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I have a client, a doctor who runs a small surgery center (something specific). Every time I talk to him, he goes off on how awful it is to work in the medical field these days. Insurance companies fight him on basically everything he does for his patients.
How did it get this bad? How did these insurance companies get this powerful?
my friends family that works in medicine, have for generations, say that basically you are working for the insurance companies and for whatever company you actually work for. sounded way different than most doctors having a private practice like they all did in the 90s.
Yeah, vast majority of docs are employed now. Rising costs, reducing repayments and barriers to getting patients the care they need have made it basically impossible for private practice to exist outside of surgical specialities.
I'm about to finish residency and $425k in debt from medical school. At 7% interest I'm going to be paying back $4k a month for nearly 14 years to pay it off. I can't afford the risk of a opening or buying into a private practice with that mountain of debt. Plus, thanks to CMS (federal rate setters) effective 12% rate cut (3% this year 2% next + inflation) and rising living costs means private practice groups are being squeezed out of existence.
Without major overhaul, 10-20 years is my guess unless a few congress critters have kids die while waiting to see a Dr when they get an initial appointment 6 months down the line
They aren’t in this system at all, congress and their families have access to healthcare run by the government and not insurance companies. They literally have socialized medicine for themselves while they tell us private is better.
It would need to be a large chunk of congress person having kids die, which will never happen. If its one or two that start pushing for actual positive change they just get shoved off to the side with a smile. See also Sanders and AOC.
It's already in the midst of collapsing.
It's not how long until it does, it's how long until it gets so bad that people actually start revolting.
It's already in the midst of collapse, don't kid yourself, these things aren't happening because it's not collapsed already.
Yeah, we're in the middle of it. The shit I'm pulling in the ED on a daily basis is like battlefield medicine. Dilt, nitro, or heparin drips in the lobby. Pelvic exams and sutures being repaired in storage rooms. All the beds full of disease-riddled shells of people who can't survive outside of a hospital for more than a few days. The hallways are lined with beds filled with demented, undead boomers who flail around and grab for anyone who passes by like a zombie movie. And the kids say, "do EVERYTHING."
Shit sucks.
You’re vastly underestimating how *okay* we are as a society to let people die in the name of please-anything-but-helping-the-icky-poors!
It feels nearly pathological.
Edit: Did you know there are *2nd* *GENERATION* homeless people? Consider the implications of that; what that means in a society that has boundless wealth.
Yea I went into medicine all those years ago because I didn’t want to be a corporate slave. Nowadays If you are in private practice you are a slave to insurance companies. If you are employed by a hospital system you are just another faceless corporate employee. The CEO for the system I work for routinely says behind closed doors that physicians are just replaceable as the janitors. The goal is to replace any non surgeons with as many 23 year old NPs with online degrees and pay them nothing. Once they get some experience and ask for a pay raise they replace them with the next batch.
I had an internist as my PCP. She was one of the last ones in the area and she just told me she is leaving for a practice in another state. So I am looking for a new PCP and all that I can find on my providers website are ARNP'S. There are 2 MD'S and over 100 ARNP'S. I am not disparaging ARNP'S in any way shape or form but it seems to me the industry is pushing MD'S out purposefully to save money hiring ARNP'S.
Even in New York City, most of the internists are in private or concierge practices that leave the patient to sort out coverage with their insurer if they can’t pay OOP.
I have long belonged to a primary care practice that first boasted a choice of MDs and 1hr20 annual exams and seamless referral navigation for specialty care. Now it’s majority very young/inexperienced NPs and PAs. At north of 45 years, I refuse to leave navigating across one or two therapeutic verticals to anyone like that. I also refuse their railroading referrals to their “preferred” hospital network for specialty care.
Obv I have one foot out the door. For a working couple to pay $20k per annum for insurance, $10k+ OOP for deductibles and co-pays, we’re being screwed.
Doctors aren't even upper class citizens anymore. You guys need to fucking do something holy shit.
Like at the end of the day if you're the best and brightest that Humanity has to offer, and you become something like a doctor or an engineer or a lawyer that's respected in their field, and you get squeezed by the balls like this?
Writing has been on the wall for a long time. I dodged medicine for a path in medical devices because medicine was already seeing diminishing returns (had a 41 on my MCAT, so I had options), then the economy took a shit and I ended up in private education (graduated in '08). Medicine hasn't been able the money for about three decades, at this point there are financially far better options available for people smart enough to get through medical school and the medical field will continue to devalue MDs in favor of more cost effective approaches (PA, NP, etc.).
I’m in medicine and very fortunate that I enjoy my job and the practice I work for, however I have a lot of colleagues who encourage their kids to not go into medicine but rather other fields like investment banking, etc, to earn a better living. For a few people who’s kids are commited to medicine, they encourage them to go to PA school so they don’t end up saddled with as much debt and still make a good salary.
>How did it get this bad? How did these insurance companies get this powerful?
Basically 2009/2010 - the whole Obamacare debate. A huge portion of the country was foaming at the mouth to keep things the way they are.
We were so goddamn close to a public option it really hurts to think about now.
You can expect the Republicans to try to destroy the country at every turn, but it is especially galling when somebody who once claimed to be a democrat does it for no good reason.
Shit he only allowed the EPA to get passed to distract from all the illegal and fucked up shit he was entangled with at the time. Not like he actually believed in it.
And not to mention all the deaths of innocent bystanders. [Here is a story](https://www.nytimes.com/1973/06/25/archives/violent-drug-raids-against-the-innocent-found-widespread-viole-at.html) of the first victims of the War on Drugs from 1973.
https://www.snopes.com/fact-check/healthcare-profit-1973-hmo-act/
I was outraged by your statement, but chose to fact check, because I figured this was actually insane.
The worst that happened (from what I can tell) was _arguably_ an unintentional side effect as a result of allowing the government to sponsor HMOs. I don't know all the implications of that, but Nixon didn't somehow make for-profit health insurance 'legal' it already was legal.
It wasn't illegal, but Nixon and republicans were told point blank that the idea is to provide less care and extract profits from people.Nixon approved and was reportedly "delighted" at the idea
> A huge portion of the country was foaming at the mouth to keep things the way they are.
This is what I don't understand-
I haven't met a single person who thinks that the current system actually "works well" or serves the function it's supposed to serve. people hate having to interact with their insurance company and hate having to pay their premiums even more (especially when you pay a premium and avoid getting care anyway because it's too expensive).
BUT SOMEHOW when it comes to advocating for or moving any direction toward a new system, people scream about their coverage being changed/taken/whatever. It makes absolutely 0 sense
Hell, we almost had it in the 1940s under Truman, until the conservatives in the south realized it would be helping out black people, too, and nixed it.
Was reading "One Nation Under God" by Kruse. It highlights the rise of Corporations fighting back against Roosevelt's New Deal and the rise of Christian Libertarianism or I call it Supply Side Jesus Economics. Apparently, Truman wasnt akin to their corporate bs but they found a president that could bolster their Supply Side economics through Eisenhower. Heck, they even tried gutting Social Security and Medicare but even Eisenhower said that it's the death of Republucan party if they gutted these social services. But hey, decades past and here we are and they are trying to gutt these social services again.
Universal Healthcare was on [Frances Perkins](https://en.m.wikipedia.org/wiki/Frances_Perkins) list (social security, unemployment insurance, banning child labor, 40-hour work week) and it was pretty much the only thing she didn't get accomplished (thanks to the AMA):
>In 1933, Roosevelt summoned Perkins to ask her to join his cabinet. Perkins presented Roosevelt with a long list of labor programs for which she would fight, from Social Security to minimum wage. "Nothing like this has ever been done in the United States before," she told Roosevelt. "You know that, don’t you?"[32] Agreeing to back her, Roosevelt nominated Perkins as Secretary of Labor. The nomination was met with support from the National League of Women Voters and the Women's Party.[33] The American Federation of Labor criticized the selection of Perkins because of a perceived lack of ties to labor.[33]
>As secretary, Perkins oversaw the Department of Labor. Perkins went on to hold the position for 12 years, longer than any other Secretary of Labor.[34] She also became the first woman to hold a cabinet position in the United States, thus she became the first woman to enter the presidential line of succession.[35] The selection of a woman to the cabinet had been rumored in the four previous administrations, with Roosevelt being the first to follow through.[36] Roosevelt had witnessed Perkins’s work firsthand during their time in Albany.[36] With few exceptions, President Roosevelt consistently supported the goals and programs of Secretary Perkins.
Isabel Wilkerson. She also wrote The Warmth of Other Suns about the barely documented migration of six *million* black people fleeing the Jim Crow south and how they ended up in segregated neighborhoods in northern cities that still affect our politics today.
Of course they were. The AMA has always been against anything that provides medical services to the masses. For them, medical access is something that should only be accessible to those that can pay market rates. The AMA was vehemently opposed to medicare from the beginning, and [allied themselves with Ronald Regan](https://en.wikipedia.org/wiki/Operation_Coffee_Cup) in a campaign to tie medicare to communism.
Any time single-payer healthcare, medicare expansion, or anything like that comes up, the AMA is against it. It's been a staple of their ethos since they were founded:
> Dr. Morris Fishbein, the AMA's president, described the organization's attitude as early as 1939: ... all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism.
Any sort of social services, like medical clinics, unemployment, even food stamps, are communism/totalitarianism to them.
I'm a recent graduate, and it's wild how miserable most physicians are. It's really annoying they are not honest as mentors about what it's really like before you go into it. It's all peaches and cream when you're wide eyed coming out of college, then once you're in the thick of it they air all the grievances. Beautiful profession but the system has made it miserable.
When from the outset they tell you "think of what you'll be doing in x years, because this is not a sustainable lifestyle", you know it's not looking good.
Main complaint is down to insurance. Every time it's less $$ with more requirements. That's for office. Hospital attendings mainly hate the lack of resources specially nurses and such. The hospitals are run by MBAs nowadays who have no clue how to put a bandaid, much less the needs of actual medicine. So in the end its capitalism being the bane of all of societies ills as per usual.
"annoying they are not honest as mentors about what it's really like before you go into it."
Idk where you went to med school, but I've never met a fellow med student or resident who didn't have a story about a doctor telling them "I wouldn't do this again if I could go back." Every pre-med I talk to, I tell them the same spiel about being glad I'm here now but I don't think I'd choose this for myself again if I had the chance. I heard the same, and still chose to go into the profession.
>How did these insurance companies get this powerful?
