The Wall Street Journal reported that we are going to run short of doctors and the medical schools can't keep up. Due to the new legislation the medical schools are not able to turn out enough doctors, and most are choosing specialties due to higher reimbursement from the insurance companies. Specialties provide much needed revenue for the doctor starting off with usually over $100,000 in debt. A solution is to bring doctors in from around the world using the H1 visa. All the H1 Visa doctor must do is pass medical school in India, Batswana, or Mexico and then residence here in the US for 2 years. Heck, they have been doing this at the VA hospitals for years, and we have seen what excellent care our Veterans have received. But what do we do to solve this crisis? Yes another crisis. We update the law of course. We have already added incentives to go to medical school and for primary care physicians they receive a 10 percent bonus for seeing Medicare patients. We will spend tax money and give bonuses for number of patients seen, or we will pay for someone to become a general physician. Give the past success with Medicare, it makes you wonder why around 13 percent of doctors are refusing Medicare patients? With all of this incentives it just doesn't make sense.
Of course the fact that the amount of paperwork, incomprehensible regulations, and bureaucratic oversight to diagnosis and treatment would have no influence on the doctors decisions. That's ok. We will be able to find doctors who are more interested in conforming to these new regulations than treating patients. Those who are interesting in helping others will be better suited elsewhere like Batswana. At least when the patient dies we will have a well documented record of the attempt at a diagnosis, a list of the suggested tests that were denied, and the standard substandard treatments that were tried and failed. But it is really not their fault they did everything they could. We have examples of this in Europe, China and in the DMV. Very nice people who have become serfs. At work they cease to think for themselves or take initiative because they are either punished for violating procedures, or derided for thinking they are better than others. Having worked with multiple government agencies, I have found this to be true. Many of these individuals are very hard working, and have good ideas, but will not follow them because they understand the results. Given the current health care bill and the belief that a centralized system is the best way to handle our problems, let us explore the results.
Patient has an acute pain in the right side of their stomach on Friday morning. Our patient (Ms. Smith) calls the central scheduling office, who asks the standard scripted questions, to determine the appropriate doctor for our patient to see. After a 15 minute hold and another 10 minutes providing identification, so that the scheduler can access Ms. Smith's records to verify the supplemental insurance information she has paid to receive, the scheduler then begins the questions to determine the appropriate course of action. "Do you have a fever?", "Yes?" "Are you on any other medication than the ones I have just listed?", "Do you smoke?". "Thank you Ms. Smith", I can get you into Dr. Smeagol on Monday at 8am will that work for you.
Given that our patient is in extreme pain they ask to speak to the nurse practitioner, for a recommendation to visit the Urgent Care facility. "Of course ma'am, one moment please." Since we are experiencing a hirer than usual call volume your hold time is estimated to be 20 minutes. Twenty something minutes later the nurse practitioner, comes on-line and asks the same set of questions, "to insure quality care", and authorizes Ms. Smith to go to the Urgent care. Once at the Urgent Care facility, completing 3 sets of information and treatment authorization forms, government insurance authorization numbers, and spending 4 hours in the waiting room, they are moved to the examining room for the last hour wait to see the doctor. The resident who has been up for 14 hours and speaks pretty good English, tells Ms. Smith that she has appendicitis and she should go to the emergency room right away. He also says he will get the emergency authorization number from the Federal authorization line as soon as possible. Do to the higher than expected call volume, it takes about 30 minutes to obtain the emergency room authorization. (if this were a real emergency they would have called a special number for that authorization). See if the doctors treat without authorization they may not get paid and they waive their exemption from lawsuits. Ms. Smith authorization in hand heads to the emergency room. Once there she enters her name on a list and is soon called to provide her authorization and personal information. This is all verified and she is entered onto the schedule to be admitted. Now the pain in her stomach as really increased, and she is shaking quietly due to the fever. She is offered two Tylenol as the standard approved pain and fever control medication. Five hours later (because we have a doctor crisis), she is admitted. The nurse takes her blood pressure, temperature (yes it is 102), and pulse. The nurse dutifully notes these numbers on the emergency patient form. It is now late evening and the emergency room physician determines that Ms. Smith is suffering from acute appendicitis and needs surgery. He calls for authorization to perform the procedure (because it might be unwarranted), and requests for authorization for extended hours compensation since he must bring the surgeon in after hours. The on-call surgeon is then called. An IV is started to hydrate Ms. Smith. Because the authorization panel for the surgery grants a temporary authorization until it can review the case on Monday. No one foresees any issues. Ms. Smith receives her appendectomy Saturday afternoon, and leaves the hospital Sunday Morning (her supplemental insurance only covers one day in the hospital) to recuperate at home. This is the optimistic view. Ms. Smith was able to get surgery on a weekend and her appendix did not rupture, or any of the hundreds of other little things go wrong. I tried to focus on success in the scenario above. Somehow this seems ok and efficient to some.
This scenario is really not that far off. In fact it is easier than what some Medicare patients go through today. What is frustrating is that we have become so conditioned to the current state that is difficult to imagine that our grand-parents often had no insurance, lived saw doctors and received excellent health care. Of course it was simpler then, doctors didn't cost so much. Really? Or was it that we didn't use insurance as a prepaid health care card, and that medical schools were not as expensive, and when you didn't sue the doctor for your child having a cleft pallet. The fact that everyone will now see your private health information from the scheduler to the nurse practitioner. This was an example of a medical emergency, what about the headache that won't go away, and the doctor orders an unnecessary MRI because your are under a lot of stress. Why is it that a government board can make decisions for you, but you can't make them for yourself, based on your ability to pay and what is happening. If the headaches are very bad, and you don't feel they are just stress, then you and your doctor should make the choice whether it is a necessary test or not. Who are these people to make choices for us? Why do so many think that this is a better way to live? These issues are not government problems they are a society's view of the world. We will pay the price for all of these things, because we are not willing to think for ourselves, make critical judgments or make choices that may be painful. Until we change as a people we will have exactly what we deserve. Good intentions do not matter, only good actions. Good actions can only come from correct thinking and the courage to act.
