It’s good to be back.  Too many distractions in the summer that just make it difficult to generate great ideas.

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Today, I want to start to think about some ways that we can view the health care crisis in this country.  One problem that I have mentioned before is that the consumer is the only constituency in this fight without a lobbyist.  The hospitals, insurers, doctors, pharmaceuticals, lawyers and software companies all are paying huge sums to the legislators to push a bill one way or another.  The only way to get to a solution on health care will be to compromise. What I thought might be helpful (and sometimes controversial) would be to look at each of these constituencies and see what changes might be beneficial to the health care consumer. I would love to hear your opinions on these rantings in the comments.

Today’s topic is doctors.

We all know that they are the personal face of the health care crisis.  As the main deliverers of our health care, they are there to see the failures in our current system as we see them.  But there are lots of issues relative to this last link in our health care delivery system that can be fixed.

Today’s doctor is overworked and underpaid, at least according to her.  They spend a lot of time working to convince insurance companies to pay them for services.  They are forced to rush patients in and out in order to see as many patients as possible.  In many cases, there is not the time to get to know the patient other than as a combination of diagnoses and test results.  Is this what we really want? It obviously is not what the doctors want.

On the other hand, doctors in all specialties spend at least 4 years in post graduate study and 3 years in residency, racking up hundreds of thousands of dollars in loans.  Is this a bit of overkill for the majority of the health related needs we have?  Yes, we will still need neurosurgeons, but do we really need this level of medical experience to diagnose ear infections and perform sports physicals? We have started to see a retail physician service, brought to us by Walgreen’s and CVS, who can perform these types of low impact evaluations on a much lower cost per procedure.  I would vote to see more of these as part of our continuing care.  Even better would be if they were coordinated by the same family physician we are comfortable seeing to insure continuity of care. I understand that people are loathe to change their vision of health care provided by physicians, but this is one compromise that we as consumers need to make.

The primary care physicians are hit the hardest.  They are the ones who have to fight with the insurance companies over every decision.  In many cases, they are fighting for the authorization for procedures that they get no financial benefit from, e.g. colonoscopies, stress tests, MRIs, specific drug regimens.  Instead of being the doctor with all of the responsibility for coordinating our care and little of the revenue potential, I would vote to change the role of primary care physician to that of a project manager for each patient.  They would call in the troops necessary to fulfill the patient’s requirements, whether that was a Physician’s Assistant for that ear infection or a Cardiac Surgeon to insert stents.  The primary care physicians would get paid for the coordination and project management of each patient and the doctors that were called in for ancillary services would get paid by the procedure.

Rather than a residency program where the new doctor works in a hospital for little money and no sleep, I would propose that the residency program actually become more like an apprentice role.  Newly minted doctors could work with established physicians in their specialty and learn the business from the ground up.  One initial benefit would be that the new folks would be given the opportunity to see how a practice works, the ins and outs of insurance, billing, scheduling and all of the other myriad details of a modern physician’s world.  Sure, the aspiring cardiac surgeon would scrub in on surgeries, like they do now, but they will do it under the tutelage of a teaching physician with whom they will have the opportunity to grow.  The doctor, rather than the hospital, takes on the role of teaching the physician.

Lastly, we tend to venerate doctors in our culture, from Marcus Welby to Dr. Kildare to Dr. McDreamy.  And doctors have done a ton of good, no question. But, the doctors have read their press clippings. Especially the specialists. My friend Sandra reminds me that one of the big issues with physicians is that they are simply greedy.  Fast Company had an article that claimed new primary care physicians make an average of $186,000 per year and orthopedic surgeons make triple that.  Yes, they have college loans, but these are not minimum wage jobs.  This is not practice income; this is salary, after insurance and office help and tongue depressors are paid for. Unfortunately, this problem will take time to fix, if we are strong enough to try, as a whole new generation of physicians will need to be introduced to these changes.  But it is critical that we as consumers understand the economics behind our health care and this is an area of concern.