Yeah, I am recovering…doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I am beginning to see how much better it will be to be on my own.
The key was when I realized that the system wasn’t going to change no matter how much I accommodated its unreasonable requests. I felt that if I only did what it asked of me, however unreasonable, it would stop hurting me and, more importantly, my patients. But I’ve come to see that all the promises to take care of me and my patients were written in sand, and that it couldn’t resist the temptation to cheat on me. I tried to do what it asked of me, but as time went by I couldn’t take how dirty it made me feel.
I want to believe it was sincere when it told me it wanted to change. I think at its core, it wants to help patients and doesn’t want to go on those spending binges. But no matter how sincere the promises sounded, I was always left alone as it threw its money at every sexy treatment, procedure, or drug that walked by. Then it would go off on tirades about how much I spent and that I didn’t do enough to keep to our budget. It was always my fault. I think it’s just easier to pass blame on others than it is to do the hard things necessary to really change. To be honest, I think it was terrified at how much real change would hurt.
But I can’t sit around and wait for the system to change any more. My patients were getting less and less of my time, and I was getting to the breaking point. I know there are a lot of other doctors who are willing to do whatever the system asks, but I can’t sit around and watch it self-destruct. It’s not what’s best for the system, for us doctors, and for our patients. Sometimes the best thing you can do for someone is to let them self-destruct and pray that they finally take responsibility and learn the hard lessons. I just hope that happens soon.
So what of my life? Rebuilding everything from scratch has taken all of my energy, but I have much more of that energy when I know it will do good. I can spend more time with my patients, answer their questions, and focus on them, not the system. Even though I see how much more I could give my patients, how far their care is from where I want it to be, they are delighted with my attention and availability. They are used to doctors giving them the leftover scraps of attention, not the bulk of it. I hope they believe me when I say that my plans for them are much, much bigger than what I am giving at this time.
I’ve resisted the temptation to run to the arms of another for the sake of financial security. My experience with the system shows that nobody pays you without expecting more in return. Then I’d just end up compromising to keep the money flowing, and that is a kind of relationship I just got out of. Instead, I am trying to do it the right way, keeping my focus on what is important: giving my patients the best care possible. It’s not been real exciting – there hasn’t been much to write about, spending my creative energy on a building system that will actually improve care, not hinder it. I’ve also had to pay much more attention to the little details: tracking where the money comes from and where it goes. I’m not real good at that, so it’s been a steep learning curve, but it’s given me a sense of control I’ve not had for a very long time.
I can’t tell you how different it is, working in a job that actually rewards me for doing the right thing. I am no longer penalized for healthy patients or an empty waiting room. I am no longer paid less to spend more time with people or to handle their problems without forcing them to come in. I don’t have to live in fear of the Medicare audit. I can spend my time with my patients as they need it. I had a guy come in help him with his struggle over a decision about his elderly father. We talked for nearly an hour, and I realized that I wasn’t at all frustrated by that fact. There’s no CPT or E/M code for this kind of thing, but it was what my patient needed, and it is what he pays me for. He left with a look of appreciation we doctors seldom see. It is incredibly freeing to not have to apologize for doing the right thing.
But I don’t want to brag. I’m no saint, and the system I’ve built to this point is far from perfect. I’ve still not taken a paycheck, and that can’t go on too much longer. Things could still go wrong. But my decision to no longer try to live in my dysfunctional and destructive relationship has been worth the pain and uncertainty. I miss the patients I had to leave behind, and I am sad to hear about the care they are getting. I hope I can build something good enough that lets me offer to them what my new patients have, something I’d given up on: hope for the future of health care.
That’s all I’ve got for now. Thanks for listening. One day at a time.
Live and let live.
Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind),where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.
Go forth Brave warrior! Stay safe
Whether you are a medical facility in search of the right physician or a physician looking for the right position, DocsWanted.comis the job board for you. We operate both nationally and internationally to match up physicians and allied healthcare professionals with the perfect temporary or permanent practice.
A few days ago I was with my wife for an ortho appointment, and the doc spent half of the paltry eight-minute visit bitching about Medicare reimbursement. I hear these complaints constantly, but see very few docs acting on their feelings. You’re setting a great example by publicly taking the plunge. The only way this healthcare so-called “system” will renovate itself is by individual docs and patients changing the way they behave. To paraphrase Arlo Guthrie, one person speaking up is obviously psychotic; two is a folie à deux, but three is a subculture.
Jeff Kane MD
Congratulations! And, Neil and others: There is a large group of primary care and a few other physicians who practice like Rob, though some do take insurance! It is called ideal Medical Practices. Their website is http://www.impcenter.org and they are a very nice group of folks who help each other by sharing information. They have a map of practices throughout the US and lots of information to share. You do not need to be a member to be on their list serve; only need to be a member to get the large amount of information they have about how to practice the way they do, like how to start that kind of practice. They also meet for a few days annually.
Rob, maybe you can establish a list of primary care physicians that practice like you. You are to be commended for your courage. The entrepreneur spirit certainly comes with risk and as you found out with great rewards. Good job.
Congratulations. I am glad you are doing well. It’s nice to know that it is actually possible to practice medicine in the United States these days. For myself, I’ll wait until I can get overseas.
Your rationale makes perfect sense from the perspective of a primary care physician. But while you can opt out of the craziness of the insurance system, your patients can’t — even if they could negotiate a cash discount for an MRI, how could they pay for chemo, or a knee replacement, or a pacemaker? Preserving your own sanity and doing what’s right for a subset of your former patients is important, but a return to the self-pay model can only take us so far. We still need some mechanism to spread the risk and cost of services that all developed countries expect, and someone will have to make the tough judgment calls – if it’s not a for-profit insurance company, then it’s the physician director of a medical group.
I don’t recommend that they do. I expect them to have at least a high-deductible plan. The good news is that while most folks with HD plans stay away from care for the expense, waiting for their problems to become much worse than they should, my patients will have me alongside of them to help them. In theory, they should utilize the ER and hospital significantly less, and so could potentially be a lower risk to insure. That’s theory, but I’ve heard rumblings of this possibly being reality. My ultimate goal is to get my numbers at or near the level I once had, making this a viable alternative for both doctors and patients.
Rob: Congratulations on your courageous move, and I hope your practice continues to be meaningful and viable for you. My view; the individual physician has trusted their professional medical associations to protect their profession and the overall mission of responsible health care for our nation. These organizations have totally abandoned their mission and purpose over a 30 plus year period of collaboration with national insurance and government agencies. They, above all, should recognize that a physician can not fulfill their patient obligations and personal oath as physicians in the constrained & financial structure binding medicine today. How did we ever lose the 25 minute appointment? A return to true pubic health values by hospitals, ACO’s, physician groups and professional medical organizations is essential. I have no hope for insurance companies: profit is their being. Government agencies are polluted by political distortion.
If I weren’t a few weeks away from 66…
I’m following with interest, admiration and amazement. And no small amount of jealousy.
Thanks a lot, Peter.
Rob, we need more doctors like you. Too bad there aren’t any pioneer doctors like you in Northern Illinois (that I know of). Thanks.
Much better without the silly hat.