Doctors going broke

[n2doc]

By Parija Kavilanz @CNNMoney

NEW YORK (CNNMoney) -- Doctors in America are harboring an embarrassing secret: Many of them are going broke.

This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.

"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

more
http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/?npt=NP1

[eridani]

1. Over the past 20 years they've been turned into serfs for insurance companies

Private practices play hell trying to keep up with pointless bureaucracy. Group practices can at least afford to hire specialists.

[Ship of Fools]

3. The more bureaucracy, the less time they have for you.

I recently tried out a doc who literally stood at the door with her hand
on the doorknob during my intake interview. I didn't return.

I also had to cough up $100 to have my old medical transcripts taken by
hand by a third person to a xerox copier, then sent to the new doc. My copy
was all but illegible and it was missing some information.

I spent a number of years as an at-home medical transcriptionist, and while
I enjoyed a pretty good salary and lifestyle, it never ceases to amaze me how
bogged down the system is. Obama's intention of getting all of our material
online is no small matter, imho.

[hifiguy]

13. Indeed.

About ten years ago I was chatting with the husband of a co-worker. The guy was a neurologic radiologist who, according to his wife (my colleague) was a Repuke and came from a long line of Repuke doctors. I just about fell out of my shoes when he said he was a strong supporter of single payer. He said that any diminution in revenues would be more than made up for in efficiency.

HAving one payor and one set of forms to fill out would allow his practice to streamline clerical functions by 60-70%, he said. He told me that so much time and money was wasted filling out dozens of different insurance co forms and arguing with insurers about payment that his practice's overhead was vastly higher than it would be with single payer. He said single payer would allow him to provide better care to patients and run a far more efficient and patient-friendly practice.

[SpiralHawk]

2. "All your doctors are belong to us." - Big Health, Inc.

[dkf]

4. So who is making all the money?

How can expenses be going up 7-8% per year doctors getting less and less?

[RUMMYisFROSTED]

11. The insurance companies.

Malpractice/liability insurance being the most onerous.

[dkf]

14. But tort reform is not the solution?

[RUMMYisFROSTED]

20. One+ question.

What's rising faster? Medical Malpractice or Insurance Rates?

[Snake Alchemist]

5. I wonder how much this cardiologist is paying himself and his partners

"Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."

[alc]

8. I know one who pays himself almost nothing

Over the last 3 years he's paid himself 2 or 3 months each year. They live off his wife's salary except for vacation or home/car repair which he takes a salary for, and pays just enough to cover that. There are months when his practice bank account gets so low he's concerned about payroll the next month. He's looked at all sorts of options and said the only 2 ways he can make money are to join a practice or be a temp and fill in for doctors on vacation. He doesn't like either options because he wants to get to know his patients and spend time with them on their visits. Practices he can join have a 10-15 minute limit for most patients.

[Snake Alchemist]

9. Odd.

I know 4 or 5 doctors that I would consider good friends. A mixture of specialists and family medicine. They are all doing extraordinarily well. Nice houses, BMW's, the whole deal. Maybe it is regional.

[bermudat]

25. Most likely, he is not paying himself anything if he going into his personal assets.

Many physicians forgo paying themselves and funding their retirement to make payroll.

[Snake Alchemist]

6. And then there is this

"Changes in drug reimbursements have hurt him badly. Until the mid-2000's, drugs sales were big profit generators for oncologists.

In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients. "

Nothing like profiting hansomely from the critically ill.

[MahayanaLotus]

7. Would you think

this has anything to do with the fees they charge & the high cost of medical insurance?

[hifiguy]

10. The insurance companies are squeezing both

doctors and patients dry. Soon enough doctors too will see that they are part of the 99% no matter how much money they make. The insurers are out to crush them, too.

[lonestarnot]

12. Guess they better stand with the 99% against big insurance then?

[Catherina]

15. They have been and were some of the earliest ones out there

The insurance companies started squeezing doctors hard over 20 years ago. Blue Shield was one of the worst ones.


Here's just one old article


Occupy Wall Street Doctors: MDs for Social Justice Join Protest In Liberty Square
"Health care is a human right," say progressive doctors fighting for social change.
October 27, 2011 |


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Photo Credit: Asiya Tschannerl



A contingent of about 40 doctors in crisp white coats, carrying signs that read “Bronx doctors for Wall Street Occupation” and “My patients need jobs, education, healthcare for all, not just prescriptions, definitely not bank bailouts,” joined the throngs of activists at the Occupy Wall Street protests at New York’s Times Square two weeks ago.

