If you wonder why you can’t find a primary care physician anymore, read this article from yesterday’s New York Times. Solo family practice, pediatrics and general internists are becoming an endangered species. The starry-eyed physician who just “wants to help people” soon finds him or herself mired in debt, having to see 30+ patients a day to meet the ever-increasing overhead of insurance requirements, and quickly losing that spark that made him/her enter medicine in the first place. These doctors find that their practice, both clinically and administratively, is dictated by the government, insurance companies, and Pharma. It has become impossible for the solo primary care practitioner to financially survive in the current medical climate. As the article states, most doctors are now working for large corporations so that they can have a life, but more importantly, make a living. Witness the increase in physicians taking their services to the people in concierge or boutique practices in an effort to remain financially viable and still control their own destiny. This type of practice strives to provide the service of the “family doctor” while leaving much of the acute and traumatic care to the hospitals and emergency rooms. Services frequently focus on preventive medicine and getting healthy(services not reimbursable by insurance) as opposed to treating symptoms and managing disease to quickly clear the waiting room. However, access to services can vary and it’s not a perfect system. People have to pay out of their pocket for most services but for many, it can provide access to a doctor that schedules 30 min to 1 hour appts, does not have a packed waiting room and is available for email and telephone consult. So, physicians setting up these alternative practice systems is about much more than money. It is an effort to hang on to what we love the most: meaningful interaction with our patients and a desire to help people.
This post was prompted by a Facebook post that said, “Does anyone know how to get bio identical hormones without selling a kidney?” To this I say, “the best things in life are neither free nor easy, and where there is a will, there is a way”.
“To this I say, “the best things in life are neither free nor easy, and where there is a will, there is a way”.”
Many years ago, as a naive healthy person who has never been in debt, I would have completely agreed with that statement.
Now, not so much. I am 27 years old and have spent the last 4 years in severe debilitating pain that has spread to most of my body. I was also diagnosed with many different and relatively unknown conditions. But still, my case is so complex, we are missing vital pieces to the puzzle. I have seen more than doctors than I can count. I have stuck with some doctors much longer than I should have, exhausting all their treatment options, and even find treatments on my own to try. Now, I am still mostly home bound
4 years ago, I was a fairly new college grad, saving every penny I had for graduate school. But then I got so sick I couldn’t work. I spent my entire savings of $20,000 with no hesitation because health is priceless. Besides, once I get my health back I can easily earn that money again. But I didn’t get any better and I just continued to get worse.
By now I’ve spent probably close to $60,000 out of pocket. Luckily I have health insurance so my lab tests and medications are covered. Unfortunately, a number of my specialists are fee-for-service. So how would you expect someone in my position to afford the costs of functional medicine and continuous integrative care? Many of us patients are trapped financially and we must figure out a way to get care without going bankrupt. More than 50% of personal bankruptcies are due to medical costs. As a young person, I have no other assets except for my ability to work. And that is compromised too.
What should I do? Continue pursuing treatment after treatment and going into more and more debt? It seems like that is the only choice I have. I believe that I will get better and I have to get better. But then…one can’t help but wonder a bit – “What if I don’t get better? I mean, I’ve failed so many treatments. Doctors don’t know what’s wrong me. What am I doing to do with all that debt then, when I can’t even get off the couch??
Your Facebook response was not only condescending, but outrageously ignorant. Where you channeling Marie Antoinette? You completely dismiss the dire circumstances that some of us are unfortunate enough to fall into. As a physician who “treats the whole person” you should understand that financial stress is one aspect of our lives that are greatly affected when we fall ill. Please try to see things from my perspective and my circumstances.
I look forward to response.
Dear Sandy,
Neither conventional nor complementary medicine has all the answers and both sometimes fail to cure or heal people.
I am sorry that you are struggling with health issues and that you have not found the answers. Unfortunately this is the way our medical system works and many people do end up going bankrupt. As a physician, I have opted to gear my practice to people who are committed to reclaiming their health and are willing to invest in that. And just like in a conventional practice, somtimes people do not get better, but mostly they do. So I am grateful for that. As a primary care physician, I felt like I was mostly a pill pusher for Big Pharma, and I was struggling financially as well. At least in this model, I am able to help some people achieve their health goals.
It sounds like you are fortunate to have insurance and can get some of your care covered. A National Health Care system would at least assure that people got basic care, but I feel pretty certain that I will never see that in my lifetime so we are stuck with what we have, inadequate as that might be.