Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health insurers and physicians are not partners

Thomas Stark, MD
Physician
August 20, 2019
Share
Tweet
Share

On the face of it, this seems like a fairly simple business arrangement. My patients or their employers pay money to a health insurance corporation so they, in turn, have sufficient funds available to pay medical claims for services I render. That simple system seems to work for auto, home, and life insurance.

First of all, a little background about me.  I am a board-certified otolaryngologist who did my residency through the U.S. Navy, completing at Bethesda National Naval Medical Center in 1983.  After three years more of active duty, I started a private practice in 1986.

The mid-80s and 1990s were certainly a different time in which to practice a surgical specialty.  The patients were just as challenging and the procedures just as difficult, if not more so, but in general, I got paid for what I did.  Blue Cross Blue Shield et al. was kind of like a checking account or holding company to collect the premiums and then distribute to physicians payments for services rendered.

Obviously, this website is filled with opinion pieces describing the frustrations physicians challenge in the present.  I doubt if I can say anything more eloquently or accurate than these other writings.

The point I want to discuss may be more applicable to us dinosaurs who are in private practice, not affiliated with any large hospital system, university, or other similar practice situation.  But in here I see myself as somewhat of a partner with the major insurance corporations, and of course the government.

This will, of course, come off as terribly naive, but I keep wondering why my partners want me to struggle daily to survive financially.  I employ seven people, including one PA and one doctor of audiology.  My expenses, including supplies rent insurance and payroll, are of course increasing.  Yet through it all, my “partners” seem to feel that it is appropriate for them to systematically lower what they pay me. All surgical fields have experienced about 20 percent decrease in fee schedules over the last ten years.

They are making it increasingly difficult through prior authorizations, peer review, and other unilateral decisions for me to even take a patient to surgery for an elective procedure.

One would think that the folks who sent me the checks would like me to be successful.  One would think it might be in their best interest to have me actually be somewhat prosperous. Again how naive of me.  However, as any of us on this website know their actual level of contempt for my colleagues and me is astounding.

I realize that all of the questions I ask are rhetorical.  But to me, it cuts to the hard of the matter of the shortsightedness of those in charge behind the scenes of the finances of medicine.  Their game is to generate as much profit as possible in the short-term for themselves without any vision of the future. My game is to take care of real people and pay the bills.

Some partnership.

Thomas Stark is an otolaryngologist.

Image credit: Shutterstock.com

Prev

When Medicare stops covering a test without warning

August 19, 2019 Kevin 1
…
Next

It's time for physicians to bring clarity to their lives

August 20, 2019 Kevin 0
…

Tagged as: Practice Management, Surgery

Post navigation

< Previous Post
When Medicare stops covering a test without warning
Next Post >
It's time for physicians to bring clarity to their lives

ADVERTISEMENT

Related Posts

  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Essential health messaging tips for physicians [PODCAST]

    The Podcast by KevinMD
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • Physicians and patients must work together to improve health care

    Michele Luckenbaugh
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • How social media can help or hurt your health care career

    Health eCareers

More in Physician

  • Why judgment is hurting doctors—and how mindfulness can heal

    Jessie Mahoney, MD
  • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

    Olumuyiwa Bamgbade, MD
  • The gift we keep giving: How medicine demands everything—even our holidays

    Tomi Mitchell, MD
  • From burnout to balance: a neurosurgeon’s bold career redesign

    Jessie Mahoney, MD
  • Why working in Hawai’i health care isn’t all paradise

    Clayton Foster, MD
  • How New Mexico became a malpractice lawsuit hotspot

    Patrick Hudson, MD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • 5 blind spots that stall physician wealth

      Johnny Medina, MSc | Finance
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • 5 blind spots that stall physician wealth

      Johnny Medina, MSc | Finance
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Recent Posts

    • Why judgment is hurting doctors—and how mindfulness can heal

      Jessie Mahoney, MD | Physician
    • Why medical schools must ditch lectures and embrace active learning

      Arlen Meyers, MD, MBA | Education
    • Why helping people means more than getting an MD

      Vaishali Jha | Education
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • Why evidence-based management may be an effective strategy for stronger health care leadership and equity

      Olumuyiwa Bamgbade, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health insurers and physicians are not partners
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...