A Doctor Responds

In response to my prior piece about Medicare and doctors, I received an e-mail from a physician. I will summarize her response below.

Her perspective is that at the moment doctors aren't doing very well. Specialists are suffering, but GPs are doing even worse. Regarding Medicare, she states that it is very cumbersome and pays out at a relatively low rate, since anyone at retirement age can have it. She noted that filing a Medicare claim required an inordinately cumbersome amount of paperwork to be completed and that pro bono work might have been preferable once money had been collected. However, being that even doctors have to make ends meet, it does provide at least some income. And in all honesty, paperwork requirements for doctors are excessive all the way around, even for private carriers.

She points out that the cost of medical school nowadays, much in keeping with higher education tuition and fee increases on all fronts, is ridiculously expensive. Her suggestion is that the government ought to subsidize medical school tuition. A concern of hers is that that if that were to happen, students might have to go where they are told and simply not be given the option of choosing where they wish enroll after being accepted. This is problematic because not all med schools are created equal and receiving sufficient training frequently depends on competent instructors. Additionally, she mentions that hands-on work with actual patients is invaluable and often more instructive than abstract knowledge in a classroom.

Furthermore, the cost of being a licensed physician is high. For one, billing services required to collect income are prohibitively expensive and greatly cut into take home pay. Things really get expensive with a combination of malpractice insurance and a lack of adequate tort reform. A malpractice suit isn't just potentially pricey, with it comes emotional strain, fear, and the possible destruction of a reputation. None of these can be taken lightly. And, more often than not, what is perceived as incompetence may simply be a matter of misunderstanding and poor communication between doctor and patient.

For this reason, doctors have to practice defensive medicine. Defensive medicine means that useless tests are ordered as a means of covering themselves. If a lawsuit is brought before the court, documented evidence of any variety is invaluable. This drives up costs, but it also means that doctors are inclined to make inadequate diagnoses. What works best is a relationship built on trust with the patient and with that personal inference based on observation. However, neither of these crucial elements are especially helpful during litigation.

Doctors live in fear of being held liable based on any evidence, no matter how slight it may be. Incredibly, even up to two years ago, doctors were told to never even say that they were sorry to the family of a patient when a tragic outcome like death occurred. According to the law, expressing such sentiments would would be an admission of wrongdoing. And unless there is appropriate emotional communication, no one knows that the doctor suffers mightily too and recognizes the grief felt by family members.

For all of the focus on how doctors are overpaid, she believes that with the responsibility and the potential consequences, doctors deserve every penny that they make. Although a doctor knows how to practice medicine, he or she isn't trained on how to be a businessperson, which is crucial. Many doctors have no clue how to sell themselves or to manage their own financial affairs, which creates lots of problems. She acknowledges that some doctors place money ahead of healing the sick or injured, but believes that characterizing all who practice medicine in this way is both unfair and inaccurate.