Tuesday, May 20, 2008

Says It All

In the latest email bulletin from the American College of Surgeons:

....Practice Management Webcasts for 2008 and early 2009 include:

  • July 9, 2008 - Negotiating Better Third-Party Contracts
  • July 23, 2008 - Practice Valuations ... What's Your Practice Worth?
  • Aug. 6, 2008 - Compensation Formulas of Successful Practices
  • Aug. 20, 2008 - Effective Personnel Management
  • Sep. 10, 2008 - Dealing with Difficult People
  • Sep. 24, 2008 - Maximizing Patient Collections
  • Oct. 1, 2008 - Scheduling Techniques for Improved Productivity
  • Oct. 22, 2008 - ICD-9 Coding & ICD-9 Changes for 2009
  • Nov. 5, 2008 - E & M Coding ... Beyond the Basics
  • Nov. 19, 2008 - CPT Coding & 2009 Updates
  • Dec. 3, 2008 - Bottom-Line Budgeting for 2009
  • Dec. 17, 2008 - Billing Compliance: Avoiding Fraud and Abuse
  • Jan. 14, 2009 - Creating a 2008 Management Work Plan
  • Jan. 28, 2009 - Analyzing the Financial Health of Your Practice
  • Feb. 11, 2009 - Medicare Update for 2009
  • Feb. 25, 2009 - Advanced CPT Coding
  • Mar. 11, 2009 - E & M Coding ... From An Auditor's Perspective
  • Mar. 25, 2009 - ICD-9 Diagnosis Coding for Doctors & Staff
  • Apr. 8, 2009 - Appealing Third-Party Claims
  • Apr. 22, 2009 - Effective Governance and Management of Your Practice
  • May 6, 2009 - Benchmarking Practice Productivity and Profitability

Anyone wonder why I quit?

Yeah, I acknowledge that you can't avoid this stuff, and it's better to be smart about it. But trust me: this is but a teensy sampling of that with which we are regaled, pretty much daily. All I ever wanted to do was take care of patients. I had this silly idea that if I did a good job of it, the rest would take care of itself.


Anonymous said...

Have you ever considered lecturing or teaching? There are so many possibilities: formal academic appointment (how about A&P, phys. assessment, diagnostic reasoning and the therapeutic relationship just off the top of my head?), continuing education faculty teaching creative writing, patient advocacy, health strategies, surgical practice history - well, anything you enjoy! Leading an Explorer Scouting group focused on medicine and healthcare?

Maybe there's a way to keep your hand in without the headache aspect.

kcd said...

Yeah, Sid, this is brilliant. Thanks for sharing it. Good Lord, medicine itself (including surgery) is SICK, sick, sick today.

At my MD visit today, my wonderful not-enslaved-to-big-giant-HMO-for-whom-we-both-work MD told me Big Giant HMO has now made a new patient category . Of course it has initials. It means if you are a patient who fails to keep appointments, after a certain number of those you aren't allowed to MAKE appointments any more.

Yeah, because for poor or shut-in patients it's soooo easy to get anywhere...whenever....especially if they are in pain. so THEY deserve to be denied care, or put under suspicion. Hey! Good times!

Oooooo, now I wish I HAD become a doctor. I'd probably get my capacious ass fired, but I WOULD stand up for the least of my patients.

God, or the Universe, help us all!

rlbates said...

"All I ever wanted to do was take care of patients. I had this silly idea that if I did a good job of it, the rest would take care of itself."

My mistake too, Dr Sid. Some days .....

Anonymous said...

On one hand, I can understand how an email laced with more -ings than a Heidegger treatise and more financial jargon than an issue of Forbes would be disturbing for a surgeon. But on the other, you might do well to consider that - unfortunate as it may be - things aren't so simple as "taking care of patients."

We live in an increasingly capitalist world, particularly considering the prevalence of globalization, and while it's distasteful for a man of the scalpel to have to face that, it's also necessary. Notably, most of these webcasts - if not all - are intended to benefit you, even the financial ones: "avoiding fraud or abuse," "dealing with difficult people," "practice valuations," and so forth.

Perhaps I'm just a product of my environment and view pursuing a career in medicine - considering the "capitalization" of the modern world to which I'm accustomed - as one of the least evil professions to enter (I'm a 24-year-old pre-med), but I think it goes deeper than that. Despite the pervasive financial jargon, the "power words," and the lack of focus on medical care itself, that bulletin isn't all bad. After all, it's a list of practice management webcasts, not of academic seminars or surgery symposia.

