I am going to keep it brief today because it is gorgeous outside and my college roommates are on their way over for a surf-side happy hour – sweet tea vodka and Crystal Light all around. It doesn’t seem that long ago that we were at $5 all you can drink parties and really felt the need to get our money’s worth. It also doesn’t seem that long ago that I was a young doctor, poised to change the world one patient at a time. Twelve years ago, it was unheard of for a doctor who is not a plastic surgeon to require fee for service. Now, it is becoming more and more common. Combine doctors who don’t take your insurance with the have a staggering shortage of doctors predicted in the next ten years, and be very afraid. We took an oath. Why are so many doctors doing something that seemingly flies in the face of all that Hippocrates stood for?
1. For the money – Doctors are human. The almighty dollar is a powerful incentive.
2. For the money again, but in not such a greedy way – Many doctors are actually struggling to make ends meet. The cost of malpractice, renting space, purchasing supplies, paying an office staff, and at the same time, paying back exorbitant student loans makes it impossible to make ends meet when relying only on the ever-decreasing insurance payments. Some doctors have resorted to selling vitamins, nutritional supplements and other medical supplies out of the office in an attempt to subsidize their income. When strapped, people will do what they have to do
3. Out of a belief in a meritocracy – Being a physician is one of few professional careers where your pay does not increase based on your performance. If a doctor is exceptional, even if he or she does not accept insurance, chances are word will get out and his or her success has a chance to mirror the success seen by lawyers, businesspeople, etc.
4. Out of frustration – The amount of time spent on paperwork is monumental and often crippling to a physician. Not taking insurance means less time arguing with insurance companies and less time spent training and managing office staff. Doctors, historically, are terrible business people. Remove insurance and you remove a big part of their job dissatisfaction.
5. Out of concern for their patients – Last but not least is the most noble reason for not taking insurance. When constrained by insurance company guidelines and pay schedules, often a physician cannot practice the way he or she sees fit. Certain drugs cannot be prescribed and certain tests cannot be ordered. Most disabling to a healthy doctor-patient relationship is the speed at which a doctor accepting insurance has to practice. In order to stay financially afloat, a primary care doctor has to see a patient every 10-15 minutes. Very often, this is simply not ample time to obtain a history, do an exam, diagnose the problem, give advice and offer treatment. Without such a constraint on time, doctors can do a better job.
If I go back to practicing, there is a big part of me that would love to join a practice that doesn’t take insurance. I am sure I would never seek this out — the Catholic guilt would squash any personal benefit I received. However, from a doctor’s point of view, I can certainly see the appeal. From a patient’s perspective, I don’t want my doctors to stop taking insurance. I don’t want to pay out of pocket and then do the paperwork to try to get reimbursed. But, I do want my doctor to provide me with the best care possible. Tomorrow, some more on the patient’s side of things and some tips on how to navigate through our tumultuous health care system.