Legalized bribery. The system of campaign donations, job offers, massive speaking fees, etc has corrupted our society completely. It's not just insurance companies that got this powerful. All the big corporations did. The system of legalized bribery is the source of most of our biggest problems.
Here's a fun set of questions.
1. What is the first thing an insurance company do when it receive a claim?
2. What is the second thing?
The answer to #1 is: Look for a way, any way, to deny payment.
The answer to #2 is: Take any and all measures to delay payment.
> How did these insurance companies get this powerful?
High premiums and low payout.
It's not just lobbyists - plenty of voters believe that privatization of healthcare saves costs and leads to greater efficiency and they go ahead and elect true believer politicians to represent them.
Somewhere, a hungry person might get a sandwich they didn't pay for and that makes me angry.
-What I think whenever I think about the insanely inefficient outcomes the self regulating free market provides
It's been this way for decades.. Covid finally brought up the wages a bit for lower level health care workers but industry execs were kicking and screaming and pulling every string possible for the gov to intervene (because muh Healthcare profits -_-). Working conditions didn't improve at all, it only got much much worse.
“For me, doctoring in a broken place required a sustaining belief that the place would become less broken as a result of my efforts,” wrote Dr. Rachael Bedard about her decision to quit her job at New York City’s Rikers Island prison complex during the pandemic. “I couldn’t sustain that belief any longer.”
Trust me, it is not much better in many urban centers. We vacation in the winter in Palm Springs. It is a healthcare desert here. The primary facilities, Desert Regional Medical Center and Eisenhower, are both so corrupt that it is almost impossible to get any kind of reasonable care here.
Last year, I developed pneumonia and needed to go to the ER. I ended up at Desert Regional Medical Center. First trip, they gave me a dose of Tylenol, a Covid test (negative) and sent me home. When I continued getting worse, I returned a few days later. They tried to give me Tylenol again. I refused and needed to demand some actual care. They finally gave me a single view chest x-ray (which was how they diagnosed the pneumonia). Then a dose of antibiotics and some fluids. I was never admitted to the hospital. Total billed for these services? More than $16,000.00. It is a total shit show.
Yeah the whole system is crumbling in slow motion. My friends from residency are scattered across the country and in a variety of settings and every one of us feels like the system is just crushing us into the ground. People ask me if health care in the US will collapse, I tell them it already has we’re just dealing with the slow fallout and it’s only going to get worse.
Do doctors feel that a single payer healthcare system would solve these issues?
Edit: I guess I should say do you or your friends from residency feel this way?
The answer you’re going to get varies but in my field most of my peers are left leaning. It’s definitely a conversation worth having but the reservations aren’t the lower pay but the fact that Medicare and Medicaid are a significant source many of the problems we’re facing outside of private health insurance. So in many ways it would be like throwing gasoline on a fire.
True, it’s not often the people actually in health care are asked about how to fix it. I see a lot of editorials in the papers written by people who are administrators or who work for lobbying groups.
I totally agree. Just had a surgery in Augusta GA at AU health a medical college. Soon as I woke from anesthesia they were putting on my shoes for me and rushing me out of the recovery room. Maybe there 30 minutes. The bill for that alone $1500. It’s become a racket.
I ruptured my Achilles tendon in December. Doctor ordered an MRI to confirm it.
Insurance denied the MRI, stated it's only useful for surgery prep, demanded an xray instead.
My doctor explained to them that tendons don't show up on xrays, only the MRI will show the damage.
More than a month later we do the xray to satisfy insurance, it shows nothing. They authorize the MRI which confirms a 2cm tear > 50% through the tendon.
Gee, guess that's why I haven't been able to walk for a month...
Where do they get off thinking they can practice medicine? No wonder doctors are burned out.
I'm a resident physician, I had to explain this exact thing regarding tendons and xrays to some insurance rep asshole that was denying my MRI order. She then said she would have to consult with their inhouse physician. Or you know, you could just let me do my fucking job.
My personal favorite is them nearly forcing another patient to pay out of pocket for labs because I put "healthcare maintenance" for coding purposes in the EMR, while the insurance company said I had to do "Annual physical." I had to go back to the chart and edit it. It's become such a labyrinth of bullshit
> Or you know, you could just let me do my fucking job.
From their point of view, your job is to trick them out of their delicious monies by ordering unnecessary tests.
Physicians can no longer own hospitals/hospital systems. They deemed it a conflict of interest. It really seems like all these mbas have the best interest of the patients in mind
Early hospitals wayyyy back in the day were physician run. Now it’s run by bloated blood sucking administration that funnel profits all the way to the top. Profits over patient safety and lives always
I’m a primary care doc and I’m a little surprised your doc didn’t just order an X-ray first. It’s common knowledge that you need an X-ray before insurance will cover a musculoskeletal mri regardless of what you’re ordering it for. It’s pretty much an informality that if you’re thinking about ordering an MRI to order the X-ray first whether you think the X-ray will truly show anything or not otherwise you’ll end up in a situation like you described.
It’s dumb and I don’t agree but what I often tell my patients is I’m not a defender of this messed up system and my job is to help you navigate through its pitfalls the best we can
Sounds super inefficient and like a waste of medical resources if that's the way it has to be done, assuming you know ahead of time that the x-ray isn't going to show anything? Correct me if I'm wrong. Non-doc here.
Edit: typo
Additionally, healthcare should not be treated as some product or service that one buys in the marketplace, like dance lessons or a new set of cookware. Normal market forces of supply and demand do not apply.
i have public internet in oklahoma. best internet ever., went from getting ass blasted for 20 years by a monopoly for profit called cox. now just amazing 1 gig fiber no issues munipical. or i guess it's actually a co-op.
I live where electric is a public utility. Our prices are just over half what the other power companies in the state charge and when our last major ice storm had nearby towns without power for days, ours never went out.
I wish we our internet was the same!
Utilities are usually not for profit entities. When they are privatized, we have a system like the Texas power grid where reinvestment funding is paid out as profits.
Edit: grammer
And when they are private we keep getting rate increases that aren't lining up with their actual costs. The gas co where I live got approved for a rate increase to fix a bunch of problems then never bothered to fix them, just pocketed the profit. No repercussions.
Most of the electric and gas utilities in the US are privatized, just heavily regulated. Duke, FPL, Mid America are all private for-profit energy companies that must get permission from their respective state utility boards for most everything they do.
**Edit: I'm stating that electric utilities outside of Texas are not non-profits but are in fact mostly for profit corporations. Yes, although they must get permission from their respective utility boards for most things, regulatory capture, lobbying, and all forms of political malfeasance is, like all other aspects of our government, rampant...which is a different argument.
It should be treated as a public utility, *but* it needs autonomy.
Right now? It's neither. It's laissez-faire on the profit side (so, fuck the patient), but if, some conservative government doesn't want you to to give care to someone? They can bring the law (so, fuck the patient).
We get the worst of both worlds. Small government enough to fuck you, Big Government enough to fuck you.
This is by design! "Fuck you" is by design! On purpose!
And if the insurance company doesn’t want you to give care to someone, fuck the patient. Death panels are real, and their staffed by BCBS, Aetna, United, etc.
This is what amazes me whenever the argument against publicly funded healthcare inevitably falls back on 'I don't want a government paid doctor to make decisions about my health care!' So, you would prefer that decision be made by insurance industry actuaries?
Right? At least you can vote out government officials. Doesn't mean you can tell them what to do exactly, but there's *some* form of control via the citizens.
It is the worst system in the world, I watched my father be a good worker and citizen his whole life, get up, go to work at a bank, but had heart disease which ran in his family. At age 60 he got laid off after working for that bank for 25+ years but was so nervous about not having health care with his issues he paid for cobra that cost him almost 2k a month just for major medical. That would just cover if he had some major issue. He was burning through his 401k savings. He then got cancer, and the bills for that even with Cobra left him broke by the time he died.
The system we have is designed to keep you working your whole life, stressed, and when you die its claws back everything you saved in to the system. It is a shame, and for some unknown reason people are not marching in the streets mad as hell, and when some suggests a single payer system in the country, voters fight a against it. Got to hate this country's health care system.
This pretains to the UK and the workers in public service but I feel the message is still applicable to our workers in the US.
["How can the market decide the value of someone whos work can't be measured in cash?"](https://youtu.be/WQk99fxO9Ss?t=144)
You know the "government bloat" conservatives usually always complain about? Health insurance companies are essentially the capitalist version of that bloat. A significant percentage of healthcare costs are simply to subsidize the survival of the healthcare insurance industry including those it employs. Conservatives just love to ignore that bloat because they profit off of it.
They’re leeches and they’re needlessly complex, requiring a dedicated staff person or people to navigate their gate-keeping, exclusions, and obstacles. They add no value. Tl dr: They suck.
FUN STORY: I once got in an argument with a C-level executive at a huge Health Insuarnce Corp, and he was unable to explain why Health Insurers need to exist. I gave him multiple tries over about 45 minutes. He kept trying these arguments that were so easy to shoot down. I think I kinda embarrassed him because he shook my hand and thanked me afterward for a lively debate. But he didn’t win the debate. He was in fact UNABLE to explain why this isn’t just a skyscraper full of middlemen. It was the most fun I’ve ever had with a rich guy.
I hate that in US politics “debate” is seen as something to strive for, and that there is a winning side and a losing side. Idiots like Ben Shapiro become famous because they “debate” unprepared college students with half-truths and bigotry but because he talks fast and uses buzzwords people think he wins those debates.
Not every argument deserves to be debated and you shouldn’t be able to “win” if you have garbage ideology. If I say that people with three arms are still human and deserve the same rights as people with two arms, but you say people with three arms are disgusting abominations and deserve to be publicly executed, there is not a middle ground there that can be reached.
BASIC HUMAN RIGHTS ARE NOT UP FOR DEBATE.
Gift link:
https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html?unlocked_article_code=AAAAAAAAAAAAAAAACEIPuonUktbfqIhkSlUbBibSRdkhrxqAwvTIy6A7nGS7MS6UVztY1O0RRoiN8kPRZe9obsE-mTSHQdsLeJkeeMtP9M4NdUp8V1vv5ZKehJUOJyhy9InpAW9o0smIBOFjrHq3Yjblbe4nyeP65xzWbTO8Cqbe1nAlNx8l9cU-DSyi0H0NwKzAE-JniJIpjbp6WMcMFXpXbzKKvvLpFxx-JNyBCxna4QE9UOxTMirByZ_es_lTNVUPVi-VCS938m0-69lDOdgIPKaZLxMoeMr2hLR5GXXJ67c4q18zTc0DTivOAbYp&smid=nytcore-ios-share&referringSource=articleShare
My personal doc is absolutely demoralized. She used to be bright, vibrant, entertaining, and most importantly, engaging. She's none of these anymore, and it's difficult to communicate with her because of it. Breaks my heart to see, for both of us.
