Tips & Advice

From Dr. Liz Herself

March 2, 2017
Why I Don’t Take Insurance
Dr. Liz Discussing Insurance With Her Patient

I recently read an article written by a doctor who no longer loves being a doctor.

His writing is OK but his story is a bit melodramatic.

He talks about how his love for being a doctor got a little battered and bruised during medical school and residency, and further tested when he went out into practice. However, he says he thinks the change happened after the onset of electronic medical records, which ushered in an era of all kinds of rules, regulations and “quality control” measures.

He states, “What I do today is no longer practicing medicine. Instead it’s like dancing the waltz, tango, and salsa simultaneously to a double-timed techno beat. It’s sloppy, rushed, unpleasant to look at, and often leaves my partner more confused and anxious than when we started.”

Oy vey! Do you want to see a doctor who feels this way about their job? I don’t!

I embraced electronic medical records pretty early on, because I actually like medical notes to be legible. (The authenticity of my medical degree was often questioned when I was younger because my writing was super legible. Over time, that has changed.)

For a short while around 2009 I had my own practice. I got an electronic medical records system, and I billed insurance. It did not take long for me to realize I could not keep my doors open, mainly because I did not see enough patients per hour.

I couldn’t.

I could not spend less time with each patient than what she needed; enough time for her to tell me what was going on with her, for her to understand what I was saying, and for us to develop a mutually satisfactory treatment plan.

It was not long until I got out of the insurance-billing world of medical care.

It was a revelation!

Suddenly I had 30 or 45 or even 60 minutes to spend with my patient. If I spent time outside of my office hours handling issues, reviewing charts, answering more questions, it was worth it, because I wasn’t getting $52 for a Well Woman visit (which took a half hour IF she showed up for her appointment, and of the $52, about  $50 was the cost of doing business).

Over the last 6 years, while I have been enjoying my doctor’s life outside of the insurance world, the electronic billing and the privacy and compliance regulations that sprouted up with it have become so complex they constitute a full-time job. The only way a doctor can keep up (and keep in compliance with) all these rules and regulations is to have someone working and focusing entirely on this.

By my observation, this happens only in one of two ways:

  1. the doctor has a full-time, totally committed person who handles this, and works for FREE (usually a spouse), OR
  2. the doctor is part of a big enough group that can pay one or more full-time employees to handle this aspect of a modern medical practice.

Have you noticed how many solo and small-practice doctors are selling their practices to a giant managing group? They have to, if they want any chance of being able to stick to practicing medicine. (However, their medical decision-making gets closely examined and analyzed for “quality” and “effectiveness”, which is the new definition of “managing” care – driven by protocols and a one-size-fits-all mentality.)

Our doctor concludes his article thusly: “But make no mistake, I’ll never leave. My love for taking care of people is unwavering. As for the joy and utter exhilaration of what used to be — frankly, it’s all been legislated out.”

I am happy to tell you that because I don’t deal very much with the insurance world, I still love what I do!

I get to focus on my patients, spend the time we need, make a living, and not drown in electrons or paperwork. I can give my patients the care and attention they so richly deserve.

My love and enthusiasm for what I do has not been “legislated out”.

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