a better chance of collecting if it isn't so expensive.

i can tell you right now that wont do shit

my dad is a general surgeon, all of what the OP posted about people not having insurance and not paying is true for almost all of medicine,

my dad has sent people to collection for as little as 10$, he waits 6 months of no payment before he sends them to collection, people are cheap, many are stupid and the Medicare COs are the major prob because they reimburse less and less every year

 

[Descartes]

It's interesting to read about the business side of medicine. Having an indirect relationship with the industry, I find it almost flabbergasting how things are actually run, how patients are treated, how patients treat their health, and just how downright disorganized so much of the operation is from primary insurance companies all the way down to the individual.

So, I sympathize.

As someone who is knee-deep in the medical billing side of things (from a business perspective), my recommendation would be to shop for more billers. What are their collection methods? Are they sending the appropriate letters at the appropriate times? Are they accepting payment plans? Do they have the proper systems in place to support this?

 

[ryan256]

See sig

 

[911paramedic]

WBC of 24K? Yes, she probably required an ER visit.

The problem is many people use the ER as their primary source of care and never pay, so the hospital needs to make up for their losses. That means $12 for two advil. Same with the ambulance, $800 on up for a ride on an ALS rig.

Oh, and as you already know, health insurance is very expensive, that's why it's always an issue during elections. I do agree though, the system is broken.

P.S. You should know that people that age don't thing anything will happen to them. (The vegas trip was less expensive than an ER visit too, without a doubt.)

 

[eits]

try chiropractic... you'd have a badass practice being an md/dc.

you can treat people and fix the problem causing the symptoms rather than covering the symptoms only with drugs or surgery... and you can prescribe antibiotics and other necessary medicines if you need to without referring out.

 

[eits]

Originally posted by: moshquerade
Are you looking for or considering another job? You do know that rural areas would LOVE any family practitioners they can get their hands on, and you would be paid a lot better than you are now. Plus there are incentives to come here.

Why do you stay in the situation you are in when you obviously are being used poorly?

this.

 

[slsmnaz]

Originally posted by: eits
try chiropractic... you'd have a badass practice being an md/dc.

you can treat people and fix the problem causing the symptoms rather than covering the symptoms only with drugs or surgery... and you can prescribe antibiotics and other necessary medicines if you need to without referring out.

so the real MD is the quack and the chiro is the healer? Wow...

 

[Taejin]

Originally posted by: eits
try chiropractic... you'd have a badass practice being an md/dc.

you can treat people and fix the problem causing the symptoms rather than covering the symptoms only with drugs or surgery... and you can prescribe antibiotics and other necessary medicines if you need to without referring out.

ignorant much?