Any doc, outpatient especially, can tell you the best thing is to order medication, only for insurance to deny you and go through an archaic prior authorization process to get an attempt at getting a medication approved, followed by a denial then a peer to peer discussion about said medication.
I literally have to Google drug formularies for certain insurances just to prescribe meds. That are probably only partly covered.
> an archaic prior authorization process
I don't know if this is archaic. I recently ended up in the ICU for two weeks due to a blood infection, followed by two weeks of bed rest and home care.
When the hospital sent me home, they gave me one week worth of medicine for the blood infection, to be refilled once that ran out. It would work out to something like 3 weeks of the drug total.
So I went home, and when the first week was nearly up I called the pharmacy and asked for the refill. Pharmacy said they'd need prior authorization, even though the bottle said refill.
So I called the insurance company. They needed authorization from my GP. So I called my GP. She said she wasn't the prescribing physician (the dr. in the hospital was), and I needed him to give the authorization. So I called the hospital, tracked down his name and number and called that. That took me to an answering service, who said they would give him the message.
I did that twice and nothing happened. The nurses (I had three - a physical therapist, and occupational therapist, and someone coordinating everything) noticed I was out of my meds, and asked why. All three of them pulled whatever strings they had, getting the same run-around I went through.
I finally got the refill 3 weeks after I ran out, a week after I was discharged from the home care program.
I would have just given up on the refill without those nurses making calls.
Its lucky you had nurses with the time and attention to address it. Without them, it really goes nowhere. Theres currently an adhd med shortage and calling back and forth to reach people is pretty demoralizing. Especially when one already has adhd and already struggles to initiate that process, let alone be persistent.
> have to Google drug formularies for certain insurances just to prescribe meds. That are probably only partly covered.
How do you have time to do that? I have to mutter through the stack of denial letters and jot down notes for my nurse to send the prior auths every week.
Similar to me. Have had the same family doctor my whole life. He’s Ana amazing person and doctor. He left the local clinic for a while because he was so tired of dealing with insurance companies. I hated every other doctor I went to. Fortunately he came back a few years ago. Fortunately he is happy to do things for you and not always report it for insurance. He just wants you to feel better, ya know…like a doctor should be able to do
I'm gonna leave this here [https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis?utm\_source=pocket-newtab](https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis?utm_source=pocket-newtab)
Insurance companies don't add any value and they make more work for all of us.
Thanks for that link - it’s depressing as shit to read and definitely reflects healthcare insurance isn’t in a patient’s best interest the corporate goal is increasing profits for shareholders it to help or enable patient outcomes that are in the patients best interest.
I think part of the problem is a lot of people haven't meaningfully interfaced with the health care system. It's fine if you only have an acute problem but once you're really dependent on it it's a whole new ballgame. It's why I think I'm really unhappy in life a lot of the time.
Private equity is the next big danger to health care. They purchase practices then squeeze the insurance. Health care is going to get more expensive with less pay to providers because their corporate overlords need to make profit
Private practice doc here. You are 100% spot on. Private equity is gobbling up the local groups. After practices are sold doctor pay goes down, and the docs get less support staff help to beef up the margins. The support staff was also helpful to argue with insurance to get medically necessary tests covered. Medicine is completely different now that a generation ago, and I don’t think I’ll encourage my kids to go into medicine.
It’s so short sighted. Old docs just looking to cash out. Thankfully none of my kids wants to go into healthcare. I joked years ago about there being Walmart and target brand physicians, but it’s so much worse- they’ll just be pa/np’s since they can pay them less. See the articles about pe salivating over the glut of er physicians
I'm just a patient, but this happened to my local dermatologist's practice in 2020. The office had been co-owned by two physicians for 25-30 years. Then suddenly a conglomerate called Pinnacle Dermatology (itself a subsidiary of some other conglomerate called BayPine) bought out the practice, the PA I was seeing quit/left/fired, and suddenly wait times to see the remaining physicians or midlevels jumped from 1-2 months to 5-6 months.
It’s already here. It’s terrifying. I worked in an area of real estate that specialized in medical office buildings from early 2010s to 2020. Almost every practice was sold.
My husband had the most incredible surgeon for a procedure he needed done. The DR gave him his personal cell phone and took his anxious calls at 2am.
The DRs practice was bought out by a larger network. The DR worked there for a while, then was let go because he was spending too much time with each patient and wasn’t seeing enough patients in a day.
Nothing like rushing people who need to make decisions that will affect their health or quality of life for the rest of their lives.
what's so disgusting is knowing how deeply awful the american system is, and seeing news about how in canada and the uk the conservatives actively want to privati(s)e their healthcare. evil. i feel sorrow for the world. we might not even have examples of a better system to point to anymore
I can confirm this perspective as someone I know retired early because he could now longer actually practice medicine in a way he felt benefited his patients.
I can confirm as well. I have three friends, all in their 60's, who retired from their medical profession earlier than planned because of changes dictated by the new owners/directors of the practices they worked for. The focus was no longer patient care and well being; it is now billing and expansion of market share.
New study shows that in first world countries the US has moved to last in medical outcomes and first in medical cost.
Edit: adding link
https://www.webmd.com/a-to-z-guides/news/20230131/despite-high-spending-us-ranks-last-in-health-outcomes-study
https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html
America, where you can die and bankrupt your family simultaneously thanks to some middleman in the healthcare system.
Half this country was brainwashed by republicans to think this is a good thing somehow.
Whenever you see the mainstream media talk about staffing shortages due to "Covid burnout," *please* understand that the "Covid burnout" thing is complete bullshit meant to avoid talking about the real problem: Our healthcare system is collapsing due to capitalist greed.
The real burnout started before Covid and is due to hospitals, nursing homes, and other organizations trying to squeeze more and more profit from fewer and fewer nurses and other workers, putting the staff and patients in increasingly unsafe situations. This abuse is the real source of the burnout, driving people away from healthcare jobs and compounding the problem.
Source: Am a nurse.
Partner of doctor here. Absolutely this. People with MBAs need to keep their filthy fucking hands out of healthcare. Hospitals should be run by doctors. Full stop. And there shouldn’t be a single administrator who earns more than a doctor.
Let us not forget that the mainstream media is never going to support universal single payer. Doing so would adversely affect their advertising revenue from insurance companies, private hospitals, big pharma and so on,,,
Psychologist here.
I love my job but can confirm that I am, in fact, demoralized by our healthcare system.
A year ago I had to send a teenage client to the ER because they were suicidal.
There were no beds available in any of the pediatric psychiatric hospitals in the area.
After 16 hour they kicked them out with meds and gave instructions to the family to hide all the weapons.
That's it. That's all the care they got.
The mother had to take FMLA to be at home 24/7 while they saw me twice a week (all the insurance would pay for) and waited 3 weeks for the meds to kick in.
And this gave them financial stress on top of what they were going through, especially when the fucking hospital bill came due.
After 20 years working in mental health I can tell you firsthand, our healthcare system is an absolute failure.
Primary Care Doc here, you and psychiatrists guys are in such short supply, ***We've become the psychiatrist***. Especially with higher complexity patients, it's a doozy trying to manage that in an primary care office.
The only people who are happy with the American health care system are insurance companies, big pharma, their stockholders, and the politicians they've bought. I've honestly shared stories with a few doctors about how bad it is for them not only as Dr.s, but as patients.
Well yeah when you're:
- Forced to work 65+ hour weeks
- Have to deal with insurance "prior authorizations" where a patient with obvious aggressive cancer "has to get 6 weeks of Physical Therapy before we can look into it"
- Hospital administration grifters give you a 2% raise after covid while they drive in their new Porsche
- Have to worry about malpractice and malpractice insurance
You get a little sick of things.
Physical therapists have it horrible as well. $200k of debt for a $70k salary at *most* starting off, the NPTE boards went from 18 lifetime attempts to 6, and my favorite; "You're a doctor, you're educated and trained to prescribe, but you're not a real doctor so you can't prescribe." But don't worry. A chiropractor can prescribe...
I'm a software engineer. I make more than my friends in healthcare. My friends in healthcare have quit to become software *developers* to pay off their debts
I'm an OT and practice in rural hospital system. It's absolutelung infuriating to see insurances refuse to pay for therapy in cases of OBVIOUS need. Or, my personal favorites, where someone with a clear rotator cuff tear has to do 30 days of therapy before the insurance will pay for an MRI. It's literally torturing the patient even with gentle, pain free therapy to save the insurance some money. And let's talk about MY insurance. We have some super shitty little no name insurance company that covers NOTHING unless we go directly to the hospital I work at. Problem is I don't live there! I live in the nearby city and commute. It's so bad that I'm applying for a PRN job on the weekends JUST to pay for all the doctors bills I keep getting because my insurance literally will NOT pay for ANYTHING.
"Well if we had free healthcare, you'd be waiting crazy long times to see a doctor."
Oh, so it'd be worse than the 4 months I just waited to see a physical therapist?
Fuck outta here. There's no good reason to not have free healthcare for everyone other than billionaire pharma CEOs and our bought/sold representatives.
America is a fizzling out fart, which was originally the punchline to a killer joke, but is now just a smelly fart everyone wants to dissipate and leave.
It took me four months to even find a doctor after I moved a few years ago....compared to my dog, who was able to get a vet the first week in our new home.
>Oh, so it'd be worse than the 4 months I just waited to see a physical therapist?
My coworker used to make jokes about Canadians having to wait for care. Then he needed a surgery and was shocked when he couldn't get it for months.
Insurance companies and more specifically the lawyers of insurance companies actually write a lot more of the codes and standards for us than we typically think about. We know about insurance companies driving the bus in healthcare, which is annoying at times for sure. My work has been in the electrical field for many years and the codes for installation and repair of electrical systems are also written by insurance companies. I imagine someone in the financial sector could weigh in on this with a few words as well.
I work for a psychiatrist well past his retirement age who has stopped taking most health insurance because you can’t even fart without them getting in the way of a patient’s treatment.
We have a patient, whom I'll call Alex, who has many incapacitating mental illnesses. Alex is also very poor, and without his medications, Alex hears voices; his quality of life significantly lowers, and he begins suicide attempts. On top of that, a lot of his medications react negatively with his system. His history of prescribed medications is several pages long, and a lot of the things prescribed to him don’t work well. The doctor is constantly changing his medication to find what works best.
