Sister Mary Francis !! !!
Are those words someone else's - or are they yours - and may I use that ??
-AWESOME- !! !!
Posted on 07/19/2002 5:30:23 PM PDT by Sir Gawain
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Forty-five years ago, an immigrant from Russia (who might well have been denied admittance to this country had she faced today's oppressive restrictions) published a novel that described men of intellect withdrawing from the world. Rather than submit to increasingly onerous and stultifying laws and regulations, these business people, artists, and scientists refused to work under such chains. Better, they decided, to deny others the benefits of their skills, their knowledge, and their experience than to labor as little more than beasts of burden for unforgiving and demanding masters. The fictional scenario that Ayn Rand described in Atlas Shrugged is becoming a reality in at least one field of endeavor. Physicians are retiring from medicine or switching to other occupations in alarming numbers. Hospitals and communities scramble to decide what is causing this exodus of doctors. They fumble for solutions that reveal little understanding of the underlying factors involved. As is usual among society's "leaders," these people scratch at the symptoms of the problem while steadfastly and stubbornly remaining ignorant of the real cure to correct the malady. With the Baby Boom generation sliding slowly but inevitably into old age, the demand for medical care will only increase. Already, there is talk of a "crisis" as a "doctor shortage" looms ahead of us. Given the penchant of the State for exploiting and exacerbating crises — whether real or imagined — we can only shudder as we contemplate what "solutions" the politicians will impose upon us to deal with this problem. Other countries with socialized medicine have long had to contend with doctor shortages and the "brain drain" of professionals heading to less rigidly controlled countries such as the United States. What happens, though, when the last vestiges of freedom disappear from the last refuges for such fugitives? Consider Canada's current plight. The equivalent of "two to three medical school graduating classes per year" are leaving our northern neighbor for more congenial climes. Of 585 doctors who left Canada in 1999, only 343 returned. A "10% decrease in enrollment in [Canada's] medical schools between 1993 and 1997 . . . " creates a smaller pool of replacements for doctors who leave and for " . . . older physicians [who are] retiring at an accelerated rate." According to the President of the Canadian Medical Association, Dr. Hugh Scully, "Young physicians . . . are leaving for better working conditions and more research opportunities." The average age of specialists has reached fifty, while that for family physicians has increased to forty-six. (Mandal) Such wounds, however, are now inflicting our country, as well. Some examples of physicians who have abandoned their practices provide a sense of what is happening to these professionals: Dr. John Wickenden, 59, was an orthopedic surgeon practicing in Rockport, Maine. He retired after thirty years and has been filling his free time with " . . . writing, traveling . . . working as a . . . bartender . . . " Wickenden says that, "Dozens of times each week I have said, 'Thank God I am done with it [medicine and managed care].'" In Kalamazoo, Michigan, neurosurgeon Dr. Robert Fabi, 65, surrendered with the confession that, "What used to be a challenge before became a burden now . . . I did not want to work without enthusiasm." Rather than retiring completely, family practice physician Dr. David Abbott, 61, left the fast-pace of San Antonio, Texas, and moved to Harlem, Montana. "I was working twice as hard to maintain the same income," he said. "I had to do something different." These physicians illustrate the trend for " . . . an increasing number of [doctors] retiring, reducing their workload, changing their practice or moving into nonclinical jobs." Dr. D. Ted Lewers, AMA chair, says, "They are tired of the hassles [with managed care], the decreased reimbursement, the loss of autonomy and prestige." According to a survey conducted two years ago, " . . . 38% of doctors age 50 or older plan to retire within one to three years." Sixteen percent more intend to reduce their practices or to refuse to accept any more new patients. Asked why they are making these changes, forty-eight percent say managed care was a significant or the most important factor in their decisions. Indeed, seventy-one percent claim that managed care and/or Medicare/Medicaid hassles created their "biggest frustration." Sadly, fifty-six percent said they would not choose medicine again as a profession. (Greene) Direct State interference in the practice of medicine is not the only issue grating on doctors' nerves. Our legal system with its penchant for encouraging frivolous and lottery-style lawsuits and the lack of loser-pays requirements, makes it increasingly expensive and difficult for doctors (especially ob-gyn physicians) to remain in business. In West Virginia, for example, expensive malpractice lawsuits are driving doctors to other, less expensive states. Even though over the past five years, doctors there have won 85% of the suits brought against them, the cost of legal defense and malpractice insurance is exorbitant. Though the state Supreme Court capped the limit at one million dollars (down from $2.5 million), the level of awards in West Virginia is one of the