Who? by Ted Bacharach MD (retired)
When you ask anyone about their doctor you get a surprising array of answers. You do not get the now obsolete reply: “My doctor is Dr. Abernathy.”, or “Our family physician has always been Dr. Smith.”
In today’s environment the responses are much more likely to be: “My doctor is “Health Corporation Xylast” or our doctor is the Smithfield Medical Clinic. Common also is the response: “My doctor is Kaiser or Mayo” or some other medical clinic, medical foundation or group. While some of these entities are “not for profit” almost all of them pay their executives far more than their employed physicians whose identity has been lost.
Physicians like most tools are considered replaceable. The decision to employ a physician is no longer in the hands of colleagues but is left to the corporate executive types who hire physicians who will work for less. A surgeon is qualified if he has the proper certification on paper, his performance is expected to be exactly the same as the last surgeon regardless of experience or performance. It may take a year of bad results before it is noticed that his or her performance has produced statistical results that are below expected performance standards.
Patients sent to the hospital by their primary care physician are treated by the “hospitalist” who really needs no name since he or she will only take care of the patient on a rotation basis. Jones on Monday, Smith on Tuesday and so forth.
Physician identity in today’s environment is gone and forgotten by most people except for a few of us septo- and octogenarians who remember the “Old Days” when we had real names and identity, and were considered to be vital and valuable community members.
Has the price of regular hours and regular pay been worth what we have had to give up?
FP as a specialty is no longer viable. It will become the American Academy of Family Nurse Practitioners. Kick us FP’s out of the hospitals so we can do more uncompensatable paperwork in the office reduces us to essentially the level of an NP who can prescribe narcs and stimulants. It will just take a little change in the laws for them to do that. I am prepared to tell all med students to stay away from primary care if they want a decent life and be paid fairly.
Trouble is, the one’s I’ve seen all have chosen another specialty to shoot for so I can only confirm and encourage their choice.
The continuity of care is going down the crapper. Because I follow in the hospital, I can make better decisions than a practitioner that is not involved with in-hospital care. I’ve already seen many examples of poor care due to lack of continuity and I’m afraid that’s where the world is headed. Those of us in the trenches are the last of the breed.
You NEVER hear the word/term “Doctor” in any of the commercials either on TV and radio, anymore. The “new” buzzword seems to be “prescriber”…and that seemingly would be anyone from your Doctor, Pharmacist, Pusher or your Mama!!!, and everyone in-between.
It’s not just the physicians that aren’t happy. Many of us patients are very unhappy too. I’ve been fortunate enough to keep the same physicians for years (employed by 2 different health systems, BTW). I was a case of retiring from 1 system that my physicians were all at, but going to a 2nd system forced me to purchase a higher-tier plan in order to continue with these physicians, rather than a “normal” plan which whould have driven me to my current employer’s physicians. While the 2nd employer does have top-notch doctors, I felt the extra $ are funds well spent to stay with my original physicians that I have relationships with. Everyone doesn’t have this option. I fear what will occur when I cross into the medicare-age group…will physicians continue to accept these patients, or will the government pay cuts cause you to eliminate these patients. I am not a fan of the government’s attitude toward physicians and hospitals. Nor a fan of the large insurance companies with their huge overhead costs & executive copensation packages. And I have made trips to Washington to fight for consumer health-care needs, along with a lot of letter writing voicing my opinions on health related matters. I’m not always convinced any of this helps, but it makes me feel better to take a stand on these things.
I agree and thank God when I retired I came to a small town where we have a great hospital and lots of doctors. My internist arrived the same year I did so we sort of started out here together. Even in Eastern NC, however, I notice that folks will say Eastern Heart Clinic, or East Carolina Medicine rather than Dr. Jones, Dr. Smith etc. It is a shame to lose that personal relationship between doctor and patient. I am glad that my physician husband did not live to see this. I miss him but he would have been very unhappy with the way his profession is heading.
Good points all Ted. Have to add, it wasn’t physicians alone that chose this course. Patients have also themselves to blame.