What I'm trying to say is that maybe the solution isn't to give up on surgery, but rather to alter your perspective so it's commensurable with the present state of the field. If the financial infusion bothers you, maybe do some research on globalization from a non-medical perspective (sociological? philosophical? environmental?). Perhaps it'll give you a better understanding of what's really going on, and maybe after that, you'll feel more accepting (or at least more comfortable with it).

Sid Schwab said...

anonymous: After all, it's a list of practice management webcasts, not of academic seminars or surgery symposia.


Gary M. Levin said...

Dear Anonymous pre-med student....
Oh my, yes Sid, myself and others were as idealistic or even more so at age 24?? Still a little wet behind the ears as my wonderful father would say....We 'old folk' bear the scars of 40 or more years of caring for patients. We have witnessed increasing costs, decreasing reimbursement, less access, and a host of other 'unsolvable dilemnas.

If the 'financial infustion' really was that ie, reimbursement, rather than a plethora of jargon it would not be so bad....
Call me and Sid in 30 years.....

Anonymous said...

(I'm the anonymous poster from before - sorry for not adding a name to my comments; I didn't see the "Name/URL" button at first. You can call me Chris.)

Sid: If your quotation was implying that a list of academic seminars and surgery symposia should have been advertised instead of practice management webcasts - well, I hope all three are (I have no way of knowing). If not, I would argue that the others should be sent out in addition to, not in lieu of, the management webcasts.

HTE: I know that the medical profession has, as of late, faced a plethora of woes with respect to finances. I very much respect your seniority and am well-aware that your experience carries more weight than what I've garnered thus far. However, I would argue that if the purpose really is to help patients, and in light of the fact that the ugly capitalist machine / American health care system (which I think we can all agree we dislike) doesn't seem to be going anywhere, then one should be willing to take on the burden and help the patients nonetheless. My point is that in order to do that, a change of perspective might be in order. Instead of viewing the "financial infusion" I mentioned earlier with adversarial angst, wouldn't it be better to take what you can from it and write off the rest with an "I see how this could be useful, but no thanks"?

Sid Schwab said...

Chris: I realize I was being obtuse. What I meant both in the post and in the comment (such as it was!) is that the practice of medicine is increasingly being overwhelmed by the business of medicine. Instead of spending time listening to webcasts about patient care issues, we must spend what little education time there is (given the economic factors that dictate working harder and harder to stay above water) on the sort of stuff on my posted list. It's not that I fail to recognize the need, nor the good intent behind the offered service. It's that, more and more, that's all there is. Or so it seems, compared to, y'know, the good old days. People of your generation have an advantage: never having practiced when physicians spent nearly all their time being physicians, you won't notice the difference.

SeaSpray said...

I hear you. As a patient I would want you focused on me and not distracted by all the other.

This must be so frustrating to the docs who practiced before it all got so complicated. Not that you can't do it but just must be such drudgery by comparison. After all, you wanted hands on with your patients not a sea of papers.

SeaSpray said...

Gee Dr S...kind of funny...we posted our comments at the same time and seemed to be on the same wave length...sort of. :)

I'm sorry to hear about Ted Kennedy.


Anonymous said...

Sid: Thanks for the clarification. I see your point that time which was once spent on the practice of medicine now has to be spent on its business, and it's clearly a negative development.

What do you see as the cause? Is it that there are too many doctors, so their individual work is devalued? Are the insurance companies taking too much of what was previously profit? Would stricter government limitations be a viable solution?

As someone aspiring to be a doctor, this is an issue I'm very concerned about, both in terms of planning for my own life and understanding what my practice will be like. Any advice you could offer would be appreciated, although I realize that as someone who seems to have retired largely because of this, you must not have found a solution that was sufficient for you.

Sid Schwab said...

Chris: in my case it was multifactoral. I wrote about it here, here, and here. They're somewhat long, but covered the causes and solutions, as I saw them.

Anonymous said...

Interesting post, indeed! Actually, because it's close to home from varying perspectives, I made an entire post about it on my new blog (at ifitaintbrokedontfixit.blogspot.com if anyone's curious)that was partly inspired by you and other medbloggers who've recently commented on the state of medicine and the increasing reliance on pure numbers as a manifestation of a job that really should be seen as far more than just a way to increase revenue. I'm just a mere coder, but I see every day the way bureaucracy and paperwork tends to drown out what should be the most important aspect of medicine--the people. After all, there's no way you can truly encompass a person's life in a series of ICD-9 and CPT codes. It's just way too simplistic. One thing I'm learning, though, is that physicians and their "extenders" (PAs, NPs, etc) have moments when all the clinical jargon and numbers and codes and such dissolve into some all too real evidence of the humanity behind the documentation. Sometimes it's funny; other times it can be downright maddening, which just proves my point.

