Primary Care

Undervalued MDs.

By Chris Rangel MD ⋅ May 27, 2002 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

DB makes some great points on how insurances undervalue the time physicians spend with patients. This has lead to greater frustration among physicians about shrinking incomes and more demands on their time. More and more physicians are opting for a system that not only improves compensation for their professional services but improves their working conditions by seeing far fewer patients and spending more time with each.

What DB didn’t (yet) delve into is what I see as a coming crisis in health care should this trend continue. But don’t get me wrong! The crisis will stem from worsening insurance reimbursements combined with worsening working conditions and increasing paperwork demands. Greater numbers of physicians leaving traditional insurance for retainer arrangements will be a SYMPTOM of this crisis and not the cause. Already in California where managed care and HMOs reign, physician incomes have shrank over the last 10 years (name another industry where incomes have decreased during the longest peacetime economic expansion in history) and it is becoming more and more difficult just to get an appointment.

As physicians switch to retainer systems, those that remain in the insurance system will be hit with increasing numbers of patients and a dangerous downward spiral will start. A serious rift in the quality of health care between the few who can afford a retainer system and the rest of the insured population will develop (by “quality” of health care I mean patient satisfaction with prompt attention by and easy access to their retained physician. As of yet, there are no studies that show that this type of concierge medicine is any better than the traditional shorter office visits but it very well may be). It probably won’t be until mass dissatisfaction with the current system hits the middle class that attention will start to be paid. The insured patient population will begin to realize the difference in care that their insurance affords them compared to the privileged few who can afford to retain a physician. Initially the physicians themselves will be blamed for being greedy and self serving. Then it will be realized that managed care and insurances drove the system to where it is. If you live in a country where a lawyer gets paid hundreds of dollars an hour to sue McDonalds because their idiot client poured hot coffee into her groin but doctors get paid $39 for a 20 min office visit then you will eventually get into a situation where you get what you paid for.