6 months of Obamacare and I’m Headed Towards Bankruptcy: One Doctor’s
Insights, by Drpost, 6/20/14
Physicians are Facing Bankruptcy
Under Obamacare
I was a bright, enthusiastic, and
hopeful child full of dreams to help others. I fantasized about
performing the most challenging and complex surgical techniques and then
walking into a room with a humble smile while people greeted me with
appreciation, hope, and respect for saving lives. I was offered a full
scholarship to MIT for Computer Science and I passed it up to accrue hundreds
of thousands of dollars in medical school debt in order to become a
surgeon. MIT will you take me back? Please? Is it too late?
OK….. I was a dreamer. I
genuinely believed–from the bottom of my heart–that all the brutal physical,
mental, and financial sacrifices of training to become a physician would lead
to a comfortable and tremendously fulfilling life—financially and emotionally.
Unfortunately, rather than enjoying
the fruits of a hard-earned career this year, I noticed an alarming change in the dynamic of my career and where my
surgical practice is headed. I tried to convince myself that I was
just feeling pessimistic, and that nothing had really changed
significantly. However, when I saw that every month my earnings have been
declining, I decided that I needed to sit down and evaluate what has been
happening to my practice. I focused exclusively on the last 6 months—the
exact period since the inception of Obamacare. I sat down and looked at the
numbers and trends in detail and I was
horrified by the new reality of my private practice. I want to
share with you what has been happening around me as a private practice
physician since Obamacare was enforced.
1.
The Electronic Medical Records
requirement will lead to a 5% increase in my overhead costs. My
surgical practice has spent hours looking for an Electronic Medical Records
System to avoid penalization by the government. The costs of this new
system (even taking into account incentive payments by the government) will
raise our operating overhead by at least 5% a year. That will translate
to tens of thousands of dollars in lost revenue for each doctor in our
office. E-prescribing now leads to 2 extra hours of work per day for
our office.
2.
The number of my Medicaid patients
has risen by 12% and the number of private insurance patients has declined by
22%. I must see three to four Medicaid patients to earn the same amount
as one of my patients with private insurance
3.
Referring doctor supply is shrinking
rapidly. 20% of my referring doctors have left private practice
completely! This was the most
astonishing and disappointing discovery for me. Several doctors
who used to refer me 10 patients a week, on average, have already quit medicine
completely. One of my greatest referral sources is now earning 3X as much
working as an HMO administrator, and many of my most loyal referring docs have
moved to work for hospitals, large medical groups, or HMOs like Kaiser.
Referrals of new patients have consequently plummeted dramatically.
4.
Doctors retiring much earlier than
before. 5% of my referring doctors retired from medicine in the last six
months alone. They were young by retirement standards (in their 50s early
60s)
5.
Concierge practices on the rise.
10% of my referring doctors have decided not to take insurance at all or have
decided to practice “concierge medicine” and charge yearly retainers ranging
from $500/patient to $20,000/patient. They are seeing fewer patients now
and that means fewer surgical referrals. As a surgeon, the concierge
model is not a viable option because we don’t usually treat chronic patients.
6.
Emergency Rooms far busier with more
(not fewer) uninsured patients. Another shocker. My emergency room
on-call work hours at my local hospital have quadrupled and the
number of uninsured patients that I have seen on-call has quadrupled as well. I am not sure why, but I am working four times as
hard and collecting 75% less from the patients I see through the Emergency Room
Panel.
7.
I cannot provide a great education
for my kids. I applied for private schools for my son for Kindergarten,
because our local public school is not very good. The gifted track at our
school system is even behind most regular public schools in other districts.
When interviewing for the private schools, my friend who works for
one of the admissions offices told me that I should try to hide the fact that I
am a doctor. She said, “They rarely accept doctors’ kids (unless they are
legacies) because doctors can’t afford the tuition anymore and are pulling
their kids out.” She was right–we weren’t accepted to any private schools
for my son. One of my patients who is a successful TV producer got his
kid into three amazing private schools. My son is 5 years old and reads
third grade level books. As a doctor, I cannot even provide my kid
with the education he needs?
8.
Increased patient morbidity due to
transferring medical care from Physicians to Nurse Practitioners and Physician
Assistants. I have seen a dramatic increase in Nurse Practitioners and
Physician Assistants taking over the jobs of physicians to cut down costs.
I have utmost respect for NPs and PAs. However, I have discovered
GRAVE problems due to this rapid transfer in medical decision making and
treatment to healthcare providers without medical school and residency training.
In the last six months, I have seen one Nurse Practitioner misdiagnose a
complex toe fracture as “cellulitis.” I have seen a Physician Assistant
fail to recognize a patient who was having classic stroke symptoms. I
operated urgently on a child who had appendicitis that was misdiagnosed by a
Nurse Practitioner as a stomach flu and given Pepto-Bismol. I had two
cases where I had to re-suture complex wounds that should have been referred to
a surgeon but were repaired by Physician Assistants, and I had a patient who
had Stage III breast cancer repeatedly missed by two different Nurse
Practitioners who were hired by the hospital to perform breast cancer
screenings and the list goes on.
9.
If the California Anti-MICRA Law
passes on the November Ballot, I will be forced to shut down my practice.
The California Anti-MICRA measure—which raises the pain and suffering cap on
malpractice cases exponentially—somehow
landed on the November ballot. lf this deceptive law (hiding large
financial incentives for frivolous and subjective malpractice lawsuits under
the guise of physician safety measures) passes, it will surely force me out of
business. I will no longer be able to practice medicine as the rising
liability from this law and the rising medical malpractice premiums will completely wipe out my practice.
My revenue as a private practice
surgeon is plummeting. This demise in the profitability of my surgical
practice due to Obamacare is not a gradual process. These economic and personal losses are RAPID
and DRAMATIC. My referral pool is rapidly dwindling. I am no
longer able to provide a great education for my own children. My
liability costs will skyrocket if this new California liability provision
encouraging large payouts for “pain and suffering” lawsuits takes effect.
Doctors: I sincerely hope that you are not experiencing any of these
difficulties and that my personal situation is entirely unique. I hope
that I am still a dreamer and that this is just one very long bad dream. Sincerely,Once
Hopeful Surgeon
http://www.doctorcpr.com/blog/6-months-of-obamacare-and-im-headed-towards-bankruptcy-one-doctors-insights/
Comments from Herman Talmadge III,
on New Georgia Republican Leadership for Principle above Politicians
My friend Tom Holloway
CPA posted the following:
Spent the past few days
in seminars trying to learn to deal with the Obamacare nightmare. Want to
simplify the tax code? Repeal Obamacare. Want to make healthcare more
affordable for everyone? Repeal Obamacare. Want to allow doctors to treat your
illnesses again based on their best judgement rather than insurance regulations?
Repeal Obamacare. Want a healthier nation with more affordable healthcare?
Repeal Obamacare.
Most interesting was a
seminar Sunday night by two physicians from the GSMA/GPA. You know the new
recommendations about cutting back on diagnostic services such as mammograms
and cancer screenings? That recommendation isn't about improving health - its
about doctors getting paid. It turns out that many, maybe most people who
signed up for Obamacare didn't realize how little these exchange plans covered nor
how much they would have to pay out-of-pocket and are defaulting on their
medical bills in record amounts and numbers.
Across the country the
number of doctors suing patients into bankruptcy are poised at record levels.
Since 2012, physician practices are also going bankrupt at record levels. And
on top of it all, people who once had adequate insurance are getting sicker and
dying because we can no longer afford to pay for the healthcare that we had
before the PPACA. Remember, welfare
impoverishes society.
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