Wednesday, August 25, 2010

Physicians of Despair

The Annals of Internal Medicine released a summary by Zeke Emanuel et. al. of how the upcoming health care law will impact individual physicians.  First, I had the privilege of attending an invited talk by Zeke at the Leonard Davis Institute last November and the added treat of having him answer my question.  All stereotypes that his public statements have created of him, he is a very astute, articulate thinker with real medical experience.  The bottom line seems to be that for service to patients to become maximally effective and efficient, medical care will need to achieve electronic computerized parity with the banks, hotels, airlines and pretty much any other industry.  I've had my billing system computerized via a service since the late 1990's, as have most of my colleagues.  I do not even know if traditional One-Write Billing stationery is still available for purchase.  Patient care, however, still depends on written charts, though the large hospitals seem to be making progress in transforming to electronic record keeping which enables access to specific information more readily, as long as the doctor knows what needs to be retrieved.  To do this requires a large capital infusion with little financial return, since payment currently depends on how many patients you see or procedures you do, which will remain the same.  To address this newly mandated overhead, economy of scale will predictably be required, with a fairly safe prediction that physicians who practice alone or with a partner or two will need to seek employment, as I have already done.

For many of us, we value our autonomy above all else and found medical careers one of the few remaining outlets for continuing that.  Self-employment as we think of it will soon disappear and with it the freedom to hire who we want, set our vacation schedule, keep a share of our profits for extra work, and maybe even give us a means of product differentiation of why patients should come to our office rather than a colleague's.  Sermo, a physicians web site, printed the article and invited members to comment, which they did.  People post with considerable frequency that they are fed up and often professionally threatened.  The folks in their 30's and 40's will have little choice but to adapt and maybe withhold tuition from their kids if they express an interest in studying medicine.  The people my age are more likely to have their financial advisers total up their assets and if financially feasible call it a career.  There is clearly a sense of loss, an early expression of mourning for loss of what we once had.

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