Doctors Opting Out
While the Washington bureaucracy and all its minions scramble around trying to craft just the right regulations that will magically make doctors and hospitals coordinate care, make primary care medicine more attractive as a profession, and improve access for millions of new patients, all at the same time, there is a hearty band of physicians who have solved these problems — at no cost to the government.
Not only are these physicians hearty, they are also happy. They have fallen in love again with the practice of medicine. They are happy to do primary care — the orphaned step-child of American medicine.
Their patients are happy, too. They have doctors who know them inside and out. They don’t have to feel guilty about contacting their own doctor at any time of day (or night.) And they have someone who will advocate for them if they need to be hospitalized.
A couple of recent articles highlight this important trend. Jim Doyle reports in St. Louis Today:
Fed up with managed care and yearning to spend more time with patients, a small group of physicians in the St. Louis area are focusing their practices on personalized care — and shunning payments from insurers and the government.
And in San Diego, R.J. Ignelzi reports:
In 2005, (Dr. Martin Schulman) jumped off the traditional primary care treadmill and started Encinitas Personal Healthcare, a so-called concierge medical practice. Instead of the usual 2,500-patient load, Schulman now has just 250 patients. Hurried 10- or 15-minute appointments now stretch to one or two hours. And, patients can call, text or email him 24/7.
These are just two examples of thousands of physicians around the nation who have grown weary of government and insurance companies trying to control the practice of medicine. They are returning to the time-honored tradition of doctors and patients working out mutually agreeable arrangements for the very best of patient care.
They are making a mockery of Washington’s efforts to invent “accountable care organizations” and “medical homes” through “pay-for-performance” and “value based purchasing” incentives. They are solving the “primary care shortage” by making primary care attractive again. And they are “coordinating care” by having personal physicians go to bat for their patients.
They are putting the “care” back into “health care” by having one doctor (not a committee) take care of one patient (not the entire population.) These doctors know that “population health” is best achieved one patient at a time.
Once the current “health care system” collapses like the house of cards it has become, there will still be individual patients seeking and willing to pay for the services of individual doctors.
These physicians are simply showing the way — with no help from federal grants, bureaucrats, or insurance company administrators getting in the way.
We have a very real risk of fragmenting our physicians into 2 camps. One that is controlled by the government or its surrogate -the health plans. And one that is controlled by patients, paying for the services they need. This fault line is growing every day. When will the earthquake hit?
As concierge medical practices become more common, I expect there will be initiatives by states to make treating patients enrolled in public health plans a condition for medical licensure.
Who can blame them?
I am sort of shocked that there aren’t more concierge practices in the US. I guess insurance payment mechanisms are too pervasive for there to be more.
Michael, not sure why you consider that a “risk,” it is a blessing. It is how most socialist economies work — one system for the masses with a black market underneath to take the pain out of compliance. Sometimes the rulers crack down on the black market but it doesn’t last long. The society requires that safety valve.
Devon, you are likely correct, but see above about socialist economies. The Docs will continue to serve the black market in the evenings while doing just enough in the government system to avoid the police.
The authorities will tolerate it to stem popular discontent.
Virginia, most are complacent, willing to go along with the authorities to stay out of trouble.
All of this is no longer hypothetical. It is here today. Time to read up on how people survive in planned economies.
I agree with Joe. Who can bleame them? At least by dropping out, they can practice real medicine.
Two problems with concierge medicine. First, it is largely cherry picking (or perhaps skimming the cream) and therefore not viable for the bulk of the market. Secondly, if the Congress is willing to mandate that individuals must buy health insurance, it will be willing to tie both medical licensure and hospital admitting privileges to participation in Medicare/Obamacare. As Greg correctly points out, that will result in a shadow market or outright black market in primary care. For surgical specialties, it will be tougher to have a “back alley” clinic, so those types of services will migrate out of the US (i.e. medical tourism). Either way, the quality and accessibility of care for most is likely to go down.
I wonder if the State will just make physicians work in public hospitals and take on new patients. As the shortage gets worse, the government will grow desperate.
Devon: MassHealth in the People’s Republic of Mass the medical board requires doctors practice “non-discrimination” by accepting all medical plans, private and public. I’m quite sure there are more, and a federal law is surely on the way.