Physicians Going Broke?

[OKCTalker]

This is a guest column in today's (1/10/2012) Journal Record (copyright, all rights reserved, yadda yadda) by OKC physician David Holden. What are everybody's thoughts on this? How does a physician stay in business without having to align with a hospital? What about tort reform, capping of fees paid by Medicare/Medicaid/insurance companies? Would you recommend medicine as a career to a young person today?

There is a dirty little secret in health care that is slowly rearing its ugly head: the growing number of private-practice physicians closing their doors due to potential personal bankruptcy issues. It’s an unfortunate reality due to physicians struggling to practice on their own while battling reimbursement cuts, changing regulations and astronomical drug costs.

The days of a Norman Rockwell-inspired physician on every corner are over in America. Federal health care reform is pushing doctors onto hospital payrolls.

“A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs LLC, which advises independent physician practices about their finances.

Physicians are developing exit plans for financial security that include changing career paths or selling their practices.

Over the past three months, hundreds of New York-area physicians have found new homes within hospital/health system walls. The situation is most acute for cardiologists, whose revenue has been hit by federal cuts for diagnostic procedures. A full 60 percent of the specialty’s businesses are in merger talks with hospitals or other practices, according to a recent survey by the American College of Cardiology.

There have been fundamental changes in reimbursement for all physicians, said Dr. Andrew Brotman, NYU Langone.

“They’ve made it more difficult for independent practitioners to operate, and many have sought other opportunities,” he said.

The trend toward physicians uniting with hospital/health system practices is not going to slow down anytime soon. Hospitals pay overhead that breaks a private physician’s piggy bank. Private-practice physicians are small business owners who must ride an economic roller coaster.

“A private practice is like a small business with the only difference being a third party, and not the customer, is paying for the service,” Lion said.

The third party strangles the private-practice physicians and forces them to pursue job security through alliances. Half of all physicians in America operate a private practice, so as regulations and insurance carriers continue to squeeze physician’s pocketbooks, more and more will close their doors for good.

Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. Mandatory cuts are made every year. Unfortunately, no one is coming to the aid of physicians.

[Midtowner]

Tort reform is a very small piece of the puzzle, but it was included in the ACA. Private doctors have been the beneficiaries of a system which has been out of control for years. Our healthcare costs are nearly double what the rest of the civilized world pays. Also, some docs are atrocious businessmen. One big issue out there is their ability to properly bill medicare and get paid by insurance companies. Lots of games are being played.

That said, is there anything beyond anecdotal evidence to suggest that there are more docs declaring bankruptcy these days than in years past?

[ou48A]

I talked to a Doctor about a month ago who told me many Doctors and nurses are who can are retiring because of a huge increase of paper work.

[oneforone]

What good for the goose is good for the gander, the legal profession should be gutted like the medical industry has been gutted.

[Jersey Boss]

What good for the goose is good for the gander, the legal profession should be gutted like the medical industry has been gutted.

The two are completly unrelated. Not too many attorneys are tied to the insurance industry with the oversight of a bureacracy that is more about costs, than results.

What I see as the big problem is far to much time is spent on dealing with the insurance/for profit overlords and not enough time to spend on patient care. Of course the specialists such as anesthegeologists and surgeons do not have to spend as much one on one time with patients as FP's do.

[Sheetkeecker]

Obama would never attack the sacred cash-cow of the democrat party, the legal profession and the endless rapes they do on common people. They throw in a pity case every so often to seem decent.

[HewenttoJared]

Wait till the new medical loss ratio minimums trickle through. It might help that insurers have an incentive to actually pay for medical procedures.

[Midtowner]

Obama would never attack the sacred cash-cow of the democrat party, the legal profession and the endless rapes they do on common people. They throw in a pity case every so often to seem decent.

Just wait until you're injured by someone's negligence or charged with a crime you didn't commit. It can happen to anyone.

[betts]

Physician reimbursement hasn't come close to keeping up with inflation for years, while employees' salaries and benefits, rent and expenses have risen significantly. In addition, many people think all health care should be free and think nothing of ignoring medical bills. Insurance companies reimburse at about 55% of charges. There's almost no incentive to stay in private practice and so, yes, the system we are used to will be gone within one generation, at the longest.