Even though the doctor won't take his insurance, it still causes problems; some medication still gets denied every single time. And every single time, the insurance company will call and ask for letters and documents from the doctor, documents, specifications. We always send full records back. But they waste our very limited time only to get his medications denied because some guidelines in some book say so. Alex cannot afford medication without insurance.
Meanwhile, Alex is racking up suicide attempts, getting gradually more violent, and being a general inconvenience to his aging father, who is also his only caretaker and gets more and more feeble as the years pass.
Alex is an extreme case, but we get multiple insurance denials like this in the office every single day, day after day. Some insurance companies require yearly letters or reports from the doctor stating medications are needed. This need to go in circles is ridiculous, exhausting, redundant, and even insulting to a point. This shit directly affects individuals' health. Insurance companies are essentially the ones running things; they decide what the doctor can and can’t prescribe. It’s wild out there.
The real bottleneck is at the residency training stage that happens after medical school. There are hundreds of medical students who graduate and are unable to match in to residency training programs because there simply isn’t enough funding and therefore not enough residency training spots for all of the graduating medical students. Medical school graduates may have an MD/DO behind their name but can’t actually practice any medicine without going through residency.
Residency programs are starting to infect hospital pharmacy too. Give us free labor for two years or pay off your loans selling your soul to Walgreens, your choice...
We don’t need more medical schools, we need more slots for residency. If we built more med schools without improving the former we would be setting students up for failure.
Doctors are the burger flippers of the health care industry.
If they were paid for their work, the owners wouldn't make as much profit.
Here on Reddit, I once worked out the math for a doctor to bill like insurance. (based on a Redditors broken arm bill) They could be paid around $1-$2m per year. That was factoring a full time nurse assistant, full time accountant, full time receptionist, medical insurance, furnished medical space, and leasing their own private MRI machine.
Funny you bring up the burger flipper comparison. As a pharmacist I've felt like that for a while. 15 min or less, want shots (fries) with that? Wait until they start adding drive-throughs in the doctor's offices.
They straight up abuse staff and doctors, especially as residents. Admin pockets a lot of cash doing fuck all and then doctors/nurses etc get the blame for being “greedy” for wanting to be paid more.
Residents, who are full fledged doctors in training, make 50-70k working ridiculous hours. The system is a fucking joke
As a resident, I made less per hour than the legal minimum wage in my city. I literally would have made more money working the same hours at a McDonald’s and have a much easier work.
America has enough medical schools - we don’t have enough residency spots for all the medical graduates already. Agreed on 24+ hour shifts though, they’re miserable.
These are really good reads
https://www.theatlantic.com/ideas/archive/2022/02/why-does-the-us-make-it-so-hard-to-be-a-doctor/622065/
https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/
“Imagine you were planning a conspiracy to limit the number of doctors in America. Certainly, you’d make sure to have a costly, lengthy credentialing system. You would also tell politicians that America has too many doctors already. That way, you could purposefully constrain the number of medical-school students. You might freeze or slash funding for residencies and medical scholarships. You’d fight proposals to allow nurses to do the work of physicians.”
“The U.S. is one of the only developed countries to force aspiring doctors to earn a four-year bachelor’s degree and then go to medical school for another four years. (Most European countries have one continuous six-year program.) Then come the years of residency training. (12 years including degree work!) Many graduates have $200,000 to $400,000 in outstanding student loans when they enter the workforce. “
> Many graduates have $200,000 to $400,000 in outstanding student loans when they enter the workforce. “
I just graduated and have $452k student loan debt
Not entirely true. Overworked, increased paperwork and EMR entry, less qualified support staff due to cost cutting measures, entitlement of patients, limited access to specialist care, minimal access to psychiatric care, a bloated middle-management comprised of people who were never health-care providers or who are so far away as to be out-of-touch, decreased patient access time…oh I could go on and on.
One would argue your first 4 points are a direct result of insurance practices. Being overworked and less qualified support staff due to declining insurance reimbursement leading to an increased volume caseload to compensate. Paperwork and EMR demands are directly from having to document as thoroughly as possible and follow all guidelines to ensure that insurance won’t deny claims. Not all issues are directly related to insurance but it has a definitive trickle down effect in day to day practices.
I would add that a lot of documentation requirements come from trying to prevent people from suing you. The more you that you document that you did, the less they can claim you missed or didn’t do and sue you over it. Don’t get me wrong, getting paid is a huge reason clinicians need to document everything they do, but the litigious nature of healthcare in the US also plays a significant role.
I never realized how fucked Healthcare in the US was until I watched New Amsterdam on Ntflx. There is nothing that can be done to fix the system because the only people who have the power to fix it don't think that the system is a problem and they don't care about the people it affects.
I mean who would want to work in this field? I hear the pay is going up which is great, I think anyone working full time as a registered nurse should make $100k/yr minimum, and doctors 3-4x that, but having to deal with insurance must be a big hit to morale.
Not to mention the covid pandemic exposing how selfish many Americans are. You won’t get a shot or wear a mask because you think your “right” not to is more important than potentially someone else’s life? Hearing some of these stories of people paying the ultimate price because they didn’t do something so simple and basic, and having to care for them and put yourself at risk must be hard on you psychologically. And I would fear working in healthcare if and when the next pandemic starts given how stupidly this one was handled.
The reimbursement per RVU is decreasing and thanks to some poorly thought out 1990s laws require budget neutrality for Medicare, it is unlikely to improve unless congress decides to undo decades of policy.
If medicare reimbursement is bad, medicaid is atrocious. The orthopedic clinic I work at is one of the only practices in the 4 surrounding rural counties that regularly accepts medicaid patients due to the reimbursements often being bellow cost. Others have very limited slots for medicaid patients that get booked out for months.
Rural reimbursement is higher than in cities, where dense populations of medicaid patients live, so their care is often delayed even further, potentially turning acute problems into chronic ones that keep them out of the workforce.
The outpatient surgery center we use does not accept medicaid patients because they lose money on those surgeries. Medicaid reimburses bellow cost for almost all surgical implants (screws, plates, grafts, all outrageously priced by their manufacturers) so all of those patients get surgery at the hospital, which is more expensive and often ties up high acuity resources for low acuity surgeries.
Not to mention uninsured patients who balk at paying 20k+ for a necessary surgery and instead just live with their badly displaced fractures, ACL tears, rotator cuff tears, ect. that will likely cause then long term problems and decrease their productivity as workers costing society far more than the up-front cost of surgery.
And don't even get me started on worker's comp insurance. It is so beaurocratic, our small practice has a full time employee dedicated just to dealing with worker's comp insurance companies. They will frequently delay medically urgent surgeries by weeks. They legally have 10 business days to make a decision on any surgery we propose, and they almost always use that full time. This cost could be eliminated entirely if we just had universal coverage.
Neither doctors nor registered nurses with BSNs are making more on average. Doctors wages are pretty stagnant. Traveling nurses make decent pay, and we had more of them filling that role during the pandemic, but in typical times only so many are needed and only people with few other commitments are free to be traveling nurses. And practical nurses, medical assistants, phlebotomists, etc., make almost nothing.
Oh, dude, I am a doctor and can confirm. It sucks to watch the horror show and try everything in your power to do good and reverse it but be swallowed by the massive volume of trash, that is the current healthcare system.
But, the fight must go on, I am not out for the count and I have hope in our younger generation to help reverse these trends through organization and civic engagement.
Though we are burnt out from overwork.
If there was someway they could come together and organize themselves into a collective group and force their employers to listen to them or face a work stoppage. What would they call that? Can't think of anything that sounds like they are in solidarity with each other against their greedy corporate employers.
My first career was as a nurse. I knew my days were numbered in that career when I found myself arguing with a phone moron that dialysis was not an elective procedure and you can’t cut insurance coverage.
Usually I am nice as possible to phone farms but it literally came down to me me telling him he was too stupid to talk to and get me a supervisor. All while my patient was crying in the waiting room wondering if they were going to now die.
I hate the American insurance for profit system. It’s only gotten worse since back then.
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I have a client, a doctor who runs a small surgery center (something specific). Every time I talk to him, he goes off on how awful it is to work in the medical field these days. Insurance companies fight him on basically everything he does for his patients. How did it get this bad? How did these insurance companies get this powerful?
my friends family that works in medicine, have for generations, say that basically you are working for the insurance companies and for whatever company you actually work for. sounded way different than most doctors having a private practice like they all did in the 90s.
Yeah, vast majority of docs are employed now. Rising costs, reducing repayments and barriers to getting patients the care they need have made it basically impossible for private practice to exist outside of surgical specialities. I'm about to finish residency and $425k in debt from medical school. At 7% interest I'm going to be paying back $4k a month for nearly 14 years to pay it off. I can't afford the risk of a opening or buying into a private practice with that mountain of debt. Plus, thanks to CMS (federal rate setters) effective 12% rate cut (3% this year 2% next + inflation) and rising living costs means private practice groups are being squeezed out of existence.
god that is depressing.
T-minus how long until healthcare collapses?
Without major overhaul, 10-20 years is my guess unless a few congress critters have kids die while waiting to see a Dr when they get an initial appointment 6 months down the line
Then longer. Most of those congressmen are rich enough to simply skip the line and pay for immediate attention.
They aren’t in this system at all, congress and their families have access to healthcare run by the government and not insurance companies. They literally have socialized medicine for themselves while they tell us private is better.
It would need to be a large chunk of congress person having kids die, which will never happen. If its one or two that start pushing for actual positive change they just get shoved off to the side with a smile. See also Sanders and AOC.
Are you kidding? We're paying for the best health insurance money can buy them. They're not going to be waiting in any line.
Members of Congress and their families are insulated from these problems. They have top-notch health care paid for by us.
It's already in the midst of collapsing. It's not how long until it does, it's how long until it gets so bad that people actually start revolting. It's already in the midst of collapse, don't kid yourself, these things aren't happening because it's not collapsed already.
Yeah, we're in the middle of it. The shit I'm pulling in the ED on a daily basis is like battlefield medicine. Dilt, nitro, or heparin drips in the lobby. Pelvic exams and sutures being repaired in storage rooms. All the beds full of disease-riddled shells of people who can't survive outside of a hospital for more than a few days. The hallways are lined with beds filled with demented, undead boomers who flail around and grab for anyone who passes by like a zombie movie. And the kids say, "do EVERYTHING." Shit sucks.
prob right before the entire country does.
