Twenty-two years in one location


Twenty-two years ago I came on board to my medical practice, and I’ll be leaving in about 12 weeks.

I do not walk away from a twenty-two year bond lightly. I will not go into the precise events precipitating my departure except to say the decision to leave belongs to me. My partners would prefer that I not go. I will have sterling recommendations.

The events have led me to a re-examination of my original mission statement, looking again at why I became a doctor and why I’ve stayed in medicine.

I went through my day, cajoling my adult patients about their diets and their exercise habits. I bonded to the young children by playing my way through the examinations. Two patients know. Some of my partners know.

One came to me today, three separate times, to talk about it. We agreed about a lot of things, but not about the bottom line.

I told an Hispanic couple who came in today as a new prenatal. Their young faces glowed with anticipation of the first child. In Spanish I told them that I would no longer be doing deliveries after May 7 (which is common knowledge) but I also told them that I’d be leaving the practice in the next few months, and that I would prefer that they not share that knowledge. They smiled just because I spoke to them in their own language.

A Nurse Practitioner whom I helped train several years ago stopped by after I finished with patients as I sat at my computer, entering data. I spoke to her about ten days ago about the medical directorship at the Carl T. Curtis Health Center on the Omaha Reservation, 44 miles south of Sioux City. The position offers a four-day work week and a competitive wage (monopoly money). Plus all the snow days off. Plus all the tribal holidays off. Plus insurance, both health and liability. We didn’t get as far as talking about vacation and Continuing Medical Education.

She loves her work and her position, and in her words, she can concern herself more with taking care of people than with RVU’s.

(About thirty years ago an evil consortium of government and private bureaucrats teamed up to make a fee schedule equivalency system for medicine. It disses the thought process and rewards procedures, and I rate it as Terrible. If I spend twenty minutes taking care of a person’s high blood pressure, high cholesterol and diabetes, I will earn almost as much as I will from freezing her wart. Which you can train a monkey to do. A stupid monkey. The system measures medical care in Relative Value Units.)

I have decided to Go Walkabout. If you haven’t heard the phrase before, it’s Australian for wandering around and having an adventure. I’m looking forward to it. I’m still generating a time line.

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4 Responses to “Twenty-two years in one location”

  1. Joyce Hays Says:

    Although this anecdotal account is interesting, it would be
    helpful if this physician would make some suggestions, as to
    how she/he would solve some of the dilemmas facing doctors
    everywhere. If I understand the future goals of the Obama
    administration, it would be, over time, to exit any health insurance
    company that is profit-making. Employees and executive of
    these insurance companies, do not add anything to the business
    of medicine. The huge profits that go to the executives of insurance
    companies, should go to physicians, in a different kind of distribution
    of wealth. Insurance companies should simply be the paper-pushing
    employees of a non-profit group, that keeps the files in order.
    Harvard business school along with Harvard medical school, crunched
    the numbers and concluded that the US should have a universal health
    care system……………a single payer plan, to be fair to all.

    • walkaboutdoc Says:

      Please check my post of 2/28/2010: Health care reform according to Gordon. The current system cannot be improved without dealing with tort reform, insurance deregulation, medical education reform, and tobacco taxation; my proposals are detailed.

      Insurance companies, evil though they are, take risks with money and generate profit thereby. In general, those who take risks should generate more profits. I think we all object to the amount of profit the insurance companies generate, and the way they break rules.
      But increased regulation leads to decreased competition, which leads to increased costs and increased profits.

      Basic economics.

      Harvard is ignoring their own teachings.

  2. Joyce Hays Says:

    i can still remember when BlueCross/Blue Shield did not make a profit,
    and this is not to say that employees didn’t get fair wages.

    Doctors were doctors then and spent valuable time with all of their patients. Doctors, in those days, did not have to fill out tedious forms accounting for their time.

    It is only when the insurance carriers decided to make a profit and become competitive with each other, that everyone began to suffer. They are the ones who put stupid regulations into place, requiring physicians to fill out forms and check off listed items.

    My great great grandfather, a country doctor, would drive his horse and buggy, at night, to treat a patient in need. He would also accept pay in the form of a chicken.

    While we’re not suggesting that the 21st century physician be paid with anything other than money, we do feel that the focus in medicine be on patients, physicians and medical research.

    Who are insurance companies that they should be in a position to dictate what a doctor should prescribe to his/her patients….and much more.
    As you know, if a doctor prescribes a particular medicine to his/her patient, the medicine will not be covered by an insurance company if they deem it too expensive (and cutting into their profit).

    • walkaboutdoc Says:

      While in the past the doctor’s autonomy was better, I would not return there for a moment. For all the hassles I put up with, I’d rather have 21st century American medicine than anything in the past. Even if I have to jump through hoops I can still diagnose and treat illness much better than I could have even a year ago.
      I have made housecalls. One of my patients so served didn’t know that the samples of medication received didn’t have to be paid for and brought me really first quality farm chickens, four and five pounders full of flavor. Sometimes I wouldn’t mind if a patient or two paid me that way.

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