[Thunder]

Its just not for those in the medical profession, its all the careers out there. People just need to stop living elaborate life because they make more and more money. If they just be realistic and only spend on what they need with controlled splurges, then they will be just fine. For example, if I was to pursue my dream of being a deaf actor, I will obviously be realistic by just settling for a nice small to mid-size home, one truck and one car, and one custom designed 5th wheel RV from NuWa. That's all I need on the elaborate side. My focus will be my job, which will keep me busy, and watching out for friends and family, etc. I wouldn't go broke like many celebrities are now. If your doctor is going broke, you should question your own judgement on why that person is your doctor. I wouldn't want a irresponsible doctor messing with my body before it decay in the ground after death.

[PennyQuilts]

Physician reimbursement hasn't come close to keeping up with inflation for years, while employees' salaries and benefits, rent and expenses have risen significantly. In addition, many people think all health care should be free and think nothing of ignoring medical bills. Insurance companies reimburse at about 55% of charges. There's almost no incentive to stay in private practice and so, yes, the system we are used to will be gone within one generation, at the longest.

I've read several articles on this subject, recently. It is a scary thought, particularly with an aging population. One article that caught my attention was how some doctors treating the elderly, including many oncologists, are no longer being reimbursed for prescription meds the way they once were and because of that, they often can't keep up with costs of an expensive practice, leading to bankruptcy. I suppose you are right that many believe health care should be free so they simply blow off paying. They'd pay their phone bill before they would their doctor. Doctors can't simply shut off a phone or evict a deadbeat patient. Moreover, they don't want to be in the business of hounding sick people for money.

[Thunder]

Doctors can't simply shut off a phone or evict a deadbeat patient. Moreover, they don't want to be in the business of hounding sick people for money.

They did it to me the past few days and I was not aware of it. There was no known outstanding balance owed....until I attempted to set an appointment. OKC Clinic (I go to the MWC location) said that my account was blocked by the business administration, so I had to contact them to find out what was wrong. There was a tiny balance owed...really tiny...and that something got messed up with Medicare and Medicaid. It all got sorted and I finally was able to set an appointment. So, yes, they can stop people. However, ER can not turn people away when those people owe them hundreds or thousands of dollars. And, yes, hospitals do harass patients for money. Some hospitals harass me, but I take my time to pay however much I can each time I make a payment.

[Sheetkeecker]

Just wait until you're injured by someone's negligence or charged with a crime you didn't commit. It can happen to anyone.

Probably you have a fast car for chasing ambulances.

[Hawk405359]

There's a reason why our country is sorely deficient in primary care and family practice doctors. For much less pay, they take on many more hours and patients than specialists. They have skyrocketing drug costs to deal with, ever-increasing malpractice insurance, stingy insurance companies, as well as bureaucratic price adjusting all affecting their bottom line. Add that to continuously declining public perception, since for some reason people think Google or webMD can diagnose their problems better than a doctor can, and it's no surprise that things are turning south. Something has to give somewhere, or traditional health care is going to continue to decline in this country.

[Midtowner]

Probably you have a fast car for chasing ambulances.

The problem ain't lawyers, it's a system that's so rigged against injured folks that they need lawyers to ensure they don't get screwed.

[HewenttoJared]

The problem ain't lawyers, it's a system that's so rigged against injured folks that they need lawyers to ensure they don't get screwed.

This is exactly the root of the problem.

[Just the facts]

What good for the goose is good for the gander, the legal profession should be gutted like the medical industry has been gutted.

The US has 70% of the world’s lawyers with an average pay of $110,000. I say we cap the income at $110,000. This will ensure that cases are spread evenly across the entire lawyer profession and stop the "phone book cover' lawyers from hogging all the jobs. A cap will ensure that a vast majority of the money awarded goes to the person that actually got hurt.

We should also either nationalize the profession or ban anyone with a law degree from holding elected office, because clearly mixing the two the way we do it now isn't working.

Out of the 540 current members of Congress (including 5 non-voting members), 236 hold law degrees (58 Senators and 178 Representatives). That makes 44%.

[Jersey Boss]

The US has 70% of the world’s lawyers with an average pay of $110,000. I say we cap the income at $110,000. This will ensure that cases are spread evenly across the entire lawyer profession and stop the "phone book cover' lawyers from hogging all the jobs. A cap will ensure that a vast majority of the money awarded goes to the person that actually got hurt.