You’re vastly underestimating how *okay* we are as a society to let people die in the name of please-anything-but-helping-the-icky-poors! It feels nearly pathological. Edit: Did you know there are *2nd* *GENERATION* homeless people? Consider the implications of that; what that means in a society that has boundless wealth.
Yea I went into medicine all those years ago because I didn’t want to be a corporate slave. Nowadays If you are in private practice you are a slave to insurance companies. If you are employed by a hospital system you are just another faceless corporate employee. The CEO for the system I work for routinely says behind closed doors that physicians are just replaceable as the janitors. The goal is to replace any non surgeons with as many 23 year old NPs with online degrees and pay them nothing. Once they get some experience and ask for a pay raise they replace them with the next batch.
I had an internist as my PCP. She was one of the last ones in the area and she just told me she is leaving for a practice in another state. So I am looking for a new PCP and all that I can find on my providers website are ARNP'S. There are 2 MD'S and over 100 ARNP'S. I am not disparaging ARNP'S in any way shape or form but it seems to me the industry is pushing MD'S out purposefully to save money hiring ARNP'S.
Translation for those too poor for doctors?
Nurse practitioners
Also for your visit you pay the same for the visit. It’s just they don’t have to pay the nps as much.
Even in New York City, most of the internists are in private or concierge practices that leave the patient to sort out coverage with their insurer if they can’t pay OOP. I have long belonged to a primary care practice that first boasted a choice of MDs and 1hr20 annual exams and seamless referral navigation for specialty care. Now it’s majority very young/inexperienced NPs and PAs. At north of 45 years, I refuse to leave navigating across one or two therapeutic verticals to anyone like that. I also refuse their railroading referrals to their “preferred” hospital network for specialty care. Obv I have one foot out the door. For a working couple to pay $20k per annum for insurance, $10k+ OOP for deductibles and co-pays, we’re being screwed.
Joys of late stage capitalism.
End-stage
optimistic
Doctors aren't even upper class citizens anymore. You guys need to fucking do something holy shit. Like at the end of the day if you're the best and brightest that Humanity has to offer, and you become something like a doctor or an engineer or a lawyer that's respected in their field, and you get squeezed by the balls like this?
Writing has been on the wall for a long time. I dodged medicine for a path in medical devices because medicine was already seeing diminishing returns (had a 41 on my MCAT, so I had options), then the economy took a shit and I ended up in private education (graduated in '08). Medicine hasn't been able the money for about three decades, at this point there are financially far better options available for people smart enough to get through medical school and the medical field will continue to devalue MDs in favor of more cost effective approaches (PA, NP, etc.).
I’m in medicine and very fortunate that I enjoy my job and the practice I work for, however I have a lot of colleagues who encourage their kids to not go into medicine but rather other fields like investment banking, etc, to earn a better living. For a few people who’s kids are commited to medicine, they encourage them to go to PA school so they don’t end up saddled with as much debt and still make a good salary.
>How did it get this bad? How did these insurance companies get this powerful? Basically 2009/2010 - the whole Obamacare debate. A huge portion of the country was foaming at the mouth to keep things the way they are. We were so goddamn close to a public option it really hurts to think about now.
>We were so goddamn close to a public option Fuck Joe Lieberman.
>Fuck Joe Lieberman. And 40 other Republican Senators.
You can expect the Republicans to try to destroy the country at every turn, but it is especially galling when somebody who once claimed to be a democrat does it for no good reason.
$omething tell$ me he had a rea$on.
> it is especially galling when somebody who once claimed to be a democrat does it for no good reason. Kyrsten Sinema comes to mind...
And Joe manchin.
Nixon also allowed health insurance companies to be for profit when previously they were all required to be not-for-profit
Obligatory fuck Nixon and Reagan for various reasons
All the reasons. Various implies there are reasons not to. (I guess EPA for Nixon)
Shit he only allowed the EPA to get passed to distract from all the illegal and fucked up shit he was entangled with at the time. Not like he actually believed in it.
The "War on Drugs" mostly. Set us back decades on psychedelics research. Incarcerated god knows how many people on non-violent drug offenses.
And not to mention all the deaths of innocent bystanders. [Here is a story](https://www.nytimes.com/1973/06/25/archives/violent-drug-raids-against-the-innocent-found-widespread-viole-at.html) of the first victims of the War on Drugs from 1973.
https://www.snopes.com/fact-check/healthcare-profit-1973-hmo-act/ I was outraged by your statement, but chose to fact check, because I figured this was actually insane. The worst that happened (from what I can tell) was _arguably_ an unintentional side effect as a result of allowing the government to sponsor HMOs. I don't know all the implications of that, but Nixon didn't somehow make for-profit health insurance 'legal' it already was legal.
It wasn't illegal, but Nixon and republicans were told point blank that the idea is to provide less care and extract profits from people.Nixon approved and was reportedly "delighted" at the idea
> A huge portion of the country was foaming at the mouth to keep things the way they are. This is what I don't understand- I haven't met a single person who thinks that the current system actually "works well" or serves the function it's supposed to serve. people hate having to interact with their insurance company and hate having to pay their premiums even more (especially when you pay a premium and avoid getting care anyway because it's too expensive). BUT SOMEHOW when it comes to advocating for or moving any direction toward a new system, people scream about their coverage being changed/taken/whatever. It makes absolutely 0 sense
I mean we were probably closer in the 90s when Hillary Clinton was pushing for public health care and then that shit Lieberman fucked it up.
Hell, we almost had it in the 1940s under Truman, until the conservatives in the south realized it would be helping out black people, too, and nixed it.
In short, the history of any fight for progress in the US.
Well the rich people hated it and saw a way of killing it by convincing everyone it would help the undesirables.
You could easily be describing any public service.
Was reading "One Nation Under God" by Kruse. It highlights the rise of Corporations fighting back against Roosevelt's New Deal and the rise of Christian Libertarianism or I call it Supply Side Jesus Economics. Apparently, Truman wasnt akin to their corporate bs but they found a president that could bolster their Supply Side economics through Eisenhower. Heck, they even tried gutting Social Security and Medicare but even Eisenhower said that it's the death of Republucan party if they gutted these social services. But hey, decades past and here we are and they are trying to gutt these social services again.
Universal Healthcare was on [Frances Perkins](https://en.m.wikipedia.org/wiki/Frances_Perkins) list (social security, unemployment insurance, banning child labor, 40-hour work week) and it was pretty much the only thing she didn't get accomplished (thanks to the AMA): >In 1933, Roosevelt summoned Perkins to ask her to join his cabinet. Perkins presented Roosevelt with a long list of labor programs for which she would fight, from Social Security to minimum wage. "Nothing like this has ever been done in the United States before," she told Roosevelt. "You know that, don’t you?"[32] Agreeing to back her, Roosevelt nominated Perkins as Secretary of Labor. The nomination was met with support from the National League of Women Voters and the Women's Party.[33] The American Federation of Labor criticized the selection of Perkins because of a perceived lack of ties to labor.[33] >As secretary, Perkins oversaw the Department of Labor. Perkins went on to hold the position for 12 years, longer than any other Secretary of Labor.[34] She also became the first woman to hold a cabinet position in the United States, thus she became the first woman to enter the presidential line of succession.[35] The selection of a woman to the cabinet had been rumored in the four previous administrations, with Roosevelt being the first to follow through.[36] Roosevelt had witnessed Perkins’s work firsthand during their time in Albany.[36] With few exceptions, President Roosevelt consistently supported the goals and programs of Secretary Perkins.
Racism is the reason for much of America’s problems
"Caste: The origin of our Discontent" Isabella Wilkins Book detailing exactly what you just said. She's a Pulitzer prize winning author
Isabel Wilkerson. She also wrote The Warmth of Other Suns about the barely documented migration of six *million* black people fleeing the Jim Crow south and how they ended up in segregated neighborhoods in northern cities that still affect our politics today.
Banned in Florida...probably.
If you mean in schools, Florida's current policy amounts to *all* books are *banned by default* until explicitly reviewed and approved.
Caste - it has CRT in the title, of course it is banned. Edit: I just realized Caste doesn't have an R... Yes, I took my moron pills today 😂😂
Racism is America's original sin. It taints everything we do and are.
Which is why racists don’t want history to be taught in schools
The AMA was against it too
Of course they were. The AMA has always been against anything that provides medical services to the masses. For them, medical access is something that should only be accessible to those that can pay market rates. The AMA was vehemently opposed to medicare from the beginning, and [allied themselves with Ronald Regan](https://en.wikipedia.org/wiki/Operation_Coffee_Cup) in a campaign to tie medicare to communism. Any time single-payer healthcare, medicare expansion, or anything like that comes up, the AMA is against it. It's been a staple of their ethos since they were founded: > Dr. Morris Fishbein, the AMA's president, described the organization's attitude as early as 1939: ... all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism. Any sort of social services, like medical clinics, unemployment, even food stamps, are communism/totalitarianism to them.
I'm a recent graduate, and it's wild how miserable most physicians are. It's really annoying they are not honest as mentors about what it's really like before you go into it. It's all peaches and cream when you're wide eyed coming out of college, then once you're in the thick of it they air all the grievances. Beautiful profession but the system has made it miserable. When from the outset they tell you "think of what you'll be doing in x years, because this is not a sustainable lifestyle", you know it's not looking good. Main complaint is down to insurance. Every time it's less $$ with more requirements. That's for office. Hospital attendings mainly hate the lack of resources specially nurses and such. The hospitals are run by MBAs nowadays who have no clue how to put a bandaid, much less the needs of actual medicine. So in the end its capitalism being the bane of all of societies ills as per usual.
"annoying they are not honest as mentors about what it's really like before you go into it." Idk where you went to med school, but I've never met a fellow med student or resident who didn't have a story about a doctor telling them "I wouldn't do this again if I could go back." Every pre-med I talk to, I tell them the same spiel about being glad I'm here now but I don't think I'd choose this for myself again if I had the chance. I heard the same, and still chose to go into the profession.
>How did these insurance companies get this powerful? Legalized bribery. The system of campaign donations, job offers, massive speaking fees, etc has corrupted our society completely. It's not just insurance companies that got this powerful. All the big corporations did. The system of legalized bribery is the source of most of our biggest problems.
Here's a fun set of questions. 1. What is the first thing an insurance company do when it receive a claim? 2. What is the second thing? The answer to #1 is: Look for a way, any way, to deny payment. The answer to #2 is: Take any and all measures to delay payment. > How did these insurance companies get this powerful? High premiums and low payout.
