I am not a PCP, Primary care “Provider”. That is a demeaning term invented by the insurance companies to place me amongst the nurses, physician assistants and nurse practitioners. I am a Primary Care Doctor. I have gone to more schooling, classes and years of training to be the best in this field. I can hire these people to assist me with MY medical care, but I, and most people, do not want these very dedicated people to be the final answer in my or their medical care. The Doctor has the ultimate responsibility and is proud to take it. The insurance companies are trying to allow the other “Providers” to act like your doctor without supervision. There are people who refuse to let their insurance company force them to accept a “provider” when they want a real doctor.
There are people who do not want minimal, rushed, un-personal care even if they have insurance. Others will be willing to accept their 5.7 minutes of office visit time after their 1 hour or longer wait to be seen. They will also have to accept that this will be 4 and one half minutes in a few years. There is no way that I could ever feel comfortable at the end of the day knowing that a patient, as important as they are to me, actually received any kind of appropriate care from that kind of visit. And remember, if the patient before you took an extra few minutes, the doctor has to average out his time by taking away a few more from you next.
An insurance company’s bottom line is profit. They are large corporations that are out to make money for their shareholders. If they don’t make enough money, they fire their CEO and hire a new one that will raise income and lower expenses. Their way of raising income is to raise your premium. You say that your employer will just make up the difference for you? Well think again! That was your pay raise that they just used. You now have less to take home due to inflation. The CEO will also reduce the payments out to doctors and hospitals to improve their profit.
I was offered a BCBS contract when I first started practice. It was too good to be true, and therefore had to be untrue. They offered to find me at least 100 patients and pay me my full fee schedule and 10-15 days sooner than a regular contract. I knew that something had to be wrong. Sure enough, in 6 months, my “new” fee schedule was cut by 5%. If I didn’t like it, they would gladly have my patients move to some doctor that would take it, but if I would bend, they would find even more patients. By the next 6-month contract, they were happy with my patient satisfaction surveys of my 200 patients, but I would now need to take only 90% of my usual fees. I tried to raise my fees to compensate, but was told that the only fee schedule was the very first one and if I didn’t like it, they would happily take this now sizable chunk of my practice away. It wasn’t long until there were 500 patients and 75% reimbursement. This is the classic Bait and Switch game. They hooked me with a deal that was too good to be true and then switched the rules of the game, until I was trapped. But little did they know that some fish could get away and live.
When Medicare first realized that they were going broke in the 1980’s, they reduced their payments to doctors and placed all sorts of severe restrictions on how doctors can practice medicine. Most doctors took an ethical and understanding view and did not fight this major change. They expected that the restrictions would be relaxed as Medicare started to rebuild its footing. Doctors accepted the role of providing discounted price but good quality care to the elderly and disabled as a community service and charity type work, and depended on their other patients for the loss of income. Their fees had to go up to compensate. Unfortunately, Medicare saw a good thing and progressively got worse each year rather than better. Now doctors have to compromise and provide care that is commensurate with the minimal reimbursement. The large insurance companies then followed suit and each has reduced their fees with many being a percentage of what Medicare will allow, so fees for other insurance companies went even higher. Then the government said that all doctors must charge the same fee schedule to all patients regardless of where the money came from. Therefore a $100 visit would have to be paid in full for a person without insurance so that a small insurance company could pay $70, a large company could pay $50 and Medicare could pay $40 for the same service. Medicaid had always been a community service, charity care since they have never even gotten close to paying enough to cover overhead at $20 reimbursed for a visit that was worth at least $85. Who got screwed on this deal? The doctor and the person who couldn’t afford health insurance! If the doctor tries to be nice to that uninsured person, “he is discounting his services” and therefore breaking his insurance contract, cheating the insurance company and doing FRUAD. If he is allowed to stay on the plan, his reimbursements will be reduced by his own discounted percentage. This is unfair and unethical, but the doctors have done their best to get fair treatment for all patients as well as for ourselves, but all of the lobbying, letter writing and complaining haven’t swayed Congress or these big corporations.
Corporation uses the root word “Corp” to refer to a body. But corporations have no heart, body or soul and really do not care about morals or ethics. Only that one overriding, all-important issue to them which is Profit. Currently, the thinking at these insurance corporations is that if they cut doctors fees enough, doctors will complain. If they then cut further, some doctors will pull out. If too many doctors pull out, then they may not be able to provide services for all of their policyholders. When they have cut enough that most doctors have quit working with them, then they have reached the market rate bottom. Unfortunately, the patients are stuck with the doctors that are willing to be paid the least, and provide the cheapest, lowest quality, shortest visit time and longest wait care possible. Is that what you, the patient and customer, wants for your health care?
Do people expect to go to the grocery store and to pay only $10 of the bill? Do you expect your hairdresser and mechanic to wait 6 to 9 months to get paid for their service? Do you expect your accountant to always write off (throw away) 60% of his bill for his hard work on saving you taxes? Do you go to dinner at a restaurant and tell them that you might get around to paying them someday? If not, then why would you do all of these things to your personal doctor who has given you the best service possible?
I have decided to be employed by my patients and not be a slave to insurance companies.
I will let my value to my patients be determined by my patients rather than a business CEO out looking for a huge salary.
Job Offer! Be a doctor in private practice! Look forward to 80 hour or more workweeks with NO paid vacations, NO employer paid health benefits, disability insurance, or retirement benefits and NO paid sick days. All it takes is 11-15 years of poverty and masochistic treatment for you to then take Enormous Responsibility and Liability Exposure. Just think of the income that will go down every year and the possible loss of your position to a lower paid, less trained person. This has been reported in the past as the best job on earth. SIGN UP NOW!