Members of the umbrella group “Healthcare for the 99 Percent,” they are one of a growing number of OWS constituencies that view their particular cause not as a stand-alone issue, but integrated with other social grievances represented by the movement.

These doctors care for the people who live in the poorest congressional district in the country: the South Bronx’s 16th district. They see large numbers of patients each day who are hungry, who don’t have jobs or stable homes, who can’t afford their prescriptions. Widespread poverty means that Motrin and Lipitor won’t do much to help these New Yorkers; their health problems have much deeper socioeconomic roots.Not surprisingly, the Bronx is the unhealthiest county in the state of New York, according to a recent University of Wisconsin study.Dr. Cameron Page, who completed his residency in the Bronx and now works at Manhattan’s Beth Israel Medical Center, says that what he calls "upstream problems" have to be addressed first, because by the time patients get to the exam room, "it’s too late."

These progressive doctors, whose clinic prefers not to be publicly affiliated with them, believe in social medicine, which seeks to address the underlying social and economic conditions that impact health. Page says the intimate personal information he is privy to inspires his activism. A patient may be too ashamed to tell anyone but her doctor that her boyfriend beats her, that she’s living in a shelter, or that she’s hungry. “They tell you things they won’t tell anyone else,” he says. “Once you’ve been given that access...that comes with a certain responsibility.”

...

http://www.alternet.org/world/152872/occupy_wall_street_doctors%3A_mds_for_social_justice_join_protest_in_liberty_square/



Edit to add a statement from Doctors For America

A Physician Response to Occupy Wall Street: Occupy Health Care!

By Dr. Lisa Plymate
December 14, 2011 at 10:28am.


In recent months, many of us have been inspired and at times bewildered by the Occupy Wall Street movement. What is impressive to me is the way these demonstrators have managed to change the tone and even the content of our national debate. I think all of us recognize in our hearts that we as a nation have to address the needs of "the 99%" if we are to continue to function as a democracy.

With this in mind, a group of us in the DFA Discussion Group worked together on a statement to explore and express our common ground with OWS. In the spirit of the movement, we wanted a true call to action. We affirm that our action has to include telling the public and lawmakers in Washington DC what physicians want to see.

A Physician Response to Occupy Wall Street: Occupy Health Care!

We are physicians who are committed to reforming our health care system so that every person has access to affordable, high quality care. We cannot achieve this without fighting for economic and social justice. As doctors, we support many principles of the Occupy Wall Street movement. We cannot stand by; we must speak out.

We believe:

- Health care is a human right. We are not just doctors for the 1% or for the 99%, but for everyone.

- Economic and social inequalities are toxic to all Americans. These widening disparities directly affect our ability to perform our duties as doctors: to care for each patient as an individual and to improve our overall national health.

- In these hard times, a rising number of people suffer from inadequate income, lack of affordable housing, a failing educational system, a polluted environment and lack of access to affordable health care, yet national policies continue to favor those who have the personal means to avoid these problems.

- Too many aspects of our health care system have become corporate, and health care does not belong on Wall Street. Corporate decisions are based on shareholder profits and CEO salaries, not patient needs. A for-profit health care industry raises costs, lowers quality and reduces access. Our obligation as physicians is to work with our patients to help them receive the care they deserve.

- A healthy society is built on a healthy democracy with fair treatment of all people. The rights and needs of people, not corporations, are central to the health of our democracy. The highest duty of government is to promote and protect the welfare of its people. This includes promoting conditions leading to better health, while ensuring that everyone has access to appropriate health services when needed.

We agree with the Occupy movement that changes in our national agenda are long overdue. Further, as physicians we must champion the ethical values of our profession by fighting for our patients’ rights. We believe we can – and must – change the health care system and our society to make them more just. We will fight for these principles in our communities and in Washington DC, pushing our system to achieve what we know is right.