2. Lobbyists
It's not just lobbyists - plenty of voters believe that privatization of healthcare saves costs and leads to greater efficiency and they go ahead and elect true believer politicians to represent them.
More like they don't like the idea of people "beneath them" receiving healthcare
Somewhere, a hungry person might get a sandwich they didn't pay for and that makes me angry. -What I think whenever I think about the insanely inefficient outcomes the self regulating free market provides
It's been this way for decades.. Covid finally brought up the wages a bit for lower level health care workers but industry execs were kicking and screaming and pulling every string possible for the gov to intervene (because muh Healthcare profits -_-). Working conditions didn't improve at all, it only got much much worse.
>How did it get this bad? How did these insurance companies get this powerful? Republican obstruction.
“For me, doctoring in a broken place required a sustaining belief that the place would become less broken as a result of my efforts,” wrote Dr. Rachael Bedard about her decision to quit her job at New York City’s Rikers Island prison complex during the pandemic. “I couldn’t sustain that belief any longer.”
As a doctor at a rural hospital, this is exactly how I feel.
Trust me, it is not much better in many urban centers. We vacation in the winter in Palm Springs. It is a healthcare desert here. The primary facilities, Desert Regional Medical Center and Eisenhower, are both so corrupt that it is almost impossible to get any kind of reasonable care here. Last year, I developed pneumonia and needed to go to the ER. I ended up at Desert Regional Medical Center. First trip, they gave me a dose of Tylenol, a Covid test (negative) and sent me home. When I continued getting worse, I returned a few days later. They tried to give me Tylenol again. I refused and needed to demand some actual care. They finally gave me a single view chest x-ray (which was how they diagnosed the pneumonia). Then a dose of antibiotics and some fluids. I was never admitted to the hospital. Total billed for these services? More than $16,000.00. It is a total shit show.
Yeah the whole system is crumbling in slow motion. My friends from residency are scattered across the country and in a variety of settings and every one of us feels like the system is just crushing us into the ground. People ask me if health care in the US will collapse, I tell them it already has we’re just dealing with the slow fallout and it’s only going to get worse.
Do doctors feel that a single payer healthcare system would solve these issues? Edit: I guess I should say do you or your friends from residency feel this way?
The answer you’re going to get varies but in my field most of my peers are left leaning. It’s definitely a conversation worth having but the reservations aren’t the lower pay but the fact that Medicare and Medicaid are a significant source many of the problems we’re facing outside of private health insurance. So in many ways it would be like throwing gasoline on a fire.
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True, it’s not often the people actually in health care are asked about how to fix it. I see a lot of editorials in the papers written by people who are administrators or who work for lobbying groups.
I totally agree. Just had a surgery in Augusta GA at AU health a medical college. Soon as I woke from anesthesia they were putting on my shoes for me and rushing me out of the recovery room. Maybe there 30 minutes. The bill for that alone $1500. It’s become a racket.
I felt this way as a teacher. I also left.
40 years in public education, and I retire next year entirely disillusioned with the Ed hegemony.
My wife and I just had both of our docs leave...
I ruptured my Achilles tendon in December. Doctor ordered an MRI to confirm it. Insurance denied the MRI, stated it's only useful for surgery prep, demanded an xray instead. My doctor explained to them that tendons don't show up on xrays, only the MRI will show the damage. More than a month later we do the xray to satisfy insurance, it shows nothing. They authorize the MRI which confirms a 2cm tear > 50% through the tendon. Gee, guess that's why I haven't been able to walk for a month... Where do they get off thinking they can practice medicine? No wonder doctors are burned out.
I'm a resident physician, I had to explain this exact thing regarding tendons and xrays to some insurance rep asshole that was denying my MRI order. She then said she would have to consult with their inhouse physician. Or you know, you could just let me do my fucking job. My personal favorite is them nearly forcing another patient to pay out of pocket for labs because I put "healthcare maintenance" for coding purposes in the EMR, while the insurance company said I had to do "Annual physical." I had to go back to the chart and edit it. It's become such a labyrinth of bullshit
> Or you know, you could just let me do my fucking job. From their point of view, your job is to trick them out of their delicious monies by ordering unnecessary tests.
It would be so refreshing to have a medical system run by doctors.
Physicians can no longer own hospitals/hospital systems. They deemed it a conflict of interest. It really seems like all these mbas have the best interest of the patients in mind
I had an attending who said the only job hospital administration has is to make sure *they* have a job.
Yup. Most useless job out there and primary reason why health insurance is so damn expensive these days
Early hospitals wayyyy back in the day were physician run. Now it’s run by bloated blood sucking administration that funnel profits all the way to the top. Profits over patient safety and lives always
"Here, have some unnecessary radiation to satisfy my uninformed opinion."
Plus the extra $250 out of pocket for a useless xray.
I’m a primary care doc and I’m a little surprised your doc didn’t just order an X-ray first. It’s common knowledge that you need an X-ray before insurance will cover a musculoskeletal mri regardless of what you’re ordering it for. It’s pretty much an informality that if you’re thinking about ordering an MRI to order the X-ray first whether you think the X-ray will truly show anything or not otherwise you’ll end up in a situation like you described. It’s dumb and I don’t agree but what I often tell my patients is I’m not a defender of this messed up system and my job is to help you navigate through its pitfalls the best we can
Sounds super inefficient and like a waste of medical resources if that's the way it has to be done, assuming you know ahead of time that the x-ray isn't going to show anything? Correct me if I'm wrong. Non-doc here. Edit: typo
Health insurance companies should not exist. They’re leeches on the system.
Additionally, healthcare should not be treated as some product or service that one buys in the marketplace, like dance lessons or a new set of cookware. Normal market forces of supply and demand do not apply.
That means that it should be treated as a public utility.
Yes, exactly. Same as roads, police, fire protection, water...
Funny how ~~utilities~~ electricity and telecoms are just monopolies instead of public utilities.
i have public internet in oklahoma. best internet ever., went from getting ass blasted for 20 years by a monopoly for profit called cox. now just amazing 1 gig fiber no issues munipical. or i guess it's actually a co-op.
When I lived in Tennessee my internet and cable was a public utility. It was the best service I’ve ever had.
I live where electric is a public utility. Our prices are just over half what the other power companies in the state charge and when our last major ice storm had nearby towns without power for days, ours never went out. I wish we our internet was the same!
Utilities are usually not for profit entities. When they are privatized, we have a system like the Texas power grid where reinvestment funding is paid out as profits. Edit: grammer
And when they are private we keep getting rate increases that aren't lining up with their actual costs. The gas co where I live got approved for a rate increase to fix a bunch of problems then never bothered to fix them, just pocketed the profit. No repercussions.
Most of the electric and gas utilities in the US are privatized, just heavily regulated. Duke, FPL, Mid America are all private for-profit energy companies that must get permission from their respective state utility boards for most everything they do. **Edit: I'm stating that electric utilities outside of Texas are not non-profits but are in fact mostly for profit corporations. Yes, although they must get permission from their respective utility boards for most things, regulatory capture, lobbying, and all forms of political malfeasance is, like all other aspects of our government, rampant...which is a different argument.
It should be treated as a public utility, *but* it needs autonomy. Right now? It's neither. It's laissez-faire on the profit side (so, fuck the patient), but if, some conservative government doesn't want you to to give care to someone? They can bring the law (so, fuck the patient). We get the worst of both worlds. Small government enough to fuck you, Big Government enough to fuck you. This is by design! "Fuck you" is by design! On purpose!
And if the insurance company doesn’t want you to give care to someone, fuck the patient. Death panels are real, and their staffed by BCBS, Aetna, United, etc.
This is what amazes me whenever the argument against publicly funded healthcare inevitably falls back on 'I don't want a government paid doctor to make decisions about my health care!' So, you would prefer that decision be made by insurance industry actuaries?
Right? At least you can vote out government officials. Doesn't mean you can tell them what to do exactly, but there's *some* form of control via the citizens.
It is the worst system in the world, I watched my father be a good worker and citizen his whole life, get up, go to work at a bank, but had heart disease which ran in his family. At age 60 he got laid off after working for that bank for 25+ years but was so nervous about not having health care with his issues he paid for cobra that cost him almost 2k a month just for major medical. That would just cover if he had some major issue. He was burning through his 401k savings. He then got cancer, and the bills for that even with Cobra left him broke by the time he died. The system we have is designed to keep you working your whole life, stressed, and when you die its claws back everything you saved in to the system. It is a shame, and for some unknown reason people are not marching in the streets mad as hell, and when some suggests a single payer system in the country, voters fight a against it. Got to hate this country's health care system.
This pretains to the UK and the workers in public service but I feel the message is still applicable to our workers in the US. ["How can the market decide the value of someone whos work can't be measured in cash?"](https://youtu.be/WQk99fxO9Ss?t=144)
You know the "government bloat" conservatives usually always complain about? Health insurance companies are essentially the capitalist version of that bloat. A significant percentage of healthcare costs are simply to subsidize the survival of the healthcare insurance industry including those it employs. Conservatives just love to ignore that bloat because they profit off of it.
They’re leeches and they’re needlessly complex, requiring a dedicated staff person or people to navigate their gate-keeping, exclusions, and obstacles. They add no value. Tl dr: They suck.
Accountants should not be making healthcare decisions.
FUN STORY: I once got in an argument with a C-level executive at a huge Health Insuarnce Corp, and he was unable to explain why Health Insurers need to exist. I gave him multiple tries over about 45 minutes. He kept trying these arguments that were so easy to shoot down. I think I kinda embarrassed him because he shook my hand and thanked me afterward for a lively debate. But he didn’t win the debate. He was in fact UNABLE to explain why this isn’t just a skyscraper full of middlemen. It was the most fun I’ve ever had with a rich guy.
I hate that in US politics “debate” is seen as something to strive for, and that there is a winning side and a losing side. Idiots like Ben Shapiro become famous because they “debate” unprepared college students with half-truths and bigotry but because he talks fast and uses buzzwords people think he wins those debates. Not every argument deserves to be debated and you shouldn’t be able to “win” if you have garbage ideology. If I say that people with three arms are still human and deserve the same rights as people with two arms, but you say people with three arms are disgusting abominations and deserve to be publicly executed, there is not a middle ground there that can be reached. BASIC HUMAN RIGHTS ARE NOT UP FOR DEBATE.
Ben Shapiro is to debate as the WWE is to UFC.
