Interesting healthcare discussion

Before I get to the real meat of this post, my last call wasn’t really my last. Funny how things work. A fellow coworker had to go on medical leave and guess who got stuck covering her ass? In the 3 days I covered, I worked 2X as much as I would’ve worked the whole week on the rotation I was on. :wallbash:

Now to the main story.

I found an interesting topic on the Anesthesia forums regarding job satisfaction. There was a member of the USAF promoting a socialized care system based on what he’d seen in the movies and his interactions with military style medicine. One post really stuck out as a well informed response and an overview of the current state of affairs in medicine today. I’ll admit it’s may come off as a tad extreme and “soapboxy” but the USAF guy was the one threatening to kill people.

Click below to read the long response.

Taken with permission from http://forums.studentdoctor.net:

…As for the third, the active military model of health care is one of limitless spending and limitless resources. Everyone would love to have that model as the national model of healthcare because it is unrealistic to translate to the public sector. You are a fighting soldier. The government wants to keep you around to be an active duty soldier. It will pay whatever it has to to keep you on your feet and keep you going and keep your family going so you don’t have to leave the service. Break your leg? Instant operation to fix it. Bowel blockage or injury? Instand lap to fix it. Have a heart injury or heart attack? Instant sternotomy and repair.

Now let’s say you are permantly incapacitated (amputation, PTSD, injury unsuitable for continued service in general). You will now get to experience the joys of socialized health care for the masses: the VA hospital.

Break your leg now? Better hope it’s a compound/life threatening fracture because now you get rehab, minimal PT, long waits in a VA hallway for a cast, cast removal, or new cast, and surgery in 2-6 months if you fail conservative treatment and hopefully haven’t developed a contraction, infection, permanent nerve injury, etc. Bowel blockage or injury? Let’s try laxatives for a couple of weeks. Hopefully you won’t perforate and become septic and die in the interim. We can get a CT scan by Tuesday, but you have to stay here and wait in line or you lose your place. Heart attack? Wow. Maybe we should try to stent it. Hopefully we can because if not, you get an operation by the most overworked, underpaid, bitter old CT surgeon (if you’re lucky. If not you get junior who likely chose CT surgery because he/she had no other options and comes to you with a less than desirable skill set to operate on your ticker).

Is this the model you would like to see? 9-5 doctors or 7-3 depending on your time frame who get paid a flat income, have no incentive to be efficient, get paid regardless of what they actually do every day, destroy any push for innovation, etc.? How many groundbreaking medical breakthroughs/discoveries/innovations have come from the VA hospital system in the last 20 years?

Better yet, let’s be fair and force socialized working systems on other professions such as law, acting, engineering, computer science, etc.

Great to know that Leonardo DiCaprio and George Clooney will now be making films for the socialized rate of $100,000 for actors instead of $15,000,000 per film. I’m sure they’ll still put their best foot forward because of their passion for acting.

Steve Jobs and the Apple crew? Keep bringing us exciting, new, and innovative technologies like my iPhone, but you’ll have to do it for $60,000 for the engineers who designed it and $80,000 for Mr. Jobs who marketed it.

John Edwards? Can’t make that $10,000,000 in consulting fees for that hedge fund. Remember you are a LAWYER. What you are doing with that company still qualifies as practicing law so you need to return $9,900,000. But by all means, continue to campaign against the overpaid doctor in favor of the overpaid administrator, insurance company, and hospital in the new world of socialized health system.

Sadly, I speak from my experiences at both the Audie Murphy VA hospital of San Antonio, and the Dallas VA Hospital. By comparison, Brooke Army Medical Center and Wilford Hall, where active duty military personnel and their families receive care in San Antonio were the fountains of resources and spending that gave active duty personnel the best doctors, nurses, ancillary staff, and equipment. I would gladly accept that type of environment to work at and be treated at.

By contrast, the VA hospitals attracted physicians, nurses, and other personnel, unable to get jobs elsewhere, with suspect skill sets, suspect training, immigration issues, desiring long term benefits with minimal work requirements, or with personalities more suited for federal prison jobs.

Instead of removing the reasons that NO health care system can resist (health care for 11,000,000+ illegal aliens that contribute no taxes to the system, prohibitive new technologies costs, excessive hospital administrative and general function fees, soaring pharmaceutical costs, soaring multibillion dollar insurance company profits combined with denied heatlh coverage to subscribers, leading those subscribers to obtain government funded heatlh programs even when they have supposed “full coverage” under a private plan, etc.), legislators want to put a 2% doctor’s tax on MY income on top of continuing declines in reimbursement (70% decrease in income from 1990 to 2006 based on Medicare physician reimbursement data), possibly raising our taxes to 50%, continuing to deny, deny, deny reimbursement, and wanting me to see more patients in less time on a flat rate of income?

Do you now understand why physicians are become at the very least disgruntled with the propaganda surrounding health care? Most of us came into medicine for the love of medicine as you went into the Air Force for the love of its principles and its options. What we didn’t expect is to have to fight a daily battle to get necessary procedures approved, get paperwork timed and stamped, spend countless hours on administrative issues, fight the government over how much we have to give to the government on top of the countless free hours of work we already provide, fight “turf” wars with CRNA’s, midwives, optometrists, chiropractors, etc. wanting to practice medicine through legislation instead of education, fielding endless barbs and attacks from self-motivated, exaggerating, publicity hounding film makers and politicians, dispelling myths propagated by the media or on the internet, fight to get paid for procedures and visits done 6-9 months ago, AND keep up to date on current medical information, medications, procedures, and public health trends, on top of trying to have ANY semblance of life away from work.

My typing this response on my only day off this week after a day of 3 emergency heart surgeries (of which two are “charity pending” – i.e. hospital gets paid by the county, surgeon gets paid by the hospital, I get paid NOTHING, but still take the risk of getting sued should those patients experience a complication, whether or not it is related to my work), should serve as another example of what a physician has to do just to try and make other people understand why the 6-8% of the annual national health care expenditure (Medicare, insurance, Medicaid, etc.) that goes to physicians should not only NOT be decreased, but in fact increased.

Think about that for a second: >90% of all health care costs currently goes to everyone EXCEPT physicians, so why are so many people looking to cut costs from the smallest part of the pie. Go back to the 1950’s and 1960’s when physicians received 40-50% of the total expenditures and notice that on an inflation adjusted scale, total health care costs have skyrocketed more than 1,200% with gains in life expectancy and general morbidity from common disease processes still spearheaded by physicians’ (and yes pharmaceutical) research, not the insurance companies that have raked in the majority of that increase in huge profit margins, not the hospital conglomerates, and certainly not the endless line of government administrators directly paid to maintain (create?) the morass of rules and regulations.