Sincerely,

Lisa Plymate, MD
Syed Taznim Raza, MD FACS FACP FCCP
Rebecca Jones, MD
Ina Roy-Faderman, MD
Heidi Sinclair, MD
AJ Layon, MD
Linda Burke-Galloway, MD MS FACOG
Mark D. Tolpin, MD FAAP
Teeb Al-Samarrai, MD
Lisha Barré, MD
Peter Reed, MPH
Eleanor Greene, MD
Christopher M. Hughes, MD

http://www.drsforamerica.org/blog/a-physician-response-to-occupy-wall-street-occupy-health-care#.TwcP7NRSTAJ

[lonestarnot]

16. Beautiful. We need more visible vocal docs.

[Catherina]

18. If only the media was doing its job! If I find pictures of some marches, I'll post them later

Doctors Support Occupy Wall Street Because Wall Street Is Occupying Health Care

We support Occupy Wall Street because the private health insurance industry exemplifies the OWS movement’s central tenet: its unchecked corporate greed tramples human need.

We support OWS because economic and social inequalities make our patients sick. Low wages, high unemployment, inadequate education, unhealthy food, unaffordable housing, unsafe jobs, a polluted environment, and a lack of access to affordable health care breed death and disability.

We support OWS because health care is a human right. We reject a system that forces us to treat patients differently based on their insurance and the treatments they can “afford.”

We support OWS because we believe in evidence, and evidence shows us that profit-driven health care decreases access, raises costs and lowers quality. It’s unhealthy for the 99%; only a few corporate executives, bankers, and lobbyists benefit.

We support OWS because our political leaders, held hostage by corporate money, reject evidence-based health policies such as a single-payer reform that would save both lives and money.

We support OWS because the health care economy – like the overall economy – has ample resources to take care of 100%, but those resources are siphoned off by profit-driven corporations in the interest of the 1%.

We support OWS because we took an oath to do no harm, and our corrupt political and economic systems are harming us all.

We support OWS because we are hopeful that we can change our society.

Join us!

http://www.pnhp.org/ows/index.php

FOR IMMEDIATE RELEASE: NOVEMBER 30, 2011

Nation’s Medical Students Join the Occupy Movement
Reston, VA—The American Medical Student Association (AMSA), the nation’s oldest and largest, independent association for physicians-in-training, in line with its long-standing principles, is officially standing in solidarity with the Occupy Movement and calling for access to quality, affordable health care, among other social priorities and policies that support the 99%.


On December 4, 2011 at 11 a.m., AMSA members will participate in the Health Professional Students for Health Access for the 99% rally. In collaboration with Healthcare for the 99% working group, hundreds of medical students in white coats and scrubs will join other health professional students and allies at Louise Nevelson Plaza in New York City and then march to Zuccotti Park.

While the nation’s top 1% continues to amass greater and greater wealth, the majority of Americans – the 99% -- sees our social safety net slashed with cuts to health programs, schools, unemployment coverage, disability and student loans. Americans are struggling to provide food and shelter for their families and to pay for medications - which are basic human rights. As the nation’s future health professionals, we are calling on America to change its priorities.

“It is time to refocus on the 99% and to develop equitable policies that support hard-working Americans,” says Danielle Salovich, AMSA National President. “AMSA has long fought for issues affecting the group of people that has now become known as the 99% - our neighbors, our colleagues, our patients, and our families - everyone who makes up the patchwork quilt of the United States. We are calling for access to health care, education, food, housing and other fundamental rights that are out of reach of so many.”

“As future health professionals, we are dedicated to the service of the 99% and we rise against those who continue to promote societal inequities that make all of us sicker,” says Colin McCluney, AMSA Education and Advocacy Fellow. “We join our voices together and we will not be silenced.”

To learn more about AMSA’s involvement with the movement see our Occupy-related web content. Click here to sign AMSA’s Health Professional Student Statement of Solidarity.
About AMSA and the AMSA Foundation

The American Medical Student Association (AMSA) Foundation, founded in 1962 to support the work and mission of AMSA, provides physicians-in-training with unique educational and career development and enrichment opportunities, research projects, and innovative community impact programs. AMSA is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at www.amsa.org

http://www.amsa.org/AMSA/Homepage/About/News/113011.aspx

[MH1]

23. I'll bet most of them are up to their eyeballs treating patients.

I have a relative who is a family practice doc and tries to treat as many needy patients as he can. He does a little bit of political action here and there but mostly he is too busy a) caring for patients and b) figuring out how to take care of his own family and c) helping his wife figure out how to get reimbursed by insurance/Medicare/Medicaid when the claims process gets gummed up, which is a high percentage of the time.