We should also either nationalize the profession or ban anyone with a law degree from holding elected office, because clearly mixing the two the way we do it now isn't working.

Lame satire. Winner of the triple "U" award for the day so far. Unreadle, Unfunny, Uninspired.




U.S.A.: There is one lawyer for every 265 Americans.

Brazil follows closely with one lawyer on every 326 Brazilians.


Clarification: While it looks like the US has the most number of lawyers, the per capita numbers suggest Spain and Italy are not "by far" the most although the 1MM+ number is staggering.

Country Lawyers Population People/Lawyer

US: Lawyers: 1,143,358 Pop: 303MM P/L:265
Brazil: Lawyers: 571,360 Pop: 186MM P/L: 326
New Zealand: Lawyers: 10,523 Pop: 4MM P/L 391

Spain Lawyers:114,143 Pop: 45MM P/L:395
Italy Lawyers:121,380 Pop: 59MM P/L:488
UK Lawyers:151,043 Pop: 61MM P/L401
Germany Lawyers:138,679 Pop: 82MM P/L: 593
France Lawyers:45,686 Pop: 64MM P/L: 1,403

Among the Top 7 "lawyerly countries" listed above, the US has about 50% of the lawyers, with 37 percent of the population of this group.

There is a myth that the US has seventy percent of the world's lawyers, but the numbers above show that this is wrong.

India alone has around one million lawyers, about the same absolute number as th US, although its per capita number is only a quarter or fifth of th US (see http://www.lawyersweekly.ca/index.ph...&articleid=580).

This means the US has a much smaller portion of the overall total than 70 percent, or even 50 percent.

The lawyer number for the US comes from the ABA (active) for 2007: http://www.abanet.org/marketresearch...NALonepage.pdf for the other countries I used the data from the Council of European Lawyers (active when stated)


The lawyer number for Brazil comes from Brazilian's ABA equivalent OAB (active) for 2007: http://www.oab.org.br/relatorioAdvOAB.asp


http://www.ccbe.eu/fileadmin/user_up...1179905628.pdf

The population numbers were pulled on Jan 2nd 2008 from Wikipedia: http://en.wikipedia.org/wiki/List_of..._by_population

Of course, with 2.2 million people in US prisons, that means there is about 1 lawyer for every inmate http://en.wikipedia.org/wiki/Prisons...opulation_stat

(Answers .com)

[Just the facts]

I don't care how they do things in Brazil or Spain. America blazes its own trail. Besides, they didn't wait around on nationalized healthcare because the US wasn't doing it? Doesn't Obama have a Pay Czar that can take care of this?

[Jim Kyle]

A cap will ensure that a vast majority of the money awarded goes to the person that actually got hurt.

Only if you require that all "expenses" be included in that $110,000. Most verdicts and settlements allow for "attorney fees PLUS expenses" and those expenses are what eat up a large part of the theoretical 50 to 67 percent that goes to the injured party. And it's not unheard of for the attorney's relatives to be hired and their fees to be included in the expenses... This isn't theory; For almost 30 years I lived with an insurance adjuster (she's still here but has retired) and heard such stories most every day!

[Midtowner]

How does the above count lawyers? The number of folks with J.D. or equivalent? Or the number of folks admitted to the Bar?

[Just the facts]

Only if you require that all "expenses" be included in that $110,000. Most verdicts and settlements allow for "attorney fees PLUS expenses" and those expenses are what eat up a large part of the theoretical 50 to 67 percent that goes to the injured party. And it's not unheard of for the attorney's relatives to be hired and their fees to be included in the expenses... This isn't theory; For almost 30 years I lived with an insurance adjuster (she's still here but has retired) and heard such stories most every day!

I am fine with including the expenses. Why should lawyers be exempt from shopping around for the best price?

[Midtowner]

Only if you require that all "expenses" be included in that $110,000. Most verdicts and settlements allow for "attorney fees PLUS expenses" and those expenses are what eat up a large part of the theoretical 50 to 67 percent that goes to the injured party.

That's just false. Sure it happens, but trying to represent that it happens like that routinely, or even more than very rarely is misleading.

And it's not unheard of for the attorney's relatives to be hired and their fees to be included in the expenses... This isn't theory; For almost 30 years I lived with an insurance adjuster (she's still here but has retired) and heard such stories most every day!

Maybe not unheard of, but again, exceedingly rare, and pretty dumb on the attorney's part if that person is going to be testifying. And sitting where I do, on the opposite side of the insurance equation, some of the games played by insurance adjusters and their companies are pretty bad as well. Insurance companies are out there to make a profit. They do so by paying injured folks as little as they can. That amount is not always a fair amount and sometimes, the way they go about getting out of paying things, i.e., giving folks the run around until the statute of limitations runs, is fairly common.

[Midtowner]

I am fine with including the expenses. Why should lawyers be exempt from shopping around for the best price?

Best price =/= best services. Say you're taking a medical malpractice case. In Oklahoma, the Physicians' insurance company, which covers 99% of physicians here, has an internal rule which states that they will not insure a physician who acts as an expert for a Plaintiff. To even get the case at issue, (this was ruled unconstitutional, but passed again, so I'm not really sure what actual medmal attorneys are doing) you're supposed to attach an expert's affidavit to the Petition. It's not unheard of for those affidavits to cost $5K or so. Then, you have to hire an expert for the trial.

Do you want your attorney to hire the cheapest expert witness he can find?

The lawyer is only going to get paid if you are paid, and those expenses are not a sure thing. He's fronting those only because he believes he can win your case. If you're in business, do you invest $100K if you think there's even a moderate chance you might lose it? (that's about what it takes to take a medmal case to trial, or so I'm told).

[PennyQuilts]

The vast number of plaintiffs' attorneys rely on settlements, not trial verdicts. Just saying.

Rant alert:

Speaking as an attorney, and a medical consumer who tends to be subjected to all kinds of extremely expensive defensive medicine expenses (mainly intended to protect the doctor but I pay for them even though I am healthy), I would applaud some sort of tort reform that might cut out some of that nonsense. It is extremely expensive, extremely stressful and inconvenient. It creates a fixation on medical care and increases anxiety by even healthy people who find themselves scheduling medical tests and procedures - constantly - "just in case." For women, between mammograms, pap smears, ultrasounds of ovaries and thyroid, thyroid profiles, bone density scans, cholesterol screenings, and the like, you end up spending days and days off work and thousands of dollars a year - and those are tests run on a healthy person! Moreover, with so many doctors now treating just the presenting problem instead of the whole person, what used to be a semi annual trip to the doctor and he/she would look you over top to bottom, you now have separate visits for" poison ivy, headaches, annual examination, visits for periodic bloodwork to check thyroid and cholestorol, etc., etc. And if something comes up looking slightly hinky - off to the specialist you go! (I suspect to keep the GP from being on the hook in case they miss something). One questionable pap smear? Off to the specialist who orders a sonogram, insists on three "good" pap smears in a row (three months apart), trips to a genetic specialist, etc. It's crazy. I realize that some women have a family history of cancer (I don't) and that many young women are apt to have fertility problems related to STD's and waiting until they are older to get pregnant - but come on! I swear, my new year's resolution is to not go to another doctor in 2012 even if it kills me. And I will grow a Y chromosome if need be. I am beginning to think stubborn men who refuse to go to the doctor unless it is to reattach a limb - and then, only certain limbs - may actually be onto something.

But back to lawyers - settlements - not wild trial verdicts - are what end up driving up the costs of malpractive insurance (which we pay for) and have contributed to changing the practice of medicine to the point where it is already nearly unrecognizable to what it was even 25 years ago. I am sorry for the poor folks screwed over by their insurance companies but seems to me, that is between them and their insurance company. And of course there are people genuinely harmed by malpractice - but that doesn't mean we need to take a knee jerk NO TORT REFORM EVER, EVER, EVER!!! All that does is shut down any effort to make the situation more workable for the rest of us. When someone screams no tort reform - what the hell does that even mean to them? This is something that needs to be discussed. The fear that some people won't get a good settlement is understandable - but the result has been to needlessly drive up the cost of medical care for the rest of us because of spastically defensive medical practice.

Swear to god, they should let us sign a waiver that we won't sue if they just rationally treat us and then let us get back to our lives, blissfully dying... grrr. (and yes, I have had close family members die of cancer who could have survived if the cancer could have been caught early and I take that into consideration when I write this).