It has been three months since I closed the door on my primary care office for the last time. It was with a heavy heart that I said goodbye to the many patients I cared for over the last six years. I am the fourth physician to leave the practice in as many years.
As the economy faltered, I found my private office practice had simply become unsustainable. With the popularity of high deductible health plans, many of my patients could not afford their share of cost. Patients frequently requested phone consultations so they could avoid the cost of an office visit. However, I struggled with an ethical quandary: although I understood their concerns, I do not believe good medicine happens over the phone. It is my responsibility to evaluate a symptom before initiating a course of treatment. It was becoming harder to practice medicine the way I was trained. The patients did not seem to realize they were asking me to compromise on the quality of care I provided.
The current practice environment has eroded the relationship between physician and patient. Insurers dictate what can be prescribed, what tests are performed, how much time we spend together, even where prescriptions can be filled. Due to concerns over being labeled with pre-existing conditions, I have had patients decline to provide their medical history to me. They would stop me in the middle of the interview to ask “do you need to write that down”?
The longer I do this, the more I have come to understand that listening is among the most important things I do as a physician. It is not high-tech or dramatic, but critical to healing. Of course, this takes time. Unfortunately, this is not what is valued in a world of managed care. Physicians who spend more time with patients are under productive. When did medicine become another production model? Physician business journals have numerous recommendations to enhance productivity. In one case, there was a recommendation that doctors give up their lunch time, eating on the run so as to be see more patients and be successful. Am I the only physician who thinks this is crazy?
After nearly a decade of training, I was disheartened to learn our local spa charges more for make-up consults, hair coloring and perms than I see for my services. It is understandable that many doctors have turned to cosmetic procedures to support their bottom line. It pays better than what we were originally trained to do; provide medical care.
With my business expenses climbing, student loan debt, a proposed 21% pay cut from Medicare and facing $40,000 in uncompensated care; I needed to make a change. I am not alone. A CNN poll revealed almost half of primary care physicians were considering leaving medicine. During a recent conversation with a newly retired colleague, he confided to me that his salary at the time of retirement was the same as it had been in the mid 1980’s. He assured me I was doing the right thing by getting out now. How I have wished that was not true.
Aldebra Schroll is a family physician who blogs An Apple a Day.
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