Gift link: https://www.nytimes.com/2023/02/05/opinion/doctors-universal-health-care.html?unlocked_article_code=AAAAAAAAAAAAAAAACEIPuonUktbfqIhkSlUbBibSRdkhrxqAwvTIy6A7nGS7MS6UVztY1O0RRoiN8kPRZe9obsE-mTSHQdsLeJkeeMtP9M4NdUp8V1vv5ZKehJUOJyhy9InpAW9o0smIBOFjrHq3Yjblbe4nyeP65xzWbTO8Cqbe1nAlNx8l9cU-DSyi0H0NwKzAE-JniJIpjbp6WMcMFXpXbzKKvvLpFxx-JNyBCxna4QE9UOxTMirByZ_es_lTNVUPVi-VCS938m0-69lDOdgIPKaZLxMoeMr2hLR5GXXJ67c4q18zTc0DTivOAbYp&smid=nytcore-ios-share&referringSource=articleShare
Thank you.
It’s hard not to go through our Heathcare system and come out the other end feeling anything but scammed.
My personal doc is absolutely demoralized. She used to be bright, vibrant, entertaining, and most importantly, engaging. She's none of these anymore, and it's difficult to communicate with her because of it. Breaks my heart to see, for both of us.
Any doc, outpatient especially, can tell you the best thing is to order medication, only for insurance to deny you and go through an archaic prior authorization process to get an attempt at getting a medication approved, followed by a denial then a peer to peer discussion about said medication. I literally have to Google drug formularies for certain insurances just to prescribe meds. That are probably only partly covered.
> an archaic prior authorization process I don't know if this is archaic. I recently ended up in the ICU for two weeks due to a blood infection, followed by two weeks of bed rest and home care. When the hospital sent me home, they gave me one week worth of medicine for the blood infection, to be refilled once that ran out. It would work out to something like 3 weeks of the drug total. So I went home, and when the first week was nearly up I called the pharmacy and asked for the refill. Pharmacy said they'd need prior authorization, even though the bottle said refill. So I called the insurance company. They needed authorization from my GP. So I called my GP. She said she wasn't the prescribing physician (the dr. in the hospital was), and I needed him to give the authorization. So I called the hospital, tracked down his name and number and called that. That took me to an answering service, who said they would give him the message. I did that twice and nothing happened. The nurses (I had three - a physical therapist, and occupational therapist, and someone coordinating everything) noticed I was out of my meds, and asked why. All three of them pulled whatever strings they had, getting the same run-around I went through. I finally got the refill 3 weeks after I ran out, a week after I was discharged from the home care program. I would have just given up on the refill without those nurses making calls.
Its lucky you had nurses with the time and attention to address it. Without them, it really goes nowhere. Theres currently an adhd med shortage and calling back and forth to reach people is pretty demoralizing. Especially when one already has adhd and already struggles to initiate that process, let alone be persistent.
> have to Google drug formularies for certain insurances just to prescribe meds. That are probably only partly covered. How do you have time to do that? I have to mutter through the stack of denial letters and jot down notes for my nurse to send the prior auths every week.
Similar to me. Have had the same family doctor my whole life. He’s Ana amazing person and doctor. He left the local clinic for a while because he was so tired of dealing with insurance companies. I hated every other doctor I went to. Fortunately he came back a few years ago. Fortunately he is happy to do things for you and not always report it for insurance. He just wants you to feel better, ya know…like a doctor should be able to do
I had to find a new PCP because the one I had and adored literally quit medicine all together
I'm gonna leave this here [https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis?utm\_source=pocket-newtab](https://www.propublica.org/article/unitedhealth-healthcare-insurance-denial-ulcerative-colitis?utm_source=pocket-newtab) Insurance companies don't add any value and they make more work for all of us.
Thanks for that link - it’s depressing as shit to read and definitely reflects healthcare insurance isn’t in a patient’s best interest the corporate goal is increasing profits for shareholders it to help or enable patient outcomes that are in the patients best interest.
I think part of the problem is a lot of people haven't meaningfully interfaced with the health care system. It's fine if you only have an acute problem but once you're really dependent on it it's a whole new ballgame. It's why I think I'm really unhappy in life a lot of the time.
Private equity is the next big danger to health care. They purchase practices then squeeze the insurance. Health care is going to get more expensive with less pay to providers because their corporate overlords need to make profit
Private practice doc here. You are 100% spot on. Private equity is gobbling up the local groups. After practices are sold doctor pay goes down, and the docs get less support staff help to beef up the margins. The support staff was also helpful to argue with insurance to get medically necessary tests covered. Medicine is completely different now that a generation ago, and I don’t think I’ll encourage my kids to go into medicine.
It’s so short sighted. Old docs just looking to cash out. Thankfully none of my kids wants to go into healthcare. I joked years ago about there being Walmart and target brand physicians, but it’s so much worse- they’ll just be pa/np’s since they can pay them less. See the articles about pe salivating over the glut of er physicians
I'm just a patient, but this happened to my local dermatologist's practice in 2020. The office had been co-owned by two physicians for 25-30 years. Then suddenly a conglomerate called Pinnacle Dermatology (itself a subsidiary of some other conglomerate called BayPine) bought out the practice, the PA I was seeing quit/left/fired, and suddenly wait times to see the remaining physicians or midlevels jumped from 1-2 months to 5-6 months.
You mean currently are.
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It’s already here. It’s terrifying. I worked in an area of real estate that specialized in medical office buildings from early 2010s to 2020. Almost every practice was sold.
My husband had the most incredible surgeon for a procedure he needed done. The DR gave him his personal cell phone and took his anxious calls at 2am. The DRs practice was bought out by a larger network. The DR worked there for a while, then was let go because he was spending too much time with each patient and wasn’t seeing enough patients in a day. Nothing like rushing people who need to make decisions that will affect their health or quality of life for the rest of their lives.
what's so disgusting is knowing how deeply awful the american system is, and seeing news about how in canada and the uk the conservatives actively want to privati(s)e their healthcare. evil. i feel sorrow for the world. we might not even have examples of a better system to point to anymore
And thebsolution is glaringly obvious yet expressed as "unfathomable": tax the ultra wealthy
I can confirm this perspective as someone I know retired early because he could now longer actually practice medicine in a way he felt benefited his patients.
I can confirm as well. I have three friends, all in their 60's, who retired from their medical profession earlier than planned because of changes dictated by the new owners/directors of the practices they worked for. The focus was no longer patient care and well being; it is now billing and expansion of market share.
I’m not even 40 yet and I’m planning my exit. The moral injury adds to (but isn’t the only factor) the distress in a soul crushing way.
New study shows that in first world countries the US has moved to last in medical outcomes and first in medical cost. Edit: adding link https://www.webmd.com/a-to-z-guides/news/20230131/despite-high-spending-us-ranks-last-in-health-outcomes-study https://www.cnn.com/2023/01/31/health/us-health-care-spending-global-perspective/index.html
America, where you can die and bankrupt your family simultaneously thanks to some middleman in the healthcare system. Half this country was brainwashed by republicans to think this is a good thing somehow.
Whenever you see the mainstream media talk about staffing shortages due to "Covid burnout," *please* understand that the "Covid burnout" thing is complete bullshit meant to avoid talking about the real problem: Our healthcare system is collapsing due to capitalist greed. The real burnout started before Covid and is due to hospitals, nursing homes, and other organizations trying to squeeze more and more profit from fewer and fewer nurses and other workers, putting the staff and patients in increasingly unsafe situations. This abuse is the real source of the burnout, driving people away from healthcare jobs and compounding the problem. Source: Am a nurse.
Partner of doctor here. Absolutely this. People with MBAs need to keep their filthy fucking hands out of healthcare. Hospitals should be run by doctors. Full stop. And there shouldn’t be a single administrator who earns more than a doctor.
Let us not forget that the mainstream media is never going to support universal single payer. Doing so would adversely affect their advertising revenue from insurance companies, private hospitals, big pharma and so on,,,
So much truth there, I hardy ever watch live tv, but when I have, it seems 8 out of every 10 commercials are for some drug to fix something.
This is what a collapsing healthcare system looks like.
This is one of the symptoms of the bigger problem, the capitalist system that once helped us can't sustain us.
Psychologist here. I love my job but can confirm that I am, in fact, demoralized by our healthcare system. A year ago I had to send a teenage client to the ER because they were suicidal. There were no beds available in any of the pediatric psychiatric hospitals in the area. After 16 hour they kicked them out with meds and gave instructions to the family to hide all the weapons. That's it. That's all the care they got. The mother had to take FMLA to be at home 24/7 while they saw me twice a week (all the insurance would pay for) and waited 3 weeks for the meds to kick in. And this gave them financial stress on top of what they were going through, especially when the fucking hospital bill came due. After 20 years working in mental health I can tell you firsthand, our healthcare system is an absolute failure.
Primary Care Doc here, you and psychiatrists guys are in such short supply, ***We've become the psychiatrist***. Especially with higher complexity patients, it's a doozy trying to manage that in an primary care office.
*cries in social work* relatable
Fight for single payer. Get business out of healthcare. And, out of decisions on reproductive rights.
The only people who are happy with the American health care system are insurance companies, big pharma, their stockholders, and the politicians they've bought. I've honestly shared stories with a few doctors about how bad it is for them not only as Dr.s, but as patients.
Well yeah when you're: - Forced to work 65+ hour weeks - Have to deal with insurance "prior authorizations" where a patient with obvious aggressive cancer "has to get 6 weeks of Physical Therapy before we can look into it" - Hospital administration grifters give you a 2% raise after covid while they drive in their new Porsche - Have to worry about malpractice and malpractice insurance You get a little sick of things. Physical therapists have it horrible as well. $200k of debt for a $70k salary at *most* starting off, the NPTE boards went from 18 lifetime attempts to 6, and my favorite; "You're a doctor, you're educated and trained to prescribe, but you're not a real doctor so you can't prescribe." But don't worry. A chiropractor can prescribe... I'm a software engineer. I make more than my friends in healthcare. My friends in healthcare have quit to become software *developers* to pay off their debts
I'm an OT and practice in rural hospital system. It's absolutelung infuriating to see insurances refuse to pay for therapy in cases of OBVIOUS need. Or, my personal favorites, where someone with a clear rotator cuff tear has to do 30 days of therapy before the insurance will pay for an MRI. It's literally torturing the patient even with gentle, pain free therapy to save the insurance some money. And let's talk about MY insurance. We have some super shitty little no name insurance company that covers NOTHING unless we go directly to the hospital I work at. Problem is I don't live there! I live in the nearby city and commute. It's so bad that I'm applying for a PRN job on the weekends JUST to pay for all the doctors bills I keep getting because my insurance literally will NOT pay for ANYTHING.
