Merrill Markoe’s reports that she was fired by her doctor in her article, “My Doctor, the Concierge,” which was both sarcastically entertaining and painfully true. She writes a powerful commentary on the divide caused by insurance companies between doctors and patients. She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy of healing those who seek my help.”
Nothing cuts the cord between the doctor and her patient like the mention of money. Yet, doctors all over the country are rushing to become “concierge physicians.” The more you pay, the closer you can get to the doctor. For $1000 a year, you can be part of the club. Pay $2000 annually and you can have the doctor’s email. Pay $3000 and you can text or call her cell.
Our society expects doctors to be healers. Who doesn’t? But the Hippocratic Oath does not address the business of medicine, nor does it demand the physician to provide uncompensated care. The Oath is a covenant to provide the best care possible with dignity.
Society must remember that doctors have to pay back an average debt of $300,000 for 12 years of graduate schooling and not forget related opportunity costs. Medicine is the only business where every year the overhead increases while third party reimbursement diminishes. Moreover, a physician can work for thirty years and on her retirement, her practice is worthless.
There are also factors which affect cost of medical care over which doctors have no control. Insurance companies take some 30% of the healthcare dollars and provide no medical benefit. The FDA places so many restrictions on drug approval that it costs $1 billion to bring a drug to market. There are universities such as UCLA which take federal and state dollars to do research while setting up practices in the community, competing unfairly with private doctors and charging hospital rates for office visits. 10% of all gross receipts of any practice is spent collecting monies from insurance companies and patients. Doctors at their own cost purchase medical supplies and provide them to patients, risking denial of reimbursed by insurance companies.
There are also government mandates which increase costs to doctors. With the advent of Obamacare, there is increased cost of ensuring valid coverage, to receiving approval for treatment plans. Populating electronic health records (EHR) and generating meaningful use is time consuming with no reimbursement. Prescribing the most cost effective treatment in a litigious environment remains an oxymoron. Doctors, too, must ensure proper coding as not to leave a bad diagnosis on the patient’s chart that could affect his eligibility for obtaining life insurance, while picking a good enough diagnosis to be paid by the insurance company.
Finally, there are a number of services that have traditionally been provided by doctors gratis. These services amount to several hours per day and include returning patient, hospital and pharmacy calls, completing letters written for return to work or disabilities, peer-to-peer discussions to get the prescribed treatment authorized. Doctors also remain on-call for emergencies and do not get paid for driving to the ER at midnight.
Lawyers have long charged clients for services rendered in their absence. Writers expect to be compensated for their creativity, wit, style. Yet, somehow we have developed an attitude that, “If I pay for insurance, I should be covered and should not have to pay my doctor.” Insurance company payments don’t begin to cover the costs of running a practice. A typical fifteen minute office visit is billed under a code of 99213 and reimbursed at $40. That is $160 per hour. Now remove all the costs mentioned above and the practice is bankrupt. Most general practitioners make less than the pharmaceutical reps who call on them.
As a healer, a doctor cares for your most important asset, your health. Should she not be compensated according to her training, abilities and talents? There is tremendous joy in the practice of medicine, but that joy does not pay student loans, cost of running a practice or for schooling for future doctors to be raised by current ones.
Afshine Ash Emrani is a cardiologist and can be reached at Los Angeles Heart Specialists.