[eridani]

19. Good for them. However, PNHP has been fighting for universal health care since 1987

http://www.pnhp.org/

[Greybnk48]

17. There are so many people now without insurance

my Doctor's office is almost always practically empty (2 to 3 patients max, and there are about 5 docs and PA's and Nurse Practitioners). I used to sit in the waiting room up to 20 minutes; my Doc was busy busy busy. Now I wait less than 5 minutes every time; this has been for at least 5 or 6 years.

No jobs, no insurance. Who the hell can afford $100 for a routine visit?

They should all be praying for universal health care. Maybe then they'll get their patients back.

[Phentex]

22. All that AND it's starting to affect more and more...

The insurance companies have been raising premiums for years now, well before Obama took office.

Used to be those with "good" insurance never said a word about coverage for others. They were fine as long as they had their butts covered. Now, employers are cutting back on insurance and even when they offer it, they are cutting back on the coverage. So people who once thought nothing of it are finding themselves with huge copays, deductibles or no coverage on the procedures they need. Oh, and now the howling has started! Even people "with money" don't want to pay a lot out of pocket. I think they will start to look at universal health care in a very different light soon.

[PhoenixAbove]

21. K&R - for the nice docs anyway...

Some are real jerks though. Lurk at the KevinMD blog for any length of time. One doc was recommending a 5,000 dollar deductible. Said that, "would weed out the chaff." I snarled at him, "With all the PCP's crying poor mouth on this blog, what would we call that; poetic justice?"

Other doctors were fuming over the fact they were forced in certain states to take Medicare and Medicaid patients. Believe me, they are not all on your side.

It's going to be interesting to see how this finally plays out.

[Boudica the Lyoness]

24. Many are greedy bastards who don't give a shit.

My orthopedic surgeon is great and so is my GP, but I have ran into some ignorant and careless docs over the years.

A few months ago, my GP was unavailable and his partner saw me for a prescription renewal I needed. He was just awful...anyway. I have a condition that could cause me to go blind and this doc was telling me I needed to see a ophthalmologist again pronto, so I asked him to refer me to one. He asked me if I had good insurance and actually asked to see my insurance card before he asked his assistant to make an appointment for me with a local Ophthalmologist.

The Ophthalmologist was located in a brand new building shaped like an eye. We were there for about 90 mins, we only saw one other patient...and he looked like he was there to pick something up. There were two doctors at the practice and my husband, who was in the waiting room the whole time, counted at least four employees hanging about.

I have been noticing the waiting rooms at all the doctors I see are almost, if not empty. Same with dentists waiting rooms. I'm not surprised they are going broke. I feel so fortunate I have insurance...for now. I have been without it in the past. I envy my fellow Brits living the UK. They don't now how lucky they are.

[liberalhistorian]

26. You know, if it didn't affect the rest of us so much,

I'd say screw 'em, 'cause a lot of it is their own damn fault. The AMA, which is supported by the majority of docs, has been staunchly against any type of single payor or government care for decades. It's been against any type of reform even of a lot of egregious insurance practices for decades. It's stood in the way of any kind of progress for decades. It and too many docs have been in bed with insurance and drug companies for too long, so that they're lobbying against any kind of reform. ANYTHING that would actually help more people be able to access and afford needed care without losing everything they have, or a good portion of it, the AMA and too many docs have been against.

Many of them also refuse to even give you the time of day if you don't have the money upfront or excellent insurance, and medical collectors are horrendous, often even worse than those for credit card companies or other creditors. People aren't going to deal with that. Where the fuck do they think people are going to get the money to see them???

The only reason they finally, grudgingly approved Medicare and Medicaid, and allowed it to go through finally (AMA opposition for decades was a huge reason why it wasn't implemented sooner than 1965) was because they recognized that the momentum was too huge and its time had come. They were also finally made to realize how much more damned money they'd make, since more people would be able to afford them. That's the important thing, see, making money.

Those who do go against the AMA are shut out by the media and the mainstream health care industry. Physicians for a National Health Plan complained that it couldn't even get a word in edgewise during the health bill debate last year, the AMA was too strong and the media paid no attention to them even though they had tons of viable research showing the strength of their position. Fortunately, I'm noting many younger doctors not going along with the AMA and recognizing the need for a single payor/national plan and for docs not to be in financial cahoots with insurance and drug companies, especially drug companies. They're recognizing that people are more important than profits and many are even refusing to join the stodgy AMA. I hope that continues.