highest in the country. (Though some states such as Illinois, Texas, and Washington have no such limits, at all.) The situation has deteriorated so much that forty percent of West Virginia's physicians are thinking of moving to another state. Thirty percent of them are thinking of retiring from medicine altogether. (Albert) In a recent survey published in Physician's Weekly, seventy-one percent said "yes" when asked, "Are we facing another physician shortage?" L. Clark, neurosurgeon, said, "The cultural expectations continue to rise: zero risk, zero complication, 'perfection' is the standard of care. All bad outcome is malpractice until proven otherwise . . . Many aspects of running a medical practice have now been criminalised. (sic)" Clifford Toliver, ob/gyn, said that, "Finally physicians are waking up. We are one of the most regulated professions in society. We have been forced to practice the business of medicine." He echoes the statistics cited above: "Physicians are fed up! Some are leaving the practice of medicine to pursue other alternatives. Others are retiring early. Those who stay are hoping for some type of intervention knowing that without it they too will be forced to quit." Gary Kaplan, pulmonary and critical care specialist, concurs: "The physician is being squeezed in all directions. Malpractice costs are skyrocketing, reimbursement is falling, and governments regs are draconian." (Physician's Weekly) With the trend towards ever-greater medical "entitlements" and State control of medicine, however, the future does not bode well for conditions to improve any time soon. "Free" prescription drug coverage, "free" health care for the uninsured, and increasing treatment mandates will simply feed into a rising demand for health care. Coupled with the natural increase in demand attendant with a graying population, and we see a recipe for disaster. Rationing of care, diminished reimbursement, and soaring power for bureaucrats will pit patients against physicians and both against insurance companies that are now primarily another arm of a fascist economic system. Calls for more federal aid, i.e., subsidies and welfare, for prospective medical students and for practicing physicians will do little to stanch the hemorrhaging that weakens our already critically ill health care system. Such actions will, however — as do most such thefts of others' money — lead to a "solution" that merely inflames the injury and gives birth to new "solutions" demanding yet another round of legal flummery. Unfortunately, much of the "shrugging" among the medical community is due more to physical, emotional, and psychological weariness than from any principled opposition to the welfare state. While a constricting of numbers among health care workers may sufficiently affect the middle-class that some controls may be loosened — for awhile — only a moral defense will stand any chance of working long-term changes. If doctors — or even a significant minority — boldly and loudly proclaimed that their lives belong to no one but themselves; that they and they alone have the right to use their skills as they best see fit; that no one has a "right" to health care any more than to any other value to be provided by other people; that they and their patients, together and in cooperation, have the sole right to determine what treatments are appropriate for any given condition; and that everyone else — and most especially the State — should butt out, then . . . maybe . . . we might witness a real shift in the twisted landscape that modern health care has become. I am not sanguine, however, that such a glorious transformation will occur. There have been doctor shortages before that led nowhere. Indeed, much of the travails and many of the tribulations doctors and patients now suffer were brought upon us by a majority of physicians themselves — in collusion with the State — as they sought to limit competition and to raise their own incomes. Doctors were the ones who helped close down alternate medical schools in the early Twentieth Century via "accreditation" requirements. Doctors were the ones who artificially limited the supply of physicians by demanding only "licensed" doctors be allowed to practice. Doctors were the ones who encouraged the development of "third-party" style health insurance. Doctors were the ones who helped impose Medicare on an unsuspecting country. Doctors are conspirators in plans to shove nationalized health care down our throats. Yes, many physicians opposed (and oppose) these horrors . . . but mostly in a halfhearted and "pragmatic" fashion. The handful of truly principled voices barely register in the political babble drowning out their objections. With new doctors emerging from medical schools and working in a society thoroughly steeped in the false assumption that medical care is a proper function of the State, there is little realistic hope that those who treat our ills and accidents will rescue us from this metastasizing nightmare. Though doctors may not be "shrugging" off their burdens and standing tall, at least many of them are recognizing that their present conditions are unacceptable for any person with a modicum of self-respect. That's a start. Still, until and unless doctors do shrug, what is happening to physicians now can stand as a lesson for all of us: Be careful what you ask for: you may actually get it. Like many of the rest of us, doctors are finally catching on that a State that is in a position to "help" you is also in a position to hurt you.