JP said...

"All I ever wanted to do was take care of patients..."

That's what I always assumed medical professionals wanted to do, or did. Thanks to many of your posts, I understand why it isn't this way, but it's still disarming to think of my doctor as a business person, or our visits as something of a business transaction.

SeaSpray said...

You know what? Even though I worked in the hospital and around doctors for twenty years (started in 86), it wasn't until July of 2006 that I ever thought of medicine as a business.

I had given my urodoc a thank you letter during the exam which he would read later. As he was walking out, I told him everything I wrote was true. He said "That means something because you're in the business."

He surprised me with saying that because I just saw docs as facilitators of healing. I never made the logical leap to what keeps the big wheel moving, although I suppose it slows it down too. I only saw the human contact, the help when I was ill.

Then in perusing the med blogosphere my eyes have really been opened and I understand so much now. And it wasn't that I didn't care...I just didn't know.

I actually prefer to think of you docs as the heroes/heroines who ride in and save the day and then off to save another. All that other stuff is important now but it ruins the fairytale image.

I am in awe of what you have to know to open your own practice. It seems that somewhere in your studies you need an MBA too. Where does all that added business savvy come from? Do you go in with someone else to learn the ropes first and then break off on your own if you want to?

The thing is...you have all the skill to fix people and it doesn't seem right that the paperwork, etc. could rob you of the OR time or office time from your patients or family. Something gets compromised. I guess it is all factored in somehow.

Anonymous said...

I have to get my dad to read your blog sometime, Dr. Schwab. He used to be in private practice, then he bought another man's practice, joined a group, and a couple of mergers later, he complains bitterly at times about how much other crap there is to be done besides the normal doctor business of patient care.

He says he can't wait to retire........at 56 he has at least nine more years to go.

I feel for you doctors...seriously.

As a physician what do you think about the idea of universal healthcare?

Anonymous said...

You know what? I take this as a great sign. It is my dream that the next generation of physicians will wise up and get business smart. Your generation buried its head in the sand and said "we're not going to sully our hands with money matters!". Well, guess what - there is nothing that sounds sweeter to the ears of insurers and hospitals than that phrase, and it cost them (and more problematically, OUR generation) the majority of their autonomy as professionals. Sure, just keep seeing patients 80 hours a week -- we'll be over here incrementally increasing our control over you.

As we head into the ever-growing realm of P4P, "best practice" guidelines (i.e. rules) and annual Medicare reimbursement cuts, having physicians who are constantly vigilant about the way the power players operate -- and the government is at the top of the list here -- is the only way to the concept of medicine as an independent profession will survive.

Sid Schwab said...

anonymous: I'm with you except for the "buried their heads in the sand" part. Oh, and the "vigilance as solution" part. And the "not sullying" as the cause of the current status part. Otherwise, a good analysis.

scalpel said...

The problem isn't capitalism, it's socialism. Specifically, the Medicare morass.

Most of the distasteful stuff on your list (and not incidentally much of what makes practicing medicine so difficult these days) is directly or indirectly related to the failing Medicare concept.

Jeffrey Parks MD FACS said...

The words have been taken from my mouth...

Anonymous said...

After 3 years of work, I've realized that in some ways, residency was far better than actually being an attending. While my hours are slightly better, and my pay is much better, the headaches are insanely worse. Medicine, as a resident, was very pure. Nothing to think of other than the best care of the patient. No worries about how to pay for your office, what the latest ICD-10 codes would be, how to dictate something "right" to actually get paid for it. As a resident, I remember rarely thinking about the legal consequences of what I was or was not about to do.

The shortage of physicians that everybody keeps talking about is not coming, it's already here. The light at the end of the tunnell that I always saw as a resident has turned out to be an oncoming train.

Sid Schwab said...

anonymous: yes. It's hard to be optimistic. If anything good happens, it'll only be after the crisis is fully upon us, and given our bankruptcy, both economic and politically, it seems unlikely. In terms of the practice, I'm glad I'm an old fart. In terms of getting sick, I'm planning to go Darwinian.


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