I recently re-entered private practice. I take no Medicaid (I loose money after overhead on every patient I see), nor Medicare without adequate supplemental insurance - but this is capped by the Feds at ridiculously low supplemental amounts, so I don’t see many of those either. Straight Medicare - without supplemental - I break even and neither earn nor loose money, but loose my time, so I don’t bother.
With the upcoming changes I will almost undoubtedly stop seeing the Medicare with supplemental patients as well. As it is now, the reimbursement for certain services is worse than others, and therefore much of their care that I could do is referred out to providers with much lower levels of training/credentials.
In this and many other ways, in my practice and my life, I am, like many doctors, going Galt, entering early semi-retirement. Where I live there is a horrible shortage in my specialty, but I’m not working much, and am highly selective in the sorts of patients I will see - not only insurance-wise, but I’m no longer wasting my time and patience on people who don’t want to do what it takes to get well and stay well. If someone wants to waste my time and professional training, or if they come to me to boost their case in some disability or legal or custody situation, I simply refer them on. I’m a doctor: I’ve worked hard to be able to successfully diagnose and treat illness. That’s what I’m doing now. As a doctor, it feels very clean, and enjoyable, and my patients get well.
It’s an interesting experience, especially as I face the day when I will also be forced by the government to join Medicare, and will be unable to find a doctor myself. If I and our civilization make it to that point, it’ll be interesting to see how it plays out. Not planning on living forever anyway.
Then I know you'll appreciate this, said by the character Dr. Thomas Hendricks in Atlas Shrugged:
'Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything--except the desires of the doctors. Men considered only the "welfare" of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only "to serve." . . . I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind--yet what is it that they expect to depend on, when they lie on an operating table under my hands?'