ReferencesAlbert, Tanya. "West Virginia Supreme Court Upholds Limits on Malpractice Awards." Feb. 5, 2001. amednews. http://www.ama-assn.org/sci-pubs/amnews/pick_01/pro20205.htm"Are We Facing Another Physician Shortage?" April 22, 2002. Physician's Weekly. http://www.physweekly.com/feedback.asp?issueid=16&questionid=14 Greene, Jay. "Physicians Enticed into Early Retirement." July 24, 2000. amednews.com. http://www.ama-assn.org/sci-pubs/amnews/pick_00/prl20724.htm Mandal, Veronique. "More Young Doctors Leaving Canada." August 10, 2000. National Post. http://www.mult-sclerosis.org/news/Aug2000/DoctorsLeavingCanada.html See Russ Madden's articles, short stories, novel excerpts, and items of interest to Objectivists, libertarians, and sci-fi fans at http://home.earthlink.net/~rdmadden/webdocs/. |
He's filling in as a temp doctor through an agency to cover other doctors who go on vacation. Thinks he'll do that for awhile while he finds another career to persue.
Instead, it proposed its own version of 'Medicare-lite' called "Eldercare". In doing so, it accepted the premise of third party direction in medicine. All that has transpired since was inevitable, only the speed at which it would occur was in question.
Instead, it proposed its own version of 'Medicare-lite' called "Eldercare". In doing so, it accepted the premise of third party direction in medicine. All that has transpired since was inevitable, only the speed at which it would occur was in question.
Well said, and sadly true.
This article is a clear, succinct summary. And physicians are to blame. Many are arrogant, patronizing, materialistic folk who willingly, daily, commit fraud of many types.
I wrote this for one of my own specialty's magazines:
TAKE A STAND AGAINST MEDICARE FRAUD
By [polycarp]
Editor: John McCord
In my first week of podiatry school, one young professor stood before our freshman class giving his first lecture. He began by saying, "Podiatry is what I do. It is not what I am. What I am is a husband, and a father, and a believer." It is the only direct quote I remember from eight years of schooling and two years of residency, and when I keep this hierarchy of priorities, life goes well.
During our early years, we lived in an apartment above our office. Patients got to know my wife and three young children, and continue to bring cards and gifts for birthdays and holidays. My training failed to prepare me for the depth and scope of the friendships I would form with many patients, or the very real sense of loss felt when patients passed away. The personal (if not financial) rewards of the practice of podiatry have far surpassed any preconceptions I had when I started my practice.
Unfortunately, all my years of training failed to prepare me for another reality of podiatry. Recently, I read a discussion on an online podiatry e-mail list about the perception that there is a federal "witch hunt" going on regarding fraud among podiatrists.
Yet daily I see evidence of the fraud the feds maintain exists, as patients come to my office after having seen other podiatrists. They uniformly expect that their routine foot care will be covered, because it always was before.
As I review their medical histories and find no qualifying systemic diseases, and find strong pulses and healthy skin, I go into what has become a standard monologue:
"Cutting toenails and trimming corns and calluses is called routine foot care. Medicare simply does not cover routine foot care unless the patient has an underlying disease that would make it dangerous for them or a family member or friend to care for them. Your feet are healthy and you have none of the underlying diseases, and you say you don't have pain in your toes from the toenails. Therefore, unfortunately, this will be a non-covered service. You may bring back your EOMB from your previous doctor's visit, and I can review it with you to see if there's some way I can get your treatment covered too."
After reviewing numerous past EOMBs with my patients and discussing this issue with peers around the country, I've come to the conclusion that the feds are not unjustified. Podiatry seems to be blind to the scope of insurance fraud rampant among our ranks. Here are some common examples:
* billing 11721 when there are only one or two mycotic nails, or, as often as not, no mycotic nails;
* reporting pain or infection where there is none;
* claiming PVD where there is no clinical evidence;
* class findings grasped out of thin air;
* billing 11721 or 11720 when 11719 is clearly the appropriate code;
* billing 11730 when no such procedure was done;
* billing for ulcers or skin neoplasms where only corns and calluses exist;
* billing the 11055-11057 procedures in conjunction with 11720/11721/11719 on patients with underlying systemic diseases where no corns/calluses existed;
* practices that bill routine foot care as covered in 100% of patients, or bill E&M codes instead when routine foot care is provided;
* unnecessary surgical procedures, such as the patient presenting with a simple, uncomplicated ingrown hallux nail who was previously told this was secondary to a very mild bunion deformity that would first need correction to resolve the onychocryptosis.
