Saturday, February 22, 2014


"The best decision I ever made was coming to the USA for advanced training. The worst mistake I ever made was deciding to stay."

So sayeth a respected physician, a department chairman in his specialty, whose name is being withheld since he didn't give us permission to use it. The point is that this doctor's doctor expected to spend his life caring for people, healing the sick, the force behind the profession for so many neophytes in medicine. They did not expect to become nursemaids to insurance companies or to the Affordable Care Act.  But that has become their fate because taking care of patients, actually comforting them, has taken second place to the requirements of paperwork without which neither doctor nor hospital can be paid. Today after  interviewing  a bevy of doctors who spent about an hour each on computerized hospital discharge orders (it used to take 10 minutes if you wrote legibly) it became clear how disillusioned they were.

In our previous column we described how the internists found a way to mega-wealth by opting out of clinical practice and opting into the rarified world of industrialized and corporate billing ($800,000 for the board chair according to that year's IRS 990 form). But here's the other side of that coin: according to Kathy Kristof's report in MONEYWATCH,  internists see one patient every 30 minutes, put in 54 hours per week, but waste 23 percent of their time doing paperwork for insurance companies. Take home pay is around $185,000 (about a half-million less than the board chair's 800 grand). The lesson is learned: income has shifted away from clinical medicine and patient care and towards control of capital just as in business.

The new motto is "profits before patients." Keep that in mind as your doctor rushes out the door from your clinical visit. You are important, yes, but the paper trail is crucial. That's where the money is. By the way, Kristof's article is entitled "$ 1 million mistake: Becoming a doctor."


$1 million mistake: Becoming a doctor, MONEYWATCH, by Kathy Kristof, 9/10/13 (my editorial comment-- insurance companies are increasingly forcing hospitals and their doctors to process patients as though they were produce, get 'em in,et 'em out, and bill 'em quickly)

Obamacare enrollees hit snags at doctor's offices, LOS ANGELES TIMES, by Chad Terhune, 2/04/14 ("people are having trouble finding doctors"),  documentary movie, Evelyn Li, MD, Medical Consultant ("Life For Sale explores dangerous nooks and crannies of healthcare that until now have remained hidden from public view" -- RLW, Editor,

Late addition to post, 2/24/2014: "Doctors, insurers face off over pay," SAN JOSE MERCURY NEWS, by Tracy Seipel, 2/14/14,  ("... insurers are often caving in to the doctors ... medical costs are the largest component of a health insurance premium ..."  What this otherwise well researched story doesn't tell is that physicians' share of the health care policy premium is from 17 to 18% and that the insurers get the last word in the 'face off' when they use Utilization Review to deny specialty services, e.g., consultations, or refusing to cover physical therapy or to approve expensive diagnostic studies)