Two doctors appointments, two views of the future; agreements about realities


Some will be choosing to flee

When Medicare starts cutting the fee

     A trend we are gauging,

    Docs and patients are aging

But no one should be working for free

I had two doctor appointments today.

Dr. Donahue, the podiatrist, confirmed my suspicions that I have posterior tibial tendonitis in my right ankle, and gave me permission to write about our conversation.

About ten years ago, I had a surgery for a similar problem in the left ankle, with mediocre results.   Neither of us  relished the idea of another surgery.  She told me to continue my current course:  rest, rigid orthotics, elevation, ice, elastic bandage, and hiking boots with a lot of ankle support; but I need to get an elaborate hinged brace made for my ankle.

I suspect that the same autoimmune tendency that gives me ankylosing spondylitis makes me prone to tendonitis; I’ve had it now in both wrists, both ankles, both elbows, and one shoulder.

We talked about slowing down.

I told her how I just finished two golden weeks in Grand Island, Nebraska, getting regular sleep, working less than forty hours a week, seeing respectful, hardworking patients.

Dr. Donahue has a three-year-old and works 30 hours a week.  We discussed the joys of rational hours.  She gets the best of both worlds; she looks forward to going to work, she looks forward to coming home and she gets regular sleep.  “So,” I said, “THAT explains your clear complexion and your shampoo commercial hair.”

Doctors’ life expectancy runs seven years behind the rest of the population because of stress and sleep deprivation.

If all the doctors do what I’ve done, I said, we won’t have enough doctors.  We can increase the number of doctors going into primary care by democratizing the first two years of medical school, and letting anyone who can pass Part I of the Boards go on to a clinical program.  We would get a lot of docs who would work fewer hours for less money.

A few hours later I talked to a doctor while he took care of a premalignant condition.  One of the few people who has read the whole health care bill, I asked him how he plans for the future.  “I’m stockpiling guns and ammunition,” he said. 

I filled him in on what I’d been doing (see my previous posts), and we talked about medical economics.  He pointed out that Congress will soon cut Medicare reimbursement by 29% and another 11% cut will follow a few months later. 

Most family practice offices run 60% overhead.  Where Medicare reimbursement falls below the cost of seeing the patient, many practices have stopped accepting Medicare.  If payment goes down, the trend will continue.

Then, we agreed, we’ll come to a situation where medical care is rationed.

One fourth of our doctors are over the age of 60; the more onerous the regulationsand the lower reimbursement, the earlier the doctors will retire.   Trying to get smart young people to give up seven years out of their ‘20’s is a tough sell now, and will only get harder.

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One Response to “Two doctors appointments, two views of the future; agreements about realities”

  1. Chaya Shuchat Says:

    What about mid-level providers? It looks like family doctors are already being phased out and primary care in the future will be provided by NPs and PA’s. All MDs will be specialists. The trend to “democratize” medical education as you put it by making it quicker and cheaper is already happening through NP and PA schools.

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