"Well if we had free healthcare, you'd be waiting crazy long times to see a doctor." Oh, so it'd be worse than the 4 months I just waited to see a physical therapist? Fuck outta here. There's no good reason to not have free healthcare for everyone other than billionaire pharma CEOs and our bought/sold representatives. America is a fizzling out fart, which was originally the punchline to a killer joke, but is now just a smelly fart everyone wants to dissipate and leave.
It took me four months to even find a doctor after I moved a few years ago....compared to my dog, who was able to get a vet the first week in our new home.
>Oh, so it'd be worse than the 4 months I just waited to see a physical therapist? My coworker used to make jokes about Canadians having to wait for care. Then he needed a surgery and was shocked when he couldn't get it for months.
Insurance companies and more specifically the lawyers of insurance companies actually write a lot more of the codes and standards for us than we typically think about. We know about insurance companies driving the bus in healthcare, which is annoying at times for sure. My work has been in the electrical field for many years and the codes for installation and repair of electrical systems are also written by insurance companies. I imagine someone in the financial sector could weigh in on this with a few words as well.
IT sector here. The codes for cyber security are often writing by insurance companies too
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Don’t forget lawyers who see us as a lootbox
I work for a psychiatrist well past his retirement age who has stopped taking most health insurance because you can’t even fart without them getting in the way of a patient’s treatment. We have a patient, whom I'll call Alex, who has many incapacitating mental illnesses. Alex is also very poor, and without his medications, Alex hears voices; his quality of life significantly lowers, and he begins suicide attempts. On top of that, a lot of his medications react negatively with his system. His history of prescribed medications is several pages long, and a lot of the things prescribed to him don’t work well. The doctor is constantly changing his medication to find what works best. Even though the doctor won't take his insurance, it still causes problems; some medication still gets denied every single time. And every single time, the insurance company will call and ask for letters and documents from the doctor, documents, specifications. We always send full records back. But they waste our very limited time only to get his medications denied because some guidelines in some book say so. Alex cannot afford medication without insurance. Meanwhile, Alex is racking up suicide attempts, getting gradually more violent, and being a general inconvenience to his aging father, who is also his only caretaker and gets more and more feeble as the years pass. Alex is an extreme case, but we get multiple insurance denials like this in the office every single day, day after day. Some insurance companies require yearly letters or reports from the doctor stating medications are needed. This need to go in circles is ridiculous, exhausting, redundant, and even insulting to a point. This shit directly affects individuals' health. Insurance companies are essentially the ones running things; they decide what the doctor can and can’t prescribe. It’s wild out there.
Oh, we’re burned out from overwork, too.
It's both. America needs more medical schools. And the system where residents do 24+ hr shifts needs to go as well.
The real bottleneck is at the residency training stage that happens after medical school. There are hundreds of medical students who graduate and are unable to match in to residency training programs because there simply isn’t enough funding and therefore not enough residency training spots for all of the graduating medical students. Medical school graduates may have an MD/DO behind their name but can’t actually practice any medicine without going through residency.
Residency programs are starting to infect hospital pharmacy too. Give us free labor for two years or pay off your loans selling your soul to Walgreens, your choice...
We don’t need more medical schools, we need more slots for residency. If we built more med schools without improving the former we would be setting students up for failure.
Funny how the free market conservatives are not willing to subject doctors to the free market....
Doctors are the burger flippers of the health care industry. If they were paid for their work, the owners wouldn't make as much profit. Here on Reddit, I once worked out the math for a doctor to bill like insurance. (based on a Redditors broken arm bill) They could be paid around $1-$2m per year. That was factoring a full time nurse assistant, full time accountant, full time receptionist, medical insurance, furnished medical space, and leasing their own private MRI machine.
Funny you bring up the burger flipper comparison. As a pharmacist I've felt like that for a while. 15 min or less, want shots (fries) with that? Wait until they start adding drive-throughs in the doctor's offices.
Walmart is getting into the medical game, no joke. Dark skies ahead
They straight up abuse staff and doctors, especially as residents. Admin pockets a lot of cash doing fuck all and then doctors/nurses etc get the blame for being “greedy” for wanting to be paid more. Residents, who are full fledged doctors in training, make 50-70k working ridiculous hours. The system is a fucking joke
As a resident, I made less per hour than the legal minimum wage in my city. I literally would have made more money working the same hours at a McDonald’s and have a much easier work.
America has enough medical schools - we don’t have enough residency spots for all the medical graduates already. Agreed on 24+ hour shifts though, they’re miserable.
These are really good reads https://www.theatlantic.com/ideas/archive/2022/02/why-does-the-us-make-it-so-hard-to-be-a-doctor/622065/ https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/ “Imagine you were planning a conspiracy to limit the number of doctors in America. Certainly, you’d make sure to have a costly, lengthy credentialing system. You would also tell politicians that America has too many doctors already. That way, you could purposefully constrain the number of medical-school students. You might freeze or slash funding for residencies and medical scholarships. You’d fight proposals to allow nurses to do the work of physicians.” “The U.S. is one of the only developed countries to force aspiring doctors to earn a four-year bachelor’s degree and then go to medical school for another four years. (Most European countries have one continuous six-year program.) Then come the years of residency training. (12 years including degree work!) Many graduates have $200,000 to $400,000 in outstanding student loans when they enter the workforce. “
> Many graduates have $200,000 to $400,000 in outstanding student loans when they enter the workforce. “ I just graduated and have $452k student loan debt
Why not both? As in both be burnt out from overwork and dealing with a deeply flawed system..
Ain’t that America
Not entirely true. Overworked, increased paperwork and EMR entry, less qualified support staff due to cost cutting measures, entitlement of patients, limited access to specialist care, minimal access to psychiatric care, a bloated middle-management comprised of people who were never health-care providers or who are so far away as to be out-of-touch, decreased patient access time…oh I could go on and on.
One would argue your first 4 points are a direct result of insurance practices. Being overworked and less qualified support staff due to declining insurance reimbursement leading to an increased volume caseload to compensate. Paperwork and EMR demands are directly from having to document as thoroughly as possible and follow all guidelines to ensure that insurance won’t deny claims. Not all issues are directly related to insurance but it has a definitive trickle down effect in day to day practices.
I would add that a lot of documentation requirements come from trying to prevent people from suing you. The more you that you document that you did, the less they can claim you missed or didn’t do and sue you over it. Don’t get me wrong, getting paid is a huge reason clinicians need to document everything they do, but the litigious nature of healthcare in the US also plays a significant role.
Insurance is ruining medicine for practitioners and patients.
I never realized how fucked Healthcare in the US was until I watched New Amsterdam on Ntflx. There is nothing that can be done to fix the system because the only people who have the power to fix it don't think that the system is a problem and they don't care about the people it affects.
I mean who would want to work in this field? I hear the pay is going up which is great, I think anyone working full time as a registered nurse should make $100k/yr minimum, and doctors 3-4x that, but having to deal with insurance must be a big hit to morale. Not to mention the covid pandemic exposing how selfish many Americans are. You won’t get a shot or wear a mask because you think your “right” not to is more important than potentially someone else’s life? Hearing some of these stories of people paying the ultimate price because they didn’t do something so simple and basic, and having to care for them and put yourself at risk must be hard on you psychologically. And I would fear working in healthcare if and when the next pandemic starts given how stupidly this one was handled.
The reimbursement per RVU is decreasing and thanks to some poorly thought out 1990s laws require budget neutrality for Medicare, it is unlikely to improve unless congress decides to undo decades of policy.
If medicare reimbursement is bad, medicaid is atrocious. The orthopedic clinic I work at is one of the only practices in the 4 surrounding rural counties that regularly accepts medicaid patients due to the reimbursements often being bellow cost. Others have very limited slots for medicaid patients that get booked out for months. Rural reimbursement is higher than in cities, where dense populations of medicaid patients live, so their care is often delayed even further, potentially turning acute problems into chronic ones that keep them out of the workforce. The outpatient surgery center we use does not accept medicaid patients because they lose money on those surgeries. Medicaid reimburses bellow cost for almost all surgical implants (screws, plates, grafts, all outrageously priced by their manufacturers) so all of those patients get surgery at the hospital, which is more expensive and often ties up high acuity resources for low acuity surgeries. Not to mention uninsured patients who balk at paying 20k+ for a necessary surgery and instead just live with their badly displaced fractures, ACL tears, rotator cuff tears, ect. that will likely cause then long term problems and decrease their productivity as workers costing society far more than the up-front cost of surgery. And don't even get me started on worker's comp insurance. It is so beaurocratic, our small practice has a full time employee dedicated just to dealing with worker's comp insurance companies. They will frequently delay medically urgent surgeries by weeks. They legally have 10 business days to make a decision on any surgery we propose, and they almost always use that full time. This cost could be eliminated entirely if we just had universal coverage.
Neither doctors nor registered nurses with BSNs are making more on average. Doctors wages are pretty stagnant. Traveling nurses make decent pay, and we had more of them filling that role during the pandemic, but in typical times only so many are needed and only people with few other commitments are free to be traveling nurses. And practical nurses, medical assistants, phlebotomists, etc., make almost nothing.
We need Medicare for All. The vast majority of doctors support it, because it's way less paper work and nobody is denied care.
Join the club. As a HUMAN BEING I'm demoralized by our health system.
Insurance companies are practicing medicine when they determine what is best for the patient rather than the doctor
Oh, dude, I am a doctor and can confirm. It sucks to watch the horror show and try everything in your power to do good and reverse it but be swallowed by the massive volume of trash, that is the current healthcare system. But, the fight must go on, I am not out for the count and I have hope in our younger generation to help reverse these trends through organization and civic engagement. Though we are burnt out from overwork.
And so are the patients.
If there was someway they could come together and organize themselves into a collective group and force their employers to listen to them or face a work stoppage. What would they call that? Can't think of anything that sounds like they are in solidarity with each other against their greedy corporate employers.
My first career was as a nurse. I knew my days were numbered in that career when I found myself arguing with a phone moron that dialysis was not an elective procedure and you can’t cut insurance coverage. Usually I am nice as possible to phone farms but it literally came down to me me telling him he was too stupid to talk to and get me a supervisor. All while my patient was crying in the waiting room wondering if they were going to now die. I hate the American insurance for profit system. It’s only gotten worse since back then.