Medicare fraud is easy to rationalize (i.e., "Medicare guidelines and reimbursements are unreasonable," "procedural definitions are unreasonable," "managed care is taking away our patient base," "our bottom line is constantly shrinking," etc.) Given the entitlement mentality of the retirement population, who demand that every conceivable medical treatment be covered, I'm seen as the bad guy and the fellow who fudges it to get it covered is the hero.
Of course, these things are rationalizations, not justifications, for fraud, which is never justifiable. The government defines the regulations and terms under which we work and get reimbursed. They may be grossly unfair. Lobbying to effect change for the better is the duty of all disagreeing with these regulations. Committing fraud to circumvent them is unethical and criminal, and the feds would be guilty of wrongdoing in the utilization of my tax dollars if they failed to investigate and eliminate it.
Fraud investigation is also the only hope I have to practice on a level playing field. Maybe my religious convictions engender a certain scrupulosity over ethical billing practices. I know that if I'm ever forced out of the practice of podiatry, it will not be due to managed care, Medicare restrictions/cutbacks, or educational loans and malpractice costs. It will be because I cannot and will not compete with those--too common in our ranks--who say, "Podiatry is what I do, a Medicare fraud is what I am."
First, there is always change. Because few have the discretionary income or savings to pay for a serious illness or injury both insurance and government care arose. The very success of modern medicine means their are great benefits for all regardless of their financial means. In times past serious illness and injuries were seldom treated for long since if the patient didn't recover he or she died quite promptly. Now that there is an alternative and a means to do it the big change has and is increasing demand for services and an increasing population of individuals with chronic illnesses. A cost explosion has resulted.
Second, another big change has been the use of ancillary and supportive personnel such as nurses and so forth to do what physicians used to do. The team approach to medicine is just beginning and will vastly increase the performance and reduce the cost of care. Unfortunately, many physicians including psychiatrists oppose such changes. They will occur nonetheless because of economic necessity.
Third, IMHO, physicians cannot assume middle to high six figure or seven figure income as a reasonable goal. Too many physicians assume that long training and hours means they will be in the upper 1% of wage earners. This is changing and will change much faster as time goes on. No physician will need a tin cup, but also few if any physicians will need three Mercedes in their 2 million dollar home. It is a wise physician who does not entrap himself into an expensive lifestyle requiring an extraordinary income.
The litigation plague is part and parcel of the liberal conviction that lawyers are priveleged members of society and deserve outrageous contingency fees. It is a general problem for society and began at the very onset of our nation when attorneys were given powers above and beyond that of ordinary citizens
In the case of medicine, this may be illustrated by considering that there are two significant income threshholds for medical professionals:
What happens, really, is that the country has considerable capital in the form of people with doctor-level medical training. If physician salaries are constrained to be below the point where few new people choose to enter the field, that capital base will be eroded. It won't show up on any balance sheet, but once it's gone there will be no way to repair the medical establishment without spending money somehow to rebuild that capital base. Of course, those who seek to do that will be accused of causing the problem in the first place.
One other note: young docs like myself are simply self employed small businessmen. While we struglle to get a practice going, we get forebearance on our student loans.
I graduated with $117,000 debt in 1992, did three years residency, and I've been in practice 7 years. At no time during those intervening years have I made enough money to pay the $2000 per month student loan payments. In fact, for the vast majority of that time, most months I took home less than that.
After paying interest on the original loans and interest on the interest for 10 years, my student loan debt has almost doubled to $225,000.
My income still is not high enough to make the payments.
And even though I'm married with three young children, I cannot afford health insurance.
A fed job with a good pay scale, benefits, and retirement looks awefully good from the hole I'm in.
Sister Mary Francis !! !!
Are those words someone else's - or are they yours - and may I use that ??
-AWESOME- !! !!
This is, I think, key. Lawyers increasingly find juries who look at trials as "Wheel of Fortune." "Oooh, he's a doctor. He's rich. Let's give this poor person some money." I really believe most juries have their minds made up before the trial starts.
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