Archive: Opinions

In a nutshell, here is what is wrong with the medical profession.  On the one side the cost of insurance for both doctors and patients is sky high.  On the other side the cost of medical services is sky high, in part because of insurance costs, and in part because medical things -- equipment, pharmaceuticals, etc. -- is sky high.  On the other other side insurance companies want to diagnose so doctors can't use their best educated judgement to fix what's wrong.  And on the other other other hand, most doctors view the human body as a collection of parts, one or two of which they choose to specialize in, rather than treating the whole human being, which in turn, leads to sky high costs as patients are shuttled from specialist to specialist.

Have I covered it?  Almost.  Because there is another other other other thing that seems to be relatively new: even though doctors are among the most highly paid professionals in the U.S. and even though, among the top 1% of earners being a physician is the most popular profession, doctors are finding it harder and harder to make a living.  Especially really good doctors who want to have their own practices.  Here in New York there is also the fact that our state is the second worst state for doctors.

According to a new Wallethub analysis only the District of Columbia is worse for doctors.  And to be picky, Washing, D.C. isn't actually a state, which makes New York the actual worst.

Source: WalletHub

Wallethub also ranks New York 48th in 'Opportunity and Competition' and dead last in 'Medical Quality'.  Our state is 45th in terms of the highest competition for doctors.  It is ranked 45th for having the highest malpractice award payouts per capita, and has the 37th most expensive malpractice liability insurance.  When you consider that the average MD leaves medical school with $180,000 of debt you have to wonder how much longer being a physician is going to be a popular profession in this age of the Affordable Care Act, a side-effect of which is more insurance company interference, and the Baby Boom of elderly patients now increasing the Medicare community.

I am one of the apparently rare curmudgeons who shops for doctors.  I insist on being treated by and as a human being by a doctor who isn't just interested in my liver or my nasal passages or sticking a camera up my you-know-what.  I had a wonderful doctor for many years.  He had a one-man practice, first in Cortland, and then in Ithaca.  But the costs and burdens of having your own practice got to him, and he sold his practice at a relatively young age.  He even wrote a book about it called Out Of Practice, which I think nails the problems the medical profession faces today.

What good is a system that has created such a miserable environment for doctors that it pops them out of the system, depriving patients of talented medical practitioners?  A system that forces doctors to become employees rather than entrepreneurs, adding a layer of regulation and second-guessing between doctors and their ability to treat their patients?

Anecdotally I thought Florida had a pretty bad medical environment, just one more reason I don't want to move to Florida, especially in my upcoming old age.

A close relative in Florida fell and broke himself.  We took him to the nearby imaging lab first, because he insisted he was OK.  He had to lie in painful poses while they took x-rays.  The picture showed a broken hip and shattered pelvis, so they told us to bring him to the hospital.  We did.  The young doctor examined him, then said he had to go for an x-ray.  I protested that he had just gotten one less than 30 minutes before, and why couldn't he look at that one?  The doctor said he didn't have access to it, and it would be easier (and left unsaid was the fact that it would be more lucrative for the hospital) to take it again.

Here is the part I left out: the imaging lab shares a parking lot with the hospital.  You can walk between the two in about two minutes if you saunter.  Here in Ithaca they can take an x-ray at Convenient Care and my doctor in Dryden can pull it up on his computer any time he wants to.  Or a specialist in Ithaca.  Or whomever.  You can even request a copy on a CD to take home so you can print a copy suitable for framing or copy it to your cell phone to show your friends.

And that was the good part!  They sent him to another hospital where an expert in hip and pelvis repairs could fix him.  He did, but must have slipped, because he gave him a dropped foot he didn't have before.  He was checked out of the hospital with no rehabbilitation facility lined up, meaning a full day on a gurney in the hospital hallway with no care or ability to get to a bathroom.  Rehabs kept dropping him, requiring more surgery.  And then the rehabs dropped him, as in wouldn't accept him, because they didn't want to be accused of dropping him.  I should add that at not time was a lawsuit threatened, and this patient had full insurance and the ability to pay his bills.

So I thought it was pretty bad in Florida, and pretty good in New York, but according to the statistics the opposite is true.  Not that I have changed my mind about moving to Florida, which ranks a relatively high 16 out of 51 on the 'good states for doctors' scale, by the way.  They have bugs in Florida.  More pollen than is really necessary.  And alligators.  And humidity.  Did I mention bugs?  I don't like those things.

But as a Baby Boomer I worry about health care I am sure to need here in New York.  I have been told by more than one doctor that doctors are almost at the point where they will not accept Medicare insurance as the environment becomes worse in terms of costs and paperwork.  Considering how many Baby Boomers there are in America it is hard to figure out who will be left to treat, but that's besides the point.

And how depressing is this?  Most of the wonderful advances in medicine are too expensive.  So we are told we could live longer or feel better, but we can't because it costs too much.  I have to wonder what is the point in making the advances if they can't help people?  Or they can only help people like Donald Trump who could afford to buy Heaven (and likely will need to if they want to get in).

How bad does it have to get before doctors can go back to being doctors?  Knowledgeable, caring human beings who see you as a person, not just a collection of parts, who earns a more than comfortable living as a reward for hard work, long hours, and the ability, unhindered by insurance companies and the state, to use all that education to actually heal people?

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