Saturday, November 19, 2011

Flame Out!

Back in the good old days, the internists, pediatricians and family medicine docs woould come to the hospital and round or even have their office next to or attached to a hospital. The doctors lounge was a place to grab a cup of coffee and run into each other to discuss cases and keep peresonal contact to see if that other doc was someone you wanted touching your patients. Now there are hospitalists. The referring docs dont want to step foot in the hospital becuase they will be forced to sit on committee after endless JACHO/CMS committee, not to mention fight yet another computer system. So, they dont even apply for hospital privaledges anymore. To keep in contact and to help build good referral relationships, we periodically go out to their offices and say hello. Last week I went to a group of awesome internists. As we were sitting down over coffee, one of them said that they were closing their practice at the end of the year. I asked him why, and said it bluntsly, he and his partners are Bingo on the fuel to practice and they were having a flame out. He said that they all find that they have loss of autonomy, loss of control of their practice conditions and their time is being more and more wasted due to all the administraction and paperwork crap. He said, in fact they were going to shut down last year but with the stock market tanking they were hanging on to see what wass going to happen. They figure it isnt going to get better so its better to just fold up. I left their office dejected, and went to the next one. Their practice is breaking up, 2 of the three are calling it quits. I wonder how much of this is happening accross the country!


SeaSpray said...

The last I new, the PCP that saw me in the hospital ...even if I was primarily a urology case got 100.00 (and this is going back at least a few years), per inpatient visit.(he was also a specialist and so maybe why and had the office near the hopsital you describe. My regular pcp didn't work in that hospital) The visits were usually very short. Multiply that times a a lot of patients seems like easy and good money. But, I never thought about the documentation, computer time at the nurse's station x how many patients. I always thought the docs just wrote out their instructions and nurses and/or med/surg reps followed through ...BUT...everything is paperless. Hospitalists are certainly important, but I do think something is lost (patient's loss and potentially physician's)when the doc who knows everything about the patient is not the one doing the assessments. Something could me missed that the pt doc would know to consider.

It's extremely disturbing to think that they and others are closing their practices. I still very much miss my former pcp who closed his doors (yrs before retirement)last March. :( He took a corporate position. It was gut wrenching for him and the staff. I've since asked about him and hear he misses his patients. I cannot fathom how awful it must be for these docs, to have put in all the time, energy and dreams into their most noble profession and the sacrifices and excitement while setting up their practice and building it over time and the pride of seeing it all come together have to give it all up and for what? because of over regulation, unfairly low reimbursements,rising costs of overhead, etc. It's just so wrong.

SeaSpray said...

Throckmorton, here is a link to a Dr Synonymous post I commented in - a bit off track from your post, but ties in with how Drs are pressured with time and I commented because I want to be more mindful of not adding to my doc's stress by being the chatty patient.

I just want to say is all so sad that quality Dr/pt relationships are being sacrificed because of all the interference and time constraints.
I have found a new pcp I really like, but I do question the process because I have experienced the wrong medication being ordered (even tho I wrote down what and where), Question regarding Husband not followed through on - even tho I was told to write it down and did,wrong lab results sent to specialist, missing test report that I personally red before handing over the med recs, med recs after 6 mos ...still not put in system, and today just hit me ..the specialist I saw for a false alarm thank God - asked why I was there. ??? Did the doc not send down a letter explaining his concern? And come to think of it never mentioned the concern I had for why I had the test in the first place and would that have altered the specialist's opinion if he knew it? I don't think so.

But a patient ..I am perplexed and not trusting the process of the office and I don't know if I am right to be concerned or being picky. I used to ALWAYS assume everything was handled and no mistakes made and I never thought to check to see if things are being done as they should. None of this stuff was emergent..thankfully. But ..I wonder ...if the little things get screwed up ...what will happen if God forbid with the big things? or when the emergent things happen, are they such a priority that mistakes don't happen? I want to say something to the doc - but I also don't want to make waves. I thought about looking for another practice ..but what's to say it won't happen there too? And maybe it is as you speak of ..with all the pressures they have ..well maybe these little things are a byproduct of that. I have also been spoiled by stellar med offices in which the docs have excellent follow through and staff does not let things fall into some black hole and are capable of following instructions.

Again ...I would not be upset about one little mistake is the consistent lack of attention to detail I guess, causing mixups that is concerning. is this stuff something a patient's physician would want to know? I don't know. I would. I'd want to know so I could look at the process and fix it if necessary.