My life as a physician began 35 years ago when I graduated from medical school. I treated patients and was compensated with a salary and benefits. It may be my failing memory, but there seemed to be very few administrators back in the 70's and 80's. The directors were actual doctors and nurses. No MBA or MHA was needed to be a boss. Recent events have highlighted the current paradigm of health care. The triumvirate of Government, Insurers, and Hospital Administrators control health care.
The cost of health care in the USA is out of control. Tests, and procedures pay. Primary preventive care doesn't. A physician with $250,000 in loans will be much more likely to choose gastroenterology (scopes pay) than primary care internal medicine. Private health insurers are run by highly paid executives whose goal seems to be the denial of care to their subscribers. Folks stay in jobs they hate because they are afraid of losing their employment-tied health coverage. The new job's insurance may not cover a pre-existing condition. So called "Obamacare" tried to make coverage less capricious and more transportable. It did not change the ever increasing cost of health care.
The other big trend in health care is consolidation. I work for a company that owns multiple hospitals. My services are based on a contract that was more than 12 pages in length. There are expectations of continuous improvements in the timely provision of care to our clients/patients. Health care is a service based industry. We, the providers, will be judged by meeting or exceeding standards and expectations of the industry and the consumers.
The city of Lowell, MA witnessed the consummation of the very long courtship between Lowell General Hospital and Saints Medical Center. The later has been unsuccessfully trying to find a partner for many years. My employer was a recent suitor but was jilted at the altar. As a resident of the Greater Lowell area, I have an interest in how this merger will play out. The financial problems at Saints (bond rating in the junk bond range) would seem to give the larger and solvent LGH the edge to deciding how services will be divided between the two "campuses". Redundancies must be eliminated to make the deal financially advantageous for both partners. I fear that some of my friends' jobs, at both facilities, will be phased out as the merger progresses.
MGH "buying" Cooley Dickinson Hospital in Northampton, MA was also in the news recently. Baystate Medical Center in Springfield will lose business because of this affiliation. Partners, the 800 pound gorilla of Massachusetts health care, seems to be on a perpetual mission to add more hospitals to its portfolio.
I am just an old ER doc; 32 years and counting. I like my current position. I work with a group of nurses, techs, secretaries and physicians who provide high quality health care in a small community hospital. My coworkers are bright and friendly. They have made me feel welcome. We are also consumers of health care and pay for our insurance, co-pays, and deductibles. Buckle up folks, it is going to be bumpy road to the future for health care in America.
Saturday, March 3, 2012
Sunday, February 5, 2012
Doc Quixote Part 5: Super Bowl Domingo
It has finally arrived. My request to be unassigned from the hospice on this day, 5 Febrero, was placed 6 months ago. At that time I had no delusions that our futbol gladiators Los Patriots would be in the great game. As a mucacho growing up in La Massachusetts, Los Gigantes was my team. The only team shown on the local television stations. YA Tittle, Sam Huff, Frank Gifford and the coach Allie Sherman were my heroes. When the two leagues merged, my loyalties became exclusively tied to Los Patriots.
The emergency sala at all Hospices will be much less busy during the contest. After the struggle concludes, the trickle of supplicants will become a great river. The presence of Los Patriots in the Super Bowl will guarantee victims of strong drink and testosterone fueled battles. Win or lose, youths of our land will celebrate or mourn with violence. The rivalry between the two cities represented by los equipos heightens the passions of the fanatics.
Los Rojo Sox vs Los Yanques, Los Celticos vs Los Knicks, Los Osos vs Los Guardas are rivalries that define the sports of the nation. In parts of the world, wars have been fought over such combatants. Volumes of words are written to document these contests. Billions of dollars are spent to see the games, buy apparel with the names of our sports teams and heroes, and purchase food and drink to consume before, during and after the games.
In my humble casa, there will be only Dulcinea, my brother by marriage Senor B and my faithful Perro Viejo, Magnus. I will cheer for Los Patriots. I will pray for my comrades in the Hospices and La Policia who must cope with the fanatics during and especially after the game. Let the Game begin.
The emergency sala at all Hospices will be much less busy during the contest. After the struggle concludes, the trickle of supplicants will become a great river. The presence of Los Patriots in the Super Bowl will guarantee victims of strong drink and testosterone fueled battles. Win or lose, youths of our land will celebrate or mourn with violence. The rivalry between the two cities represented by los equipos heightens the passions of the fanatics.
Los Rojo Sox vs Los Yanques, Los Celticos vs Los Knicks, Los Osos vs Los Guardas are rivalries that define the sports of the nation. In parts of the world, wars have been fought over such combatants. Volumes of words are written to document these contests. Billions of dollars are spent to see the games, buy apparel with the names of our sports teams and heroes, and purchase food and drink to consume before, during and after the games.
In my humble casa, there will be only Dulcinea, my brother by marriage Senor B and my faithful Perro Viejo, Magnus. I will cheer for Los Patriots. I will pray for my comrades in the Hospices and La Policia who must cope with the fanatics during and especially after the game. Let the Game begin.
Thursday, January 12, 2012
MMXII
Happy New Year! A momentous year? It is the 200th anniversary of the War of 1812. My grandniece will enter first grade. I will celebrate my 36th wedding anniversary and my 60th birthday. 2012 is the year of my 35th medical school reunion. We citizens will be inundated with exaggerations, half truths and damn lies as this is an election year.
My friends and former colleagues will be moving into their new ER. More rooms, more space, a new entrance and the same inept administration. The patients will be waiting at least as long but will be more likely to be on a stretcher than in the waiting room. I treated a young woman recently who lives 5 minutes from LGH and has a primary care doctor on the LGH medical staff. She had been vomiting and having diarrhea. She called the LGH ER and was told that the wait was at least 3 hours. Unless the policy has changed, giving wait estimates is not allowed. She drove 20 minutes to NVMC and was placed on a stretcher on arrival and was seen and began treatment within 5 minutes. Press-Ganey gold.
Today I received an e-mail from the ER director of LGH. It was a reminder of the schedule and agenda for the next two ER department meetings. The fact that I haven't been a member of the LGH ER department since June 2011 seems to have escaped his attention. He, of course, was the person who fired my aged ass. Removing me because I was labelled a "disruptive physician" does not seem to have resolved any of LGH's ER problems.
It has been a strange winter. Warmer than usual and with almost no snow. The flu season seems relatively benign. A particularly nasty and wide spread gastroenteral virus is keeping the ER census high. Many health care workers have experienced the misery of this "GI bug". A national dilemma of shortages of common medications has added to the burden of this epidemic. NVMC ran out of injectable Zofran.
The reports in the mainstream and medical press has given many reasons for the shortages. The drugs are all generic and therefore have much lower profit margins that newer, patented meds. Middlemen, who take their cut between the pharmaceutical manufacturers and the hospitals, clinics and pharmacies, seem to be price gauging. Money is the root of all evil.
One of my new duties is reviewing charts for patients who return to the ER within 48 hours. Many are for continuing symptoms of their initial visit. Some ran out of their pain meds and need more of the same. The purpose of this quality assurance exercise is to try and find issues that may lead to better clinical practices. The slow pace of the night shift af NVMC gives me time to do my part to improve care for our patients.
The world's oldest ER doc wishes everyone a Happy, Healthy and prosperous 2012.
My friends and former colleagues will be moving into their new ER. More rooms, more space, a new entrance and the same inept administration. The patients will be waiting at least as long but will be more likely to be on a stretcher than in the waiting room. I treated a young woman recently who lives 5 minutes from LGH and has a primary care doctor on the LGH medical staff. She had been vomiting and having diarrhea. She called the LGH ER and was told that the wait was at least 3 hours. Unless the policy has changed, giving wait estimates is not allowed. She drove 20 minutes to NVMC and was placed on a stretcher on arrival and was seen and began treatment within 5 minutes. Press-Ganey gold.
Today I received an e-mail from the ER director of LGH. It was a reminder of the schedule and agenda for the next two ER department meetings. The fact that I haven't been a member of the LGH ER department since June 2011 seems to have escaped his attention. He, of course, was the person who fired my aged ass. Removing me because I was labelled a "disruptive physician" does not seem to have resolved any of LGH's ER problems.
It has been a strange winter. Warmer than usual and with almost no snow. The flu season seems relatively benign. A particularly nasty and wide spread gastroenteral virus is keeping the ER census high. Many health care workers have experienced the misery of this "GI bug". A national dilemma of shortages of common medications has added to the burden of this epidemic. NVMC ran out of injectable Zofran.
The reports in the mainstream and medical press has given many reasons for the shortages. The drugs are all generic and therefore have much lower profit margins that newer, patented meds. Middlemen, who take their cut between the pharmaceutical manufacturers and the hospitals, clinics and pharmacies, seem to be price gauging. Money is the root of all evil.
One of my new duties is reviewing charts for patients who return to the ER within 48 hours. Many are for continuing symptoms of their initial visit. Some ran out of their pain meds and need more of the same. The purpose of this quality assurance exercise is to try and find issues that may lead to better clinical practices. The slow pace of the night shift af NVMC gives me time to do my part to improve care for our patients.
The world's oldest ER doc wishes everyone a Happy, Healthy